The correct order of physical assessment: How to examine your patients effectively
Performing a physical assessment is one of the core practices for healthcare professionals. A comprehensive patient assessment allows medical practitioners to identify a medical diagnosis, better understand the patient’s problems, and find the best ways forward in developing a care plan.
Each physical assessment you perform has four components that must be conducted in a specific order. These stages - or techniques - are inspection, palpation, percussion, and auscultation. Much like putting together a puzzle, all of the parts of the assessment come together to create the bigger picture and allow you to provide the best possible care to your patients.
In this article, we’ll look at physical assessments, the proper sequence to use the techniques, and the tools you’ll need to conduct the examinations.
Let’s get started.
What Is a Physical Assessment?
A physical assessment is a routine test that primary care providers (PCPs) perform to check the overall health of their patients. It can be administered by a doctor, nurse, nurse practitioner, physician’s assistant, or other medical professionals who have the right to perform the duties of a PCP. A physical assessment is also known as a physical exam, a wellness assessment, a wellness check, or a health examination. Regardless of what one calls it, physical examination and health assessments are essential parts of your duties and must be performed qualitatively for the well-being of your patients.
Why Are Physical Assessments Such a Vital Part of the Nurses’ and Doctors’ Duties?
Nursing physical assessments provide valuable information about a patient’s overall health status and aid in diagnosing and treating various health conditions. These are some of the most important reasons for performing them:
• Physical assessments allow healthcare professionals to identify any medical conditions or abnormalities that may be present in a patient. For example, a nurse or doctor may notice an irregular heartbeat, a lump in the breast, or abnormal lung sounds during a physical assessment.
• Physical assessments help establish baseline data that can be used to track a patient’s health over time.
• Through performing examinations, RNs, NPs, or MDs can detect early signs of illness before symptoms become apparent. For example, a doctor may detect an enlarged liver during a physical assessment, which could be an early sign of liver disease.
• It’s a good opportunity for healthcare professionals to build rapport with their patients.
How to Prepare for a Physical Assessment
Conducting head-to-toe physical assessments requires some preparation.
First, you need to carefully review the patient’s medical history, including any previous diagnoses, surgeries, medications, and allergies. This information can help guide the assessment and ensure appropriate tests and procedures are performed. It’s good practice to also keep in mind throughout the checkup: What is your primary goal in performing a comprehensive physical assessment?
Second, you have to check that you have all the necessary equipment. It needs to be adequately sanitized, safe to use (for both you and the patient), and in good condition. Some of the most important tools you’ll use during a physical exam are:
• Sphygmomanometer (blood pressure cuff)
• Reflex hammer
Importantly, you ought to ensure that the patient is comfortable and their privacy is respected throughout the assessment.
What Are the Steps to Complete a Physical Assessment?
The correct order of the physical examination matters significantly to the success of your assessment.
When you perform a physical assessment, you’ll go through four techniques: inspection, palpation, percussion, and auscultation. However, if you perform an abdominal examination, that order changes slightly. Since palpation and percussion can alter bowel sounds, when conducting abdominal exams, you’d inspect, auscultate, percuss, and then palpate. Let’s take a closer look at the order of physical assessments and describe each technique in more detail.
Step 1: Inspection
The primary care provider observes the patient’s overall appearance, skin color and condition, body shape, and posture using the inspection technique. They also look for any obvious signs of injury, deformity, or abnormality, such as rashes, scars, or swelling.
With the inspection technique, the nurse will examine the patient comprehensively, gathering clues from what they see. Is the patient wearing the right clothes for the weather? Are they exhibiting any signs of pain or discomfort? What is their gait like? What is their overall demeanor? What clues do their facial expressions convey?
These details can elicit important information about the patient’s health status.
Step 2: Palpation
The second technique of physical assessment is palpation. At this point, the healthcare professional uses their hands and fingers to feel for any areas of tenderness, swelling, or abnormal growths. This may involve light palpation to assess surface structures or deep palpation to assess organs located deep within the body.
Hands can convey a lot of information for a well-trained nurse or doctor. For example, you can detect if the patient’s hand feels unusually hot through an initial handshake at the beginning of the consultation. That could indicate a fever or a cold. You can also assess muscle tone, limb weakness, or abnormal stiffness of muscles through palpation.
