PHYSICAL EXAMINATION (IPPA)

A physical examination is an evaluation of the body and its functions using inspection, palpation, percussion and auscultation. A comprehensive physical examination provides an opportunity for the health care professional to obtain baseline information about the patient for future use, and to establish a relationship before problems happen. It provides an opportunity to answer questions and teach good health practices. Detecting a problem in its early stages can have good long-term results. It is done systematically or head-to-toe or cephalocaudal. However, the exact procedure will vary according to the needs of the patient and the preferences of the examiner.
Inspection – It is a visual examination. This examination must be systematic to assess color, body shape, wounds, facial expression, motor behaviors and some area to be examined. Nurses must use their clinical eye to further assess using visualization or looking at different parts of the patient's body.

Palpation – It is an examination using the sense of touch. The pads of the fingers are used because the concentration of nerve endings are highly sensitive to tactile discrimination. It is used as part of a physical examination in which an object is felt to determine its size, shape, firmness, or location. Palpation is typically used for thoracic and abdominal examinations, but can also be used to diagnose edema and to measure the pulse. It is used by veterinarians to check animals for pregnancy, and by midwives to determine the position of a fetus.

Percussion – The examiner places one hand on the patient and then taps a finger on that hand, with the index finger of the other hand. It can determine the position, size, and consistency of an internal organ. It is done over the chest to determine the presence of normal air content in the lungs, and over the abdomen to evaluate air in the loops of the intestine. Since hollow and solid areas generate different vibrations, the physician or other examiner uses this technique to determine if various organs (heart, liver, etc.) are enlarged or not. Percussion is also used to diagnose fluid in the abdominal and chest cavities or make one suspect the presence of pneumonia.There are two types of percussion: direct, which uses only one or two fingers, and indirect, which uses the middle/flexor finger. There are four types of percussion sounds: resonant, hyper-resonant, stony dull or dull. A dull sound indicates the presence of a solid mass under the surface. A more resonant sound indicates hollow, air-containing structures.

Based on the auditory and tactile perception, the notes heard can be categorized as follows:
• Tympanic
• Hyperresonant (pneumothorax)
• Normal resonance/ Resonant
• Impaired resonance (mass, consolidation)
• Dull (consolidation)
• Stony dull (pleural effusion)

Auscultation – Auscultation is the technical term for listening to the internal sounds of the body, usually using a stethoscope; based on the Latin verb auscultare "to listen". Auscultation is a skill that requires substantial clinical experience, a fine stethoscope and good listening skills. Nurse listens to the patient's heart beat, lungs and blood vessels of the neck and groin.