Chapter 8 : Assessment Techniques and Safety in the Clinical Setting
I. Cultivating Your Senses
-Physical examination requires examiner to develop technical skills - the tools to gather data
-Use your senses to gather data
-The skills required for the physical examination are:
1. INSPECTION
○ Concentrated watching; first of individual as a whole, then of each body system
○ Inspection always comes FIRST
○ Compare R and L sides for symmetry
○ Inspection begins the moment you first meet the person and develop a “general
survey”
○ Pay attention to their affect (temperament, mood), their dress, hygiene, etc
○ Observe for: symmetry, norms, size, shape, color and behavior
○ General inspection: front to back/ side to side, symmetry, injuries, abnormalities
(overall appearance)
○ Systemic inspection: each body system from head to tow
○ Inspection requires: good lighting, adequate exposure, occasional use of
instruments to enlarge view
2. PALPATION
○ Follows and confirms inspection
○ Sense of TOUCH: texture, temperature, moisture, organ location and size,
swelling, vibrations or pulsations, rigidity or spasticity, crepitation, presence of
lumps or masses and presence of tenderness/pain
○ Different parts of the hand are best suited for assessing different factors
a) Fingertips: fine tactile discrimination, as of skin texure, swelling,
pulsation and determining presence of lumps
b) Grasping action of fingers and thumb: detect position, shape , and
consistency of an organ or mass
c) Dorsa (backs) of hands and fingers: determining temperature (skin is
thinner than on palms)
d) Base of fingers or ulnar surface of hand: vibration
○ Bimanual palpation- requires use of both hands for more precise delimitation
○ Palpation technique should be slow and calm; tender areas should be palpated
last
○ Light palpation identifies surface issues: tenderness, masses, rigidity
○ Deep palpation identifies: enlarged organs, tenderness, masses
3. PERCUSSION
○ Tapping the persons skin with short, sharp strokes to assess underlying structures
○ Produces an audible vibration that helps reveal : location, density, and size of
underlying organ
○ Used also for tendon reflex
○ 2 methods:
a) Direct percussion (immediate), striking hand directly contacts body wall
I. Cultivating Your Senses
-Physical examination requires examiner to develop technical skills - the tools to gather data
-Use your senses to gather data
-The skills required for the physical examination are:
1. INSPECTION
○ Concentrated watching; first of individual as a whole, then of each body system
○ Inspection always comes FIRST
○ Compare R and L sides for symmetry
○ Inspection begins the moment you first meet the person and develop a “general
survey”
○ Pay attention to their affect (temperament, mood), their dress, hygiene, etc
○ Observe for: symmetry, norms, size, shape, color and behavior
○ General inspection: front to back/ side to side, symmetry, injuries, abnormalities
(overall appearance)
○ Systemic inspection: each body system from head to tow
○ Inspection requires: good lighting, adequate exposure, occasional use of
instruments to enlarge view
2. PALPATION
○ Follows and confirms inspection
○ Sense of TOUCH: texture, temperature, moisture, organ location and size,
swelling, vibrations or pulsations, rigidity or spasticity, crepitation, presence of
lumps or masses and presence of tenderness/pain
○ Different parts of the hand are best suited for assessing different factors
a) Fingertips: fine tactile discrimination, as of skin texure, swelling,
pulsation and determining presence of lumps
b) Grasping action of fingers and thumb: detect position, shape , and
consistency of an organ or mass
c) Dorsa (backs) of hands and fingers: determining temperature (skin is
thinner than on palms)
d) Base of fingers or ulnar surface of hand: vibration
○ Bimanual palpation- requires use of both hands for more precise delimitation
○ Palpation technique should be slow and calm; tender areas should be palpated
last
○ Light palpation identifies surface issues: tenderness, masses, rigidity
○ Deep palpation identifies: enlarged organs, tenderness, masses
3. PERCUSSION
○ Tapping the persons skin with short, sharp strokes to assess underlying structures
○ Produces an audible vibration that helps reveal : location, density, and size of
underlying organ
○ Used also for tendon reflex
○ 2 methods:
a) Direct percussion (immediate), striking hand directly contacts body wall