An important tip is to wear gloves when palpating mucous membranes or areas in contact with body fluids. Make sure to palpate tender regions last.
Step 3: Percussion
In the third stage of the physical assessment, the PCP taps on the patient’s body with their fingers to assess the density and position of underlying organs. This technique is called percussion.
Percussion is important for identifying areas of fluid buildup or air-filled spaces, which can help diagnose certain conditions. This is one of the most challenging techniques for nurses to master. But once you learn it, percussion is a great way to gather more information about your patient’s physical state.
Percussion sounds can tell you if the organ is air-filled (lungs), fluid-filled (bladder and stomach), or dense (liver). It can also help reveal the presence of masses.
Step 4: Auscultation
Auscultation involves using a stethoscope to listen for various lung, heart, and bowel sounds. With this step, you can detect normal and abnormal sounds, such as heart murmurs, Koratkoff sounds, wheezing, or bowel sounds, and drive conclusions based on what you hear.
To successfully perform this technique, you need a high-quality stethoscope that you can auscultate with. That can make or break your entire assessment. That’s why getting a stethoscope you can count on is vital.
What Are Some Trusted Stethoscopes to Use During Your Assessments?
A quality stethoscope provides clear, accurate sounds, is comfortable and durable, and offers the flexibility needed to identify abnormal body sounds, all contributing to accurate diagnoses.
Procardial Titanium Stethoscope: the Overall Best Stethoscope for the Job
Stethoscopes from the ProCardial Titanium series are an excellent option for healthcare providers who perform physical exams. With it, you’ll consistently get accurate auscultation of heart, lung, and Korotkoff sounds with acoustic integrity and clarity.
Also, the ProCardial Titanium is incredibly lightweight because of its titanium build, making it very comfortable to wear even during long shifts. The extra-deep, cone-shaped bell and ultrasensitive diaphragm allow you to detect the sounds up and down the entire frequency range that can come up during assessments.
Get your ProCardial Titanium Stethoscope now!
MD ONE Stainless Steel: Accurate Diagnoses and Great Design Go Hand in Hand
The MDF® MD One® is one of our bestsellers because health practitioners everywhere recognize what a fantastic stethoscope it is. This scope is nothing short of a premier diagnostic instrument. It’s known for its performance, durability, and aesthetics. Its acoustic performance is top-notch, and its ergonomic design ensures comfort even when you have a long day of physical assessments planned.
When it comes to design, you’ll be excited to find some beautiful color palettes. We love the white and rose gold combination, but that’s just one of many wonderful options.
Buy your new favorite stethoscope from the MD ONE Stainless Steel collection here.
Acoustica Series: Quality at an Affordable Price
If you’re on the hunt for a stethoscope that will get the job done efficiently but won’t cost a lot of money, then your best choice is an instrument from MDF’s Acoustica series.
The Acoustica® stethoscope is a lightweight economy model that delivers accurate auscultation of body sounds. It will perfectly fulfill all your needs during a physical examination, ensuring that you can assess the patients and they get high-quality care.
You’ll love your Acoustica stethoscope! Get yours now.
Plus, the great news is that all MDF® stethoscopes come with a Lifetime Sarranty and a Free-Parts-For-Life Program.
The fourth stage in the physical assessment process will be much more efficient with the right tools!
Step 5: Neurological Assessments
This type of assessment isn’t always necessary during a standard examination. However, certain situations will call for it. Nurses or doctors will perform a neurological exam whenever a patient exhibits signs or symptoms of a neurological issue, such as confusion, loss of sensation, weakness, seizures, or changes in cognitive function.
It may also be performed on patients at risk of developing neurological complications due to their underlying conditions, such as those with head injuries or those who have undergone neurosurgery.
To perform this assessment, you’ll require specific tools such as a reflex hammer, a penlight, and a tuning fork. These instruments are used to evaluate the patient’s sensory, motor, and reflex functions.
So, even though you may not perform a neurological assessment on every patient, these instruments are still vital additions to your medical or nursing arsenal.
Complete your medical toolbox with high-quality tools from MDF Instruments.
Are You One Step Closer to Mastering the Art of Performing Physical Assessments?
Combining technical proficiency, the right tools, and compassionate care will ensure the best possible outcomes for your patients. It will also solidify your position as a highly trained professional in your field. And it all starts with mastering the correct order of physical assessments.