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NUR 1060C Adult Health FINAL Better Grades GuaranteedFlorida National University
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Steps of physical examination. Four cardinal techniques of examination: inspection, palpation, percussion, and auscultation. These four techniques—inspection, palpation, percussion, and, finally, auscultation—will always be used in this order, in all systems, with the exception of the abdome...

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  • August 7, 2024
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,NUR 1060C Adult Health FINAL Better Grades Guaranteed-
Florida National University
Steps of physical examination.

Four cardinal techniques of examination: inspection, palpation, percussion, and auscultation.
These four techniques—inspection, palpation, percussion, and, finally, auscultation—will always be used in this order,
in all systems, with the exception of the abdomen. During the abdominal examination, the pattern will be inspection,
auscultation, percussion, and palpation. Auscultation follows inspection so as not to increase bowel motility with
palpation.

Inspection: Close observation of the details of the patient’s appearance, behavior, and movement such as facial
expression, mood, body build and conditioning, skin conditions such as petechiae or ecchymoses, eye movements,
pharyngeal color, symmetry of thorax, height of jugular venous pulsations, abdominal contour, lower extremity
edema, and gait.
Palpation: Tactile pressure from the palmar fingers or finger pads to assess areas of skin elevation, depression,
warmth, or tenderness; lymph nodes; pulses; contours and sizes of organs and masses; and crepitus in the joints.
Metacarpal/phalangeal joint or ulnar surface of the hand is used to detect vibration.
Percussion: Use of the striking or plexor finger, usually the third, to deliver a rapid tap or blow against the distal
pleximeter finger, usually the distal third finger of the left hand laid against the surface of the chest or abdomen, to
evoke a sound wave such as resonance or dullness from the underlying tissue or organs. This sound wave also
generates a tactile vibration against the pleximeter finger.
Auscultation: Use of the diaphragm and bell of the stethoscope to detect the characteristics of heart, lung, and bowel
sounds, including location, timing, duration, pitch, and intensity. For the heart this involves sounds from closure of the
four valves, extra sounds from blood flow into the atria and ventricles, and murmurs. Auscultation also permits
detection of bruits or turbulence over arterial vessels.

Examining from patient’s right side: is the standard position for the physical examination and has several advantages
compared with the left side: estimates of jugular venous pressure are more reliable, the palpating hand rests more
comfortably on the apical impulse, the right kidney is more frequently palpable than the left, and examining tables
are frequently positioned to accommodate a right-side approach.

Equipment for physical examination

Prior to the start of the physical examination, collect all necessary equipment and supplies and check all are in
working order.
1. Hand sanitizer
2. Examination gloves
3. Alcohol wipes
4. Paper and pen, or computer
5. Draw sheet or drape
6. Stadiometer (measure height)
7. Scale (measure weight)
8. Examination light/gooseneck lamp
9. Thermometer
10. Watch with a second hand
11. Sphygmomanometer
12. Stethoscope: auscultation; The bell is the smaller, cupped side of the stethoscope and transmits lower-
pitched sounds and the diaphragm is the larger, flatter side of the stethoscope and this transmits higher-
pitched sounds.
13. Pulse oximeter: Measures oxygen saturation.
14. Doppler: Detects blood flow and pulses.
15. Ophthalmoscope: Visualize the interior of the eye, especially the retina.
16. Otoscope/speculums: Visualize the ear canal and ear drum/ Cone-shaped attachment, attaches to otoscope
to examine ear.
17. Nasal speculum: Opens the nasal passage to visualize in the nose.

NUR 1060C Adult Health FINAL Better Grades Guaranteed-
Florida National University

, NUR 1060C Adult Health FINAL Better Grades Guaranteed-
Florida National University
18. Scents for testing sense of smell (e.g., mint, coffee, or alcohol swab if other scents are not available)
19. Snellen chart or visual acuity card: to test distant vision
20. Near vision card: to test near vision
21. Opaque card: Cover the eye not being examined.
22. Penlight: Provides additional light for viewing various areas of the body and check eyes.
23. Tongue depressors
24. 2 × 2-gauze pads
25. Cup of water
26. Ruler and flexible tape measure, preferably marked in centimeters.
27. Goniometer -instrument for the precise measurement of angles
28. Scoliometer - is a small, non-invasive device (essentially a mini-level) that is placed over the spine while a
person is in a forward bending. The scoliometer reading indicates degree of trunk asymmetry (rotation)
29. Reflex hammer: Tests strength of a reflex.
30. Tuning forks 128 and 512 Hz: Tests vibration (128 Hz) and sound (512 Hz).
31. Q-tips, paper clips, or other disposable objects for testing sense of touch
32. Cotton
33. Mini-mental status examination tool

Vital signs:

Heart rate: The radial pulse is commonly used to assess the heart rate. With the pads of your index and middle
fingers, compress the radial artery until a maximal pulsation is detected. If the rhythm is regular and the rate seems
normal, count the rate for 30 seconds and multiply by 2. If the rate is unusually fast or slow, however, count it for
60 seconds. The range of normal is 60 to 100 beats per minute.
If the radial pulse is irregular or the patient’s condition calls for a more precise pulse rate, then an apical pulse should
be assessed for 1 minute. The examiner places the stethoscope at the apex (fifth intercostal space at the
midclavicular line) and auscultates the S1 and S2, noting the rate and rhythm.

Respiratory rate: Count the number of respirations (one respiration includes an inspiration and an expiration) in 1
minute either by visual inspection or by subtly listening over the patient’s trachea with your stethoscope. Normally,
adults take 12 to 20 breaths per minute.

Blood Pressure: Normal range <120/<80
Selecting the Correct Size Blood Pressure Cuff:
• Width of the inflatable bladder of the cuff should be about 40% of the upper arm circumference (about 12 to
14 cm in the average adult).
• Length of the inflatable bladder should be about 80% of upper arm circumference (almost long enough to
encircle the arm).
• The standard cuff is 12 × 23 cm, appropriate for arm circumferences up to 28 cm.

Steps to Ensure Accurate Blood Pressure Measurement
1. The patient should avoid smoking, exercise, or caffeine for 30 minutes before the blood pressure is measured.
2. The examination room should be quiet and a comfortable temperature.
3. The patient should sit quietly for at least 5 minutes in a chair, with both feet flat on the floor and legs
uncrossed.
4. The arm selected should be accessible and without clothing, fistulas for dialysis, scars from brachial artery
that was accessed for a deep vein intravenous, or lymphedema from axillary node dissection or radiation
therapy.
5. Palpate the brachial artery to confirm that it has a viable pulse.
6. Position the arm so that the brachial artery, at the antecubital crease, is at heart level—roughly level with the
fourth interspace at its junction with the sternum.
7. If the patient is seated, rest the arm on a table a little above the patient’s waist.


NUR 1060C Adult Health FINAL Better Grades Guaranteed-
Florida National University

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