Palpation Techniques in Physical Examination

Palpation

• Fingerpads are used for fine discrimination, feeling pulses, texture, size, consistency, and shape of an organ or structure.
• Ulnar or palmar surface is used to detect vibration, thrills, and fremitus.
• Dorsal surface is used to detect temperature.

Types of Palpation

• Light Palpation: no more than 1 meter of depression, used to feel for pulses, tenderness, surface skin texture, temperature, and moisture.
• Moderate Palpation: depress the skin 2-3 cm, used to palpate body organs and masses, noting size, consistency, and mobility.
• Deep Palpation: placing dominant hand over the non-dominant hand, resulting in a depression of 2.5 to 5 cm, used to feel very deep organs and structures.
• Bimanual Palpation: using two hands, placing each side of the body part.

Percussion

• Tapping two body parts to produce a sound, used to:
  • Elicit pain and detect inflamed structures
  • Determine location, shape, and size of an organ, noting changes between its border and neighboring organ
  • Determine density (air or fluid) and detect abnormal masses within 5 cm deep
  • Elicit reflexes, specifically deep tendon reflexes

Types of Percussion

• Direct Percussion: direct tapping of a body part with one or two fingers to elicit possible tenderness
• Blunt Percussion: used to detect tenderness over organs

Auscultation

• Uses a stethoscope to listen for heart sounds and movement of blood through the cardiovascular system
• Bell: low-pitched sounds, such as murmurs and bruits
• Diaphragm: breathe, bowel, and normal heart sounds
• Resonance: heard over parts with air and solid structures
  • Intensity (loud), pitch (low), length (long) in normal lungs
  • Hyperresonance: very loud, low-pitched, and long in lungs with emphysema
  • Tympany: loud, high-pitched, and moderate, like a drum
  • Dullness: medium intensity, moderate pitch, detected in diaphragm and pleural effusion, liver
  • Flatness: soft, high-pitched, detected in muscle and bone

Validation

• Process of confirming and verifying subjective and objective data for reliability and accuracy
• Methods of validation:
  • Rechecking own data through repeat assessments
  • Clarifying data by asking additional questions
  • Verifying data with another healthcare professional
  • Comparing objective findings with subjective findings to uncover discrepancies
  • Identifying areas with missing data