What are the four stages of a physical health assessment?

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To form a well-rounded care plan, nurses have to perform a range of health assessments on the patients in their care. This allows them to collect information on a person’s mobility level, pain level, vital signs and more. The physical assessment is done alongside a general survey of the patient which includes their height, weight, personal hygiene, etc. With this raw data, nurses can objectively look at each patient to identify any medical concerns or highlight any needs they may have. Moreover, they have a chance to spot any barriers to compliance or better health outcomes, for example, if the patient has low health literacy or difficulty self-managing their ongoing conditions.

These assessments are crucial because they are relied on by healthcare providers, physicians and consultants. They include all the information these specialists use to diagnose a problem, create a treatment plan or organize the appropriate intervention. As part of initial nurse training, these head-to-toe assessments become second nature for medical staff. 

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What are the four basic techniques needed to perform a physical assessment?

A physical assessment is generally centered around four techniques, each developed to examine a different aspect of the patient’s overall health and physicality. These are inspection, palpation, percussion and auscultation. Unless a nurse has a reason to do otherwise, this sequence is always followed.

Stage one — inspection

After greeting the patient and making them comfortable, nurses begin the inspection stage. This tends to be a visual examination that includes the nurse taking a closer look at the patient’s vision, sense of smell and hearing — they check for which senses appear normal and which might not be. As they are performing this part of the test, they are looking in particular for sounds, odors, textures, movement and color in these systems.

Stage two — palpation

Using several different degrees of pressure, nurses touch the patient with various parts of their hands. Palpation involves using the hands as special tools, which is one of the reasons nurses tend to keep their nails short. For the benefit of the patient, nurses also warm their hands before beginning. They feel for the size and shape of internal organs, as well as tenderness and mobility. In other areas of the body, they check for masses, temperature and texture, as well as pain and moisture. Nurses who are palpating areas where they may be in contact with bodily fluids or mucous membranes will always wear gloves.

Stage three — percussion

This is a technique that involves a nurse tapping their hand or fingers on parts of the patient. Depending on which area of the body they are concentrating on, they can spot signs of tenderness, identify the shape of organs and assess whether the organ has gas or fluid inside. Over time, nurses become familiar with the sound that certain areas of the body should make. Knowledge of whether to anticipate a dull, flat or resonant noise means they understand what sounds normal and can identify potential abnormalities. As well as being able to learn more about an underlying issue through sound, they can ask the patient if the movement produces discomfort or watch their face for signs of distress.

Stage four — auscultation

During this process, nurses listen to the various sounds made by a patient’s heart, bowel and lungs. Before they begin auscultation, most medical professionals will ensure the room is quiet and the stethoscope has been warmed for the patient’s comfort. In order to concentrate more effectively, most nurses close their eyes when performing this part of the physical exam.

They use a common medical instrument called a stethoscope that is designed for this purpose. It is placed flat on the body in different locations, depending on the organ being examined. The patient is then asked to take a deep breath before the nurse listens to sounds on the front and back of the body. The flatter side of the stethoscope is used to detect normal sounds with a high pitch, as well as abnormal sounds. The other side, known as the bell, is used to listen for low-pitched sounds.