Skip to 0 minutes and 4 secondsThe standard method of physical examination resolves around the following approach. Inspection, which is considering clues from what we see. Palpation, gathering information from what we feel or what the patient feels as we palpate. Percussion, listening to different percussion notes and interpreting these in the context of the presenting complaint. Auscultation, using a stethoscope to listen more intensely to sounds within the body. All of these aspects of examination rely on a knowledge of what is normal in order to identify any abnormalities. We also require some knowledge of common patterns of presentation associated with different conditions.
Skip to 0 minutes and 59 secondsAll of the information gathered during these four processes will add to our bank of clues and aid us in deciding between the differential diagnoses to arrive at one working diagnosis. Let's look more closely at inspection. When we inspect our patient to discover relevant clues we look at the patient as a whole. Are they appropriately dressed for the current weather? Their demeanour, their expression. Does their facial expression indicate that they are in pain? Their gait, as discussed previously and their body shape. If we are considering specific systems, we may inspect one or more parts of the body related to that system.
Skip to 1 minute and 43 secondsFor example, next week we will be looking at examining the respiratory system, starting with overall impression of effort of breathing and inspecting the hands and face before moving onto the chest itself. Palpation. Our hands can tell us many things about the body of the patient we are examining. As we shake hands with the patient at the beginning of the consultation we are aware if the patient’s hand is hot, which may indicate a fever, or cold, possible peripheral vascular disease, whether it is clammy, sepsis or cardiogenic shock. We can assess their muscle tone, limb weakness, or spasticity.
Skip to 2 minutes and 22 secondsAll within the few short seconds of a handshake and as we move into specific system examinations we can palpate for tactile fremitus, respiratory, masses, abdomen or skin, pulses, circulation, lymph nodes, systemic infection or crepitus, musculoskeletal system. Percussion. One of the most difficult techniques for nurses to learn has been shown to be percussion of the body cavities. Percussion can give us clues to several health conditions by the change in the percussion note or sound when we percuss over solid, bone, tumour, foetus, faeces, or fat or liquid, pleural effusion, urinary bladder ascites, or gas. Flatus, fully expanded lung tissue etc.
Skip to 3 minutes and 11 secondsThe technique is to use the middle or index and middle fingers of your dominant hand as the drumstick and drop it smartly onto the middle phalanx of your non-dominant middle finger which rests on the patient’s body. The drum beat noise that this produces indicates whether solid, liquid or gas is present in that body cavity. Here are some examples of the sounds you could hear. Solid, over bone, liquid, over ascites, gas, over chest cavity. Auscultation. Auscultation is the act of listening to body parts and assessing the sounds made using a stethoscope. There are several types of stethoscope and it is important to acquire a stethoscope which is appropriate to yourself and suitable for your patient group.
Skip to 4 minutes and 17 secondsFor example, if you have a hearing deficit, an electrically amplified stethoscope may be useful for you. If you work mainly with babies and children, you may need a paediatric stethoscope which has a smaller head. You need to accustom yourself to your chosen stethoscope ensuring that the ear pieces are inserted pointing towards your face and not towards the back of your head. This way, they follow the ear canal and transmit sound more efficiently.
Methods of examination
Now that we have prepared ourselves and our environment, we review the techniques and skills which are required for physical examination.
Listen to Nicky Parker-Summers discuss the key aspects of a standard physical examination:
You can review examples of the sounds you might hear during percussion, below:
- solid – over bone
- liquid – over ascites
- gas – over chest cavity
Please note, if you have enrolled on this program, and have not already got a stethoscope, you should get one now.
Practise percussing parts of your own body, and listen for the differences in sound over each area.
Share your experience and any questions, hints or tips with the group.
Write a reflection for your portfolio about the experience of percussion. How do you feel about doing this with a real patient?