Introduction to

Health assessment
for Nursing
Dr. Walaa elleithy
Phd in medical Surgical Nursing
Mansoura university
 DEFINITION
• Health examination
• the systematic assessment of human body
which involves the use of one’s senses to
determine the general physical and mental
conditions of the body.
 HEALTH ASSESSMENT

HEALTH PHYSICAL
HISTORY ASSESSMENT
 Physical examination
• a complete assessment of a patient’s physical
and mental status.
• A physical assessment is the systematic
collection of objective information that is
directly observed or is elicited through
examination techniques
Purpose:

• To collect objective data from the client

•
• To detect the abnormalities with systematic technique
early
•
• To diagnose diseases.
•
• To determine the status of present health in health
check-up and refer the client for consultation.
 Indication of health examination
• On admission
• On discharge
• On follow up
• Health camps
• Before and after diagnostic and therapeutic
procedure.
 Patient’s positions
1. SUPINE POSITION:

2. PRONE POSITION:
 Patient’s positions Cont.’
3. SITTING POSITION:

4. SEMI FOWLER’s POSITION:

 Patient’s positions Cont.’
5. SIM’s POSITION:

6. KNEE-CHEST POSITION:
Patient’s positions Cont.’
7. DORSAL RECUMBENT POSITION:

8. LITHOTOMY POSITION:
 Patient’s positions Cont.’
9. TRENDELENBERG’s POSITION:
 Principles of Physical Examination

• Generally (head to toe) is used, but in the case

of infant, examination of heart and lung
function should be done before the
examination of other body parts, because when
the infant starts crying, his/her breath and heart
rate may change
TECHNIQUE OF PHYSICAL
ASSESSMENT
SKILLS OF PHYSICAL EXAMINATION

Look Listen Feel

(Inspection) (auscultation) (palpation)

Tap Smell
(percussion) (olfaction)
17
 INSPECTION
A method of systematic observation. Inspection
should begin with general observation of the
patient progressing to specific body areas.
 INSPECTION
•Looking at the client carefully to discover any
signs of illness. Inspection gives more
information than other method and is
therefore the most useful method of physical
examination.
 GENERAL INSPECTION OF A CLIENT
FOCUSES ON
• Overall appearance of health or illness
• Signs of distress
• Facial expression and mood
• Body size
• Grooming and personal hygiene
PALPATION
PALPATION
•Using hands to touch
and feel. Different parts
of hands are used for
different sensations
such as temperature,
texture of skin,
vibration, tenderness,
for examples,
 Using hands to
touch and feel
•Finger tips are used
for fine tactile
surfaces.
•Back of fingers for
feeling temperature .
•Flat of the palm
and fingers for
feeling vibrations
 Parts of hands used for various palpation:
Part of hand Type of palpation

Finger tips To assess texture, shape, size,

consistency and palpation

Dorsum of hand and fingers To assess temperature

Palm of hand To assess vibration

Pinching of fingers To assess turgor, consistency

and position
 PRINCIPLES OF PALPATION
• You should have short fingernails.
• You should warm your hands prior to placing them on
the patient.
• Encourage the patient to continue to breathe normally
throughout the palpation.
• If pain is experienced during the palpation. discontinue
the palpation immediately.
• Inform the patient where, when, and how the touch
will occur, especially when the patient cannot see what
you are doing.
LIGHT PALPATION
 DEEP PALPATION

Palpation used to determine:

•Consistency of tissue.
•Alignment and intactness of structures.
•Symmetry of body parts.
• Areas of warmth and tenderness
PERCUSSION
 PERCUSSION
• Determines the density of various parts of the
body from the sound produced by them, when
they are tapped with fingers.
 PERCUSSION Cont.’
• Percussion helps to find out abnormal solid
masses, fluid and gas in the body and to map
out the size and borders of the certain organ
like the heart
 TYPE OF PERCUSSION
• DIRECT PERCUSSION
INDIRECT PERCUSSION
 Technique of percussion
• ① Put the middle fingers of his/her hand of the
left hand against the body part to be percussed
• ② Tap the end joint of this finger with the
middle finger of the right hand
• ③ Give two or three taps at each area to
percussed
• ④ Compare the sound produced at different
areas
 PERCUSSION
The sounds may be:
• Resonance: a low pitched and loud sound
heard over the normal lung tissues.
• Hyper resonance: very loud , very low
pitched sound longer than resonance
signifies emphysema.
• Tympany : a drum like sound heard over
the air filled tissues such as gastric air
bubble.
• Dull: A medium pitched sound with a
medium duration without resonance heard
over solid tissues such as
heart , liver.
 Percussion sound with examples:
Percussion Intensity Pitch Percussion
sounds example
Dullness Medium Moderate Liver
Resonance Loud Low Normal lung
Hyper Very loud Lower Emphysematous
resonance lung
Tympany Loud Higher Puffed out
cheek , gastric air
bubble
AUSCULTATION
4. Auscultation

