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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

Health & Physical

Assessment in NursingFirst Edition

Chapter 6

Techniques and

 Equipment

Donita D’Amico 

andColleen Barbarito

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

LEARNING OBJECTIVE ONE

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

LEARNING OBJECTIVE ONE

Inspection

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

Figure 6.1  Inspection of client. 

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

LEARNING OBJECTIVE ONE

Palpation

• Characteristics

 – Size

 – Shape

 – Location

 – Mobility

 – Position

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

LEARNING OBJECTIVE ONE

Palpation• Characteristics

 – Vibrations

 – Temperature – Texture

 – Moisture

 – Tenderness

 – Edema

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

Figure 6.2  Sensitive areas of the hand. 

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

LEARNING OBJECTIVE ONE

Palpation

• Light

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

Figure 6.3  Light palpation. 

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

LEARNING OBJECTIVE ONE

Palpation

•Moderate

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

Figure 6.4  Moderate palpation. 

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

LEARNING OBJECTIVE ONE

Palpation

•Deep

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

LEARNING OBJECTIVE ONE

Percussion

•Methods – Direct

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

Figure 6.6  Direct percussion. 

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

LEARNING OBJECTIVE ONE

Percussion

•Methods – Blunt

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

LEARNING OBJECTIVE ONE

Percussion

•Methods – Indirect

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

Figure 6.8  Indirect percussion. 

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

LEARNING OBJECTIVE ONE

Percussion Sounds

•Tympany

• Resonance

• Hyperresonance

• Dullness• Flatness

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

LEARNING OBJECTIVE ONE

Characteristics of Percussion Sounds

•Intensity or amplitude

• Pitch or frequency

• Duration

• Quality

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

LEARNING OBJECTIVE ONE

Auscultation

•Sounds – Intensity

 – Pitch

 – Duration

 – Quality

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

LEARNING OBJECTIVE TWO

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

LEARNING OBJECTIVE TWO

Equipment used During Physical

Assessment• Stethoscope

• Doppler ultrasonic stethoscope

• Ophthalmoscope• Otoscope

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

Table 6.1  Equipment Used During the Physical Assessment 

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

Table 6.1 (continued)  Equipment Used During the Physical Assessment 

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

LEARNING OBJECTIVE TWO

Stethoscope

•Bell

• Diaphragm

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

Figure 6.9  A. Stethoscope with both a bell-shaped and flat-disc amplifier. B. Close-up of a flat-disc amplifier (left) and a bell amplifier

(right). 

A

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

Figure 6.9 (continued)  A. Stethoscope with both a bell-shaped and flat-disc amplifier. B. Close-up of a flat-disc amplifier (left) and a

 bell amplifier (right). 

B

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

Figure 6.10  Nurse using a stethoscope. 

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

LEARNING OBJECTIVE TWO

Doppler Ultrasonic Stethoscope

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

Figure 6.11  Doppler ultrasonic stethoscope. 

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

LEARNING OBJECTIVE TWO

Ophthalmoscope

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

Figure 6.12  Ophthalmoscope demonstrating aperture. 

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

Figure 6.13  Apertures of ophthalmoscope. 

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

LEARNING OBJECTIVE TWO

Otoscope

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

Figure 6.14  Otoscope. 

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

LEARNING OBJECTIVE THREE

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Health and Physical Assessment in Nursing, 1eBy Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice HallUpper Saddle River, NJ 07458

LEARNING OBJECTIVE THREE

Measures• Warm, private, distraction-free exam room

• Good overhead lighting with a portable lamp

• Clean, firm exam surface

• Knowledge of client’s preferences for personalvalues and beliefs

• Decreasing client’s anxiety

• Providing privacy and draping

• Handwashing

• Use of standard precautions

• Explanation of procedures

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Health and Physical Assessment in Nursing, 1e

By Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice Hall

Upper Saddle River, NJ 07458

LEARNING OBJECTIVE FOUR

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Health and Physical Assessment in Nursing, 1e

By Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice Hall

Upper Saddle River, NJ 07458

LEARNING OBJECTIVE FOUR

Critical Thinking and Physical Assessment

•Organize data

• Analyze data

• Interpret findings

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Health and Physical Assessment in Nursing, 1e

By Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice Hall

Upper Saddle River, NJ 07458

LEARNING OBJECTIVE FIVE

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Health and Physical Assessment in Nursing, 1e

By Donita D’Amico and Colleen Barbarito 

© 2007 Pearson Education, Inc.

Pearson Prentice Hall

Upper Saddle River, NJ 07458

LEARNING OBJECTIVE FIVE

Standard Precautions - Guidelines to

Protect the Client and Healthcare

Workers

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Health and Physical Assessment in Nursing 1e

© 2007 Pearson Education, Inc.

Pearson Prentice Hall

LEARNING OBJECTIVE FIVE

Guidelines

• Handwashing

• Gloves

• Protective barriers

• Disposal of sharps

• Cautionary handling of specimens

• Proper disposal of body wastes