Today our topic of discussion is Methods of Examination.
Methods of Examination
Inspection
Visual examination of the body is called inspection. It is the observation with the naked eyes to determine the structure and functions of the body. It means looking with eyes. It reveals any rash, scar, color, size, shape, contour or symmetry of body parts.
The quality of inspection depends on the time spent by the nurse to be thorough and systematic. In a hurry we may overlook significant findings and make an incorrect conclusion. The following principles should be kept in mind for making accurate inspections.
- Good lighting and exposure are essential
- Inspect each area for size, shape, color, symmetry and proposition and find out any deviations from normal .
- Use additional lights for examining body cavities, e.g. oral
- Use sense of olfaction along with visual to detect abnormalities e.g. bad breath indicates unhygienic mouth conditions. Acidotic smell is significant of diabetic acidosis.
Palpation
It is the feeling of the body or a part with the hands to note the size and positions of the organs. In palpation the finger pads and not the fingertips are used. Palpation resonance and is of booming quality signifies emphysema. is an assessment technique in which the examiner feels with his/her fingers and one or both hands.
Skill and gentleness are important. The degree of pressure applied during palpation varies, depending on, eg. tenderness of the area and the depth of palpation required. It reveals any swelling, coldness, hotness, stiffness, hardness, smoothness, roughness, pain, vibration, firmness and flaccidity .
The following points are to be kept in mind while doing palpation:
- The client should be relaxed and comfortable. Observe non-verbal signs of discomfort during palpation
- Palpation to be done with warm hands, short fingernails and a gentle approach
- Palpation to be done slowly, and gently
- For light palpation the hand is depressed about I cm (1/2 inch) and for deeper palpation it should be approximately 2.5 cm (1 inch)
- Use appropriate parts of the hands for doing various palpations.
Percussion
It is the examination by tapping with the fingers on the body to determine the condition of the internal organs by the sounds that are produced. It is done by placing a finger of the left hand firmly against a part to be examined and tapping with the fingertips of the right hand.
It means striking/ tapping with fingers. It elicits sounds, which indicate whether the underlying tissues are solid or filled with air or fluid (Figs. 4.3 and 4.4). The sounds may be:
Resonance: A low pitched and loud sound heard over the normal lung tissues.
Hyperresonance: Very loud, very low pitch sound longer than
Tympany: A drum-like sound heard over the air-filled tissues such as gastric air bubble.The examination is carried out in an orderly manner .
Dult: A medium-pitched sound with a medium duration without resonance heard over complete solid tissues such as heart and liver.
Flat: A high-pitched sound with a short duration without resonance heard over complete solid tissues such as hand, thigh.
Methods of percussion:
The percussion can be done by two methods. These are:
- Direct percussion: Striking the body surface directly with one or two fingers, eg ascitic thrill .
- Indirect percussion: Placing the middle finger of the non-dominant hand firmly against the body surface and striking the distal joint of now-dominant finger with the middle fingers of the dominant hand.
Auscultation:
It means listening with stethoscope/placing ear against the body. It reveals sounds produced within the body and the blood vessels such as heart beats, bowel sounds, while auscultation frequency loudness, quality and duration of the sound to be noted (Fig. 4.5).
Manipulations:
It is the moving of a part of the body to note its flexibility. Limitation of movements is discovered by this method. Testing of reflexes: The response of the tissues to external stimuli is tested by: means of percussion hammer, safety pin, wisp of cotton, hot and cold water, etc.
Read more: