Client Positioning for Physical Examination

Positions in Examination

• The Decubitus position is used to assess posture, balance, and gait, and is also used for examining male genitalia.
• In the Prone position, the client lies on their abdomen with their head to the side, and is primarily used to assess the hip joint, but is not suitable for clients with cardiac and respiratory problems.

Variations of Positions

• The Knee-Chest position involves the client kneeling on the examination table with their weight supported by their chest and knees, and is used to examine the rectum.
• The Lithotomy position involves the client lying on their back with their hips at the edge of the examination table and their feet supported by stirrups, and is used to examine the female genitalia, reproductive tracts, and rectum.

Inspection and Palpation

• Inspection involves using the senses of vision, smell, and hearing to observe normal and abnormal findings, and is used from the initial meeting of the nurse with the client.
• Palpation involves assessing by touching and feeling, and includes evaluating:
  • Texture
  • Temperature
  • Moisture
  • Mobility
  • Consistency
  • Strength
• There are several types of palpation, including:
  • Light palpation
  • Moderate palpation
  • Deep palpation
  • Bimanual palpation
• Different parts of the hand are used for different types of palpation, including:
  • Fingerpads for fine discrimination, pulses, texture, size, consistency, and shape
  • Ulnar or palmar surface for vibration, thrills, and fremitus
  • Dorsal surface for temperature

Additional Positions

• The Sitting position involves the client sitting upright, which is good for evaluating the head, neck, lungs, chest, back, breast, axillae, heart, and vital signs, as well as the upper extremities, and allows for assessment of symmetry of upper body parts.
• The Supine position involves the client lying down with their legs together, which allows the abdominal muscles to relax and provides easy access to peripheral pulse sites, and is used to assess the head, neck, chest, breast, axillae, abdomen, heart, lungs, and all extremities.
• The Dorsal Recumbent position involves the client lying down with their knees bent and legs separated, which allows for assessment of the head, neck, axillae, chest, lungs, and heart, and extremities, but not the abdomen, as the abdominal muscles are contracted.
• The Sims position involves the client lying on their right or left side, which is useful for assessing the rectal and vaginal areas, but may require assistance, and older clients may have difficulty getting into this position.
• The Standing position involves the client standing still in a comfortable, resting posture.