Health Assessment, part 1: Physical Assessment Components
by Meris Shuwarger March 24, 2023 Updated: August 10, 2023 6 min read
Full transcript and video captions coming soon!
Hi. I'm Meris, and in this video, I'm going to be reviewing the physical assessment components. I'm going to be following along using the flashcards from our health assessment deck, starting from the beginning. So if you have a set of your own, I would invite you to go ahead and break them out and follow along with me, but if you want to grab a set for yourself, you absolutely can. They're available on our website, LevelUpRN.com. All right. Let's get started.
So starting off from the very beginning, we're on card one, and in this card, we're going to be talking about the different components of a physical assessment. And obviously, throughout the health assessment deck, we're going to be talking about how to do an assessment, what needs to be assessed for which body part at which time, but right now we're just talking about the general steps of assessment. So there's four main types of physical assessment. There is inspection, and inspection as the name may suggest is involved with your sight. It's your ability to use your sight to assess the size, shape, color, symmetry of things. So if I walk in the room and I see that my patient has good, tall posture, or they're hunched over, or something is asymmetrical, something is swollen, I'm inspecting. I'm using my sense of sight to assess that patient.
Then we have palpation, and palpation is using your sense of touch, and here we're going to assess for different things. We can assess temperature. We can assess moisture, vibration, texture, and tenderness. Tenderness is a very important thing that we assess with palpation. So when it comes to assessing, we're going to use the dorsal or the posterior surface of the hand when we are assessing things like temperature. So if you think about a mom checking their child's temperature, they're usually using the back of their hand, so we're using the dorsal surface to assess temperature. Now, the palmar surface, and specifically this part right here, right underneath your fingers, that's what we're going to use to assess for vibration. This is not something we do very routinely. However, when we are assessing for things like how much vibrations are being transmitted through the lungs, which helps us to see if things are clear or if we have consolidation, we're going to use this part of our hands, the palmar surface, but specifically this nice flat part here to assess for that vibration.
Now, when it comes to assessing for tenderness, you may think of this as being what a nurse or provider may do when they come in. They push on the belly, or they push on some component of the patient's body, and "Does it hurt when I push here?" That is using palpation to assess for tenderness. There's something very important that you need to understand about this, and it is that we assess the most tender areas last. So if I have a patient who has right lower quadrant tenderness, I'm going to start far away when I'm palpating, and I'm going to tell my patient that. "Listen, I'm going to push on your belly a little bit. I'm going to start with the parts that don't hurt, and we'll finish with the part that does hurt. I will be very gentle," trying to give them that warning because otherwise if my patient thinks right away, I'm going to go for that tender spot, they're going to tense or what we call guarding. They're going to guard, and they're going to tense up those muscles, and it will make it harder to assess. Additionally, I don't want to assess the painful area first, and then my patient is in so much pain, everything is so worked up and bothered and agitated and now, maybe when I push elsewhere, they say that it hurts, when really it doesn't. It's just that they're still feeling that residual pain. So we're going to start away from the tender area and finish there last.
Now percussion. Percussion, think of like a drum. We are tapping something. So in this instance, we're using our sense of touch, but we are tapping over the patient's body parts. So when and why would we do this? I'm going to tell you that in my clinical practice, this is not something that I do routinely. However, there certainly are indications for this, and you will mostly see providers such as nurse practitioners and physicians doing percussion, but you still need to know what percussion is and what those kinds of findings would be. So with percussion, we percuss over parts of the body, usually by taking our two fingers, putting them down on whatever part of the body that we are assessing, and then we are going to tap our fingers. So we're tapping our fingers over the patient's body. There's also blunt percussion, where we might be assessing for costovertebral angle tenderness, and that's where I might take my hand and put it over the patient's back and use my fist to hit against it, and that is going to be blunt percussion.
Now auscultation. To auscultate means to listen to something, so auscultating is what I do with my stethoscope. I use my sense of hearing to listen with the stethoscope. Now here, we're going to listen for different body sounds, so we might be listening to heart and lung sounds, to bowel sounds. We might be listening for abnormal sounds. Maybe I'm listening to the carotid arteries to see if I hear a normal whooshing, or do I have that turbulent bruit sound to it. So there's lots of reasons that we may auscultate, and we'll get into those findings later.
Now, when it comes to a general physical assessment of your patients, in most cases, we're going to assess in that exact order that I just went over. We're going to assess by starting with inspection. I'm looking, then I'm going to touch, palpate, I'm going to percuss, tap, and then I'm going to auscultate and listen. There's one specific instance that you need to be aware of where these are not the normal assessment steps, and that is when we are assessing the abdomen. When we assess the abdomen, we are still going to start by inspecting. However, then we will auscultate, next we will percuss, and finally, we will palpate. And the reason for this is that if I palpate first-- in that set of steps, if I palpate, I can alter the contents of my patient's abdomen. I'm going to move those bowels around a little bit. I may end up actually altering their bowel sounds by moving some gas around, and I could end up not hearing what is actually going on. So that's why I'm going to listen first and then percuss. We're just tapping, right? We're not doing any kinds of huge pushing on our patients. And finally, I will do the palpation. And we do have one of our cool chicken hints here, and if you are new to Level Up, our cool chicken hints are our unique memory devices to help you remember these things. So our cool chicken hint here says, "Take a look at my belly. I am perfect pal." So I for inspection, am for auscultation, and then perfect is for percussion, pal is for palpation. All right. That is it for this video. I will see you in the next one, but before you go, make sure to stay to the end so you can test your knowledge with a few of my quiz questions.
All right. Here are some quiz questions to help you test your knowledge of key facts I provided in this video. Which types of assessment involve using the examiner's hands to touch or tap? The answer is palpation and percussion. Okay. Up next, what is the correct order of most assessment components? Most assessments are performed in the following order. Inspection, palpation, percussion, and auscultation. When assessing the abdomen, which type of assessment should be performed second? The step of auscultation should be performed second when assessing the abdomen. Thanks so much for studying with me. I hope you learned something, and I'll see you in the next video. Happy studying.
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