Palpation

uses pressure to assess structure size, placement, pulsation, and tenderness, ballottement, a variation, involves bouncing tissues against the hand to assess rebound of floating structures. Ballottement can be used to assess a mass in a patient with ascites.

To

perform light palpation, press gently on the skin, indenting it 1 to 3 (4-9 cm). Use the lightest touch possible; too much pressure blunts your sensitivity, Close your eyes to concentrate on feeling.

Indent the skin about 1 (4 cm). Place your other hand on top of the palpating hand to control and guide your movements. To perform a variation of deep palpation that allows you to pinpoint an inflamed area , push down slowly deeply, then lift your hand away quickly. If the patient complains of increased pain as you release the pressure, you have identified rebound tenderness. Use both hands(bimanual palpation) to trap a deep, hard-to-palpate organ organs(such as kidney or spleen) or fix or stabilize an organ(such as uterus) while palpating with the other hands

Perform

light ballottement, apply light, rapid pressure from quadrant to quadrant of the patients abdomen. Keep your hand on the surface on the skin to detect tissue rebound.

To

perform deep ballottement, apply abrupt, deep pressure: then release, but maintain contact.

2

basic purposes:-produce percussion sounds Elicit tenderness

It involves 3 types: Indirect Direct blunt

Most

commonly used method, indirect percussion, produces clear, crisp sounds when performed correctly. To perform indirect percussion, use the second finger of your nondominant hand as the pleximeter (the mediating device used to receive the taps) and the middle finger of your dominant hand as the plexor(the device used to Tap the pleximeter) place the pleximeter finger firmly against a body surface, such as the upper back or abdomen.

With

your wrist flexed loosely, use the tip of your flexor finger to deliver a crisp blow just beneath the distal joint of the pleximeter. Make sure you hold the plexor perpendicular to the pleximeter. Tap lightly and quickly, removing the plexor as soon as you delivered each blow.

To

perform direct percussion, tap your hand or fingetips directly against the body surface. This method helps assess as adults sinuses for tenderness.

To

perform blunt percussion, strike the ulnar surface of your fist against the body surface. Alternatively, you may use both hands by placing the palm of one hand over the area to be percussed and then making a fist with the other hand over the area to be percussed and then making a fist with the other hand and using it to strike the back of the first hand. Both techniques aim to elicit tendernessnot to create a sound-----over organs such as kidneys.

Another

blunt percussion method, used in neurologic examination, involves tapping a rubber tipped reflex hammer against a tendon to create a reflexive muscle contraction.