•Auscultation means listening the sounds

transmitted by a stethoscope which is used to
listen to the heart, lungs and bowel sounds.
 FOUR CHARACTERISTICS OF SOUND
• 1.Pitch (ranging from high and low):frequency or
number of oscillations generated per second by
vibrating object
• 2. Loudness (ranging from soft to loud): amplitude
of sound
• 3. Quality (gurgling or swishing)
• 4. Duration (short, medium or long)
TYPES OF AUSCULTATION

Direct auscultation: use Indirect auscultation:

of use of
unaided ear stethoscope
 EQUIPMENTS for physical examinations
• STETHOSCOPE
OPHTHALMOSCOPE
OTOSCOPE
SNELLEN CHART
NASAL SPECULUM
VAGINAL SPECULUM
TUNING FORK
PERCUSSION HARMER
SPHYGMOMANOMETER
PREPARING THE ENVIRONMENT
 PREPARING THE PATIENT
• PSYCHOLOGICAL PREPERATION
PHYSICAL PREPERATION
 ARTICLES REQUIRED

• Screen to provide privacy

• Bowl for antiseptic lotion
• Kidney tray and paper bag
• Weighing machine and height scale
• Patient gown
 ARTICLES REQUIRED
• Bath blanket to cover the patient
• Pair of leggings
• Draw sheet to cover patient’s chest
• Square drum containing test tube, gauze
piece, cotton swab, specimen bottle,
swabsticks
• Gloves
• lubricant
 ARTICLES REQUIRED
• Torch
• Ophthalmoscope
• Snellen’s chart
• Book for colour blindness
• Pen
• Flash card
• Autoscope with speculum of different sizes
• Percussion Hammer
• Tuning fork
 ARTICLES REQUIRED
• Nasal speculum
• Mouth gag
• Laryngeal mirror
• Tongue depressor
• Stethoscope
• Inch tape
 ARTICLES REQUIRED
• Sterile tray for vaginal examination
• Proctoscope
• VITALS TRAY
 ARTICLES FOR NEUROLOGICAL
• Powder, soap
EXAMINATION
• Snellan’s chart
• Pencil or pen
• Cotton wicks
• Torch
• Tuning fork
• Salt, sugar
 ARTICLES FOR NEUROLOGICAL
EXAMINATION
• Tongue depressor
• 2 test tubes one with hot water and other with
cold water
• Safety pins
• Some thing solid for grasping
• Sharp object like key
• Reading material to assess eyes and language of
person
• Knee hammer
Basic Guidelines for physical
Assessment
1. Obtain a nursing history and survey
2. Maintain privacy.
3. Explain the procedure
4. Always inspect, palpate, percuss, and
then auscultate except abdominal start
with auscultate
5. Compare symmetrical sides
6. If abnormality (Symptom analysis )
7. Client teaching
8. Allow time for client’s questions.

"Remember: the most important guideline for

adequate physical assessment is conscious,
Variation in physical assessment of the
pediatric client.
Sequence of physical assessment is
dependent upon the developmental level
of the client.
Allowing time for interaction with the child

prior to beginning the examination helps

to reduce fears.
In certain age groups, portions of
assessment will require physical restraint
Distraction and play should be intermingled
throughout the examination to assist in
maintaining rapport with the pediatric client.
Involving assistance from the child’s
significant caregiver may facilitate a more
meaningful examination of the younger
client.
The examiner should be prepared to alter the
order of the assessment and approach to the
child based on the child’s response.
Protest or an uncooperative attitude toward
the examiner is a normal finding in children
from birth to early adolescence, throughout
parts or even all the assessment process.
Variations for physical assessment of the
geriatric client.
Remember: normal variation related to aging
may be observed in all parts of the physical
examination.
Dividing the physical assessment into parts in

order to avoid fatigue in the older client.

Provide room with comfortable temperature

and no drafts.
Allow sufficient time for client to respond to
directions.
If possible assess the elderly clients in a
 GENERAL SURVEY
• Identification data
• Gender and race
• Age
• Signs of distress
• Body type
• Posture
• Gait
• Body movements
• Hygiene and grooming
• Body odor
• Affect and mood
• Speech
• Substance abuse
1. Gender and race: Certain illnesses are more
likely to affect the specific gender and race. Eg.
Risk of having skin cancer is 20% higher in
whites than in blacks.
2. Age: Age influences the normal physical
characteristics.
3. Signs of distress: There may be obvious signs
and symptoms indicating pain, difficulty in
breathing or anxiety.
4. Body type: Trim, muscular, obese or excessively
thin.
5. ) Posture: Observe whether the client has a
slumped, erect or bent posture.
6. Gait: Observe the walking pattern of the client. Not
whether the movements are coordinated or
uncoordinated.
7. Body movements: Note for any tremors involving
the extremities.
8. Hygiene and grooming: Note the appearance of
hair, skin and finger nails. Also observe for the
clothing.
9. Affect and mood: Affect is a person’s feelings as
they appear to others.
10. Speech: An abnormal pace may be caused by
emotions and neurological impairments.
11. Substance abuse: Check for the history of
substance abuse.
VITALS SIGNS
HEIGHT AND WEIGHT:
Thank you