physical assessment

Question 1

What is the order of IAPP for physical assessments?

Answer 1

The order is: Inspection, Palpation, Percussion, Auscultation. However, for abdominal assessments, the order is: Inspection, Auscultation, Percussion, Palpation to avoid altering bowel sounds.

Question 2

What is inspection and when is it performed?

Answer 2

Inspection involves concentrated observation of the patient and is always the first step.

Question 3

What do you inspect for during physical assessments?

Answer 3

Symmetry, posture, gait, facial expression, dress, skin color, contour (convex or concave), deformities, smoothness, roughness, etc.

Question 4

What is palpation and how is it done?

Answer 4

Palpation involves using touch to assess texture, temperature, moisture, organ location/size, swelling, vibration, lumps, tenderness, pulsation, and rigidity. Begin with light palpation and progress to deep palpation.

Question 5

What part of the hand is used for palpating texture?

Answer 5

Fingertips.

Question 6

What part of the hand is used to check temperature?

Answer 6

The back of the hands (dorsal surface).

Question 7

How do you assess vibration or pulsation?

Answer 7

Use the base of the fingers or the fingertips.

Question 8

What should you do before deep palpation?

Answer 8

Begin with light palpation and palpate tender areas last.

Question 9

What is bimanual palpation?

Answer 9

Palpation using both hands, often to assess deep or larger organs/masses.

Question 10

What is percussion?

Answer 10

Percussion is tapping on the body’s surface to assess underlying structures by listening for characteristic sounds that indicate the type of tissue (air, fluid, dense organ, etc.).

Question 11

What is the main purpose of percussion?

Answer 11

To determine the location, size, density, and presence of underlying organs or masses.

Question 12

What types of percussion sounds are common?

Answer 12

Resonant (air in lungs), tympany (air in a hollow organ), dull (dense organ like liver), flat (bone or muscle).

Question 13

What is an example of when percussion is useful?

Answer 13

It is often used in the gastrointestinal system, such as assessing the liver or stomach, and to check for CVA tenderness in the kidneys.

Question 14

What is auscultation?

Answer 14

Auscultation is listening to body sounds, typically using a stethoscope, to assess for normal or abnormal sounds such as breath, heart, and bowel sounds.

Question 15

What does the diaphragm of the stethoscope assess?

Answer 15

The diaphragm is used for high-pitched sounds like breath, bowel, and normal heart sounds. Press it firmly on the skin.

Question 16

What does the bell of the stethoscope assess?

Answer 16

The bell is used for low-pitched sounds like murmurs or bruits. Press it lightly on the skin.

Question 17

What are auscultation tips?

Answer 17

Always place the stethoscope directly on the skin, ensure privacy, clean the stethoscope between patients, minimize external noise, and warm the stethoscope before using it.

Question 18

Resonant

Answer 18

Low-pitched, hollow sound; heard over normal lung tissue.

Question 19

Tympany

Answer 19

High-pitched, drum-like sound; heard over air-filled hollow organs like the stomach or intestines.

Question 20

Dull

Answer 20

Soft, thud-like sound; heard over dense organs like the liver or fluid-filled areas like an impacted intestine.

Question 21

Flat

Answer 21

Very soft, flat sound with no resonance; heard over solid structures like bone, muscle, or a tumor.

Question 22

Pediatrics

Answer 22

• Use the least invasive techniques first.
• Engage in playful methods (e.g., “Say ahhhh!” or “Simon says” for ROM).
• Keep the environment friendly and fun (e.g., ticklish areas).

Question 23

Teens

Answer 23

• Acknowledge their desire for independence.
• Be mindful of awkwardness; approach with sensitivity.

Question 24

Elders

Answer 24

• Ensure proper lighting for visibility.
• Minimize distracting sounds during the assessment.
• Limit position changes to avoid discomfort; assess from the front if the patient is bed-bound.
• Prioritize obtaining a few quality auscultation points (3-4) rather than risking a full assessment.

Question 25

Standard Stethoscope

Answer 25

• Used for auscultation of body sounds.

Question 26

Diaphragm

Answer 26

• Used most often.
• Press firmly on the patient’s skin.
• Best for high-pitched sounds: breath, bowel, and normal heart sounds.

Question 27

Bell

Answer 27

• Used less frequently.
• Press lightly on the skin (or it will function as a diaphragm).
• Best for low-pitched sounds: murmurs, extra heart sounds, and bruits.

Question 28

Key Points

Answer 28

• Some stethoscopes only have one end (diaphragm or bell).
• Always warm the stethoscope before use.
• Minimize external noise (from clothing, hair, etc.).
• Avoid listening through a gown for accurate sound transmission.