Physical Examination Techniques

Physical Examination Techniques

• Assessment focus involves identifying what is being assessed for inspection, auscultation, palpation, and percussion.

Inspection

• Skin signs of breakdown, chronic wounds, or body color, such as breath or bad odor, and posture, or body shape, help assess general healthy appearances. Also look for wounds or heart lines.

Auscultation

• Usually performed assessing sounds using a stethoscope to help identify and delineate masses, edema, and muscle contractures. Helps assess pain and localize trigger points. Also used to assess normal extra heart sounds and conditions like heart rate such as S1 and S2, or tricuspid/mitral.

Palpation

• Examines texture, temperature, size, consistency, and tenderness of a body part. Texture is the feel of skin/tissue and temperature that includes warmth or coolness, sensitivity. It involves doing light palpation, and removal toe of odor min/tissue, size, body parts/organs, consistency, crematory touch, location, size body part is located.

Percussion

• Assesses size, consistency, and borders of organs, including the presence of fluid, it involves tapping the body with the fingers. Helps assess the liver, spleen, woodoren, and Hemach. Percussion includes tympanic hollow drum line sounds. Dullness indicates solid organs.

A-G Framework

• Undertaken in the CSL this week in order to define highlighted medical terms, and find additional unknown terminologies within the framework.

Airway

• Look for signs of airway obstruction and for evidence of mouth/neck/swelling/hematoma. Listen for the security of an artificial airway, and for noisy breathing, e.g. gurgling, snoring, or stridor. Feel for the presence and security of artificial airway, and for air movement.
• Hematoma is a localized collection of blood outside of a blood vessel, usually caused by injury that damages the vessel wall. It can appear as visible discoloration
• Stridor is a harsh vibrating sound when breathing, caused by obstruction of the windpipe or larynx

Breathing

• Look at the chest wall movement to see if it is normal and symmetrical, and to see if the patient is using their neck and shoulder muscles to breathe (accessory muscles). Listen to the patient to measure their respiratory rate and oxygen saturation. Listen to the patient talking to see if they can complete full sentences. Feel for the position of the trachea to see if it is central, as well as for surgical emphysema or crepitus.
• Wheezing: A high-pitched whistling or rattling sound that occurs when your airways narrow
• Surgical emphysema (Corepious) is a condition where air becomes trapped under the skin, causing a crackling or popping sensation when palpated, typically due to a surgical procedure or trauma.

Circulation

• Look at the skin color for pallor and peripheral cyanosis, at the capillary refill time, and at the patient's central venous pressure and jugular venous pressure. Listen for patient complaints of dizziness and headaches. Feel for patient's blood pressure and heart sounds, patient hands and feet to see if they are warm or cold, and the patient's peripheral pulses for presence, rate, quality, regularity, and equality.
• Peripheral cyanosis: Condition that causes the skin on the hands, feet, or limbs to turn blue, symptoms being a bluish discoloration of the skin, especially in the hands, fingertips, and toes.
• Capillary refill time is a quick test that measures how long it takes for blood to return to the nail bed after pressure is applied. It is used for cardiopulmonary assessment for critically ill patients.

Disability

• Look at the level of consciousness, for facial symmetry, abnormal movements, seizure activity, or absent limb movements, and at pupil size, equality, and reaction to light. Listen to patients' response to external stimuli and pain, and for slurred speech, as well as for patient's orientation to person, place, and time. Feel for the patient's response to external stimuli, and for muscle power and strength.

Exposure

• Look for skin integrity, signs of pressure injuries or damage, and for any bleeding e.g., investigate wounds and drains that may be hidden by bedclothes. Listen for air leaks in drains.

Fluids

• Look at the observation and fluid charts, noting the fluid input and output, at losses from all drains and tubes, and at the amount and color of the patient's urine and urinalysis results. Listen for bowel sounds. Feel the patient's abdomen and for patient's complaints of thirst, and the skin turgor.
• Skin turgor: Elasticity of your skin, meaning its ability to return to its original shape after being pinched or pulled.

Glucose

• Look at blood glucose levels and for signs of hypoglycemia, including confusion and decreased conscious state. Listen at the medication chart for insulin and oral hypoglycemics. Feel for patient's complaints of thirst and for patient's orientation to person, time and place if the patient is diaphoretic.
• Hypoglycemia is a condition where your blood sugar level is too low, resulting in excessive thirst, lethargy, frequent urination, blurred vision, lack of concentration, and a change in behavior.
• Diaphoretic: Excessive or abnormal sweating for no apparent reason. This isn't usually a cause for concern and will clear up when the underlying cause is treated.