Physical Examination/Assessment of Human Body and Assessment Methods

Physical Examination is the process by which a medical professional investigates the body of a patient for signs of disease. It generally follows the taking of the medical history—an account of the symptoms as experienced by the patient. Together with the medical history, the physical examination aids in determining the correct diagnosis and devising the treatment plan. Basic skills which are used for physical examination are:   

Inspection, Palpation, percussion, auscultation, which of this method come first depends of the case and area of the body to be examined. Just like when examining the abdominal area, it is best to perform auscultation before percussion or palpation. This will preserve certain auscultatory sounds that should not be elicited or masked by touch. 

Inspection:  During this portion of the examination, the physician inspects or looks at different parts of the patient's body. It is visual examination. It requires the use of naked eye. During Physical health care practitioner looks for:

Body features and symmetry appearance, Nutritional state or weight, Skin colour, Frequency and volume of breaths during respiration, Movement of the abdomen and each side of the chest during respiration, Hair distribution, Wounds, Discoloration, Swelling, Tremor etc. However physical examination is not limited to the visualization other organoleptic evaluation like odour and smell , listening of sound etc also included in inspection.     

Palpation:  is a technique used in physical examination in which the examiner feels the texture, size, consistency, and location of certain body parts with the hands. It should not be confused with palpitation which is awareness of heat beats. 

Prior to palpating a patient, some basic principles need to be observed. You should have short fingernails to avoid hurting the patient as well as yourself. Also, you should warm your hands prior to placing them on the patient; cold hands can make a patient’s muscles tense, which can distort assessment findings. Encourage the patient to continue to breathe normally throughout the palpation. Most significantly, inform the patient where, when, and how the touch, will occur, especially when the patient cannot see what you are doing. Palpation may be superficial or deep. Light palpation reveals information on skin texture and moisture; overt, large, or superficial masses; and fluid, muscle guarding, and superficial tenderness. Deep palpation can reveal information about the position of organs and masses, as well as their size, shape, mobility, consistency, and areas of discomfort.

Percussion:  is the technique of striking one object against another to cause vibrations that produce sound. The density of underlying structures produces characteristic sounds. These sounds are diagnostic of normal and abnormal findings. The presence of air, fluid, and solids can be confirmed, as can organ size, shape, and position. Any part of the body can be percussed, but only limited information can be obtained in specific areas such as the heart. The thorax and abdomen are the most frequently percussed locations.

 It is done with the middle finger of one hand tapping on the middle finger of the other hand using a wrist action, which is placed firmly on the body over tissue, not bone. When percussing bony areas such as clavicle the stationary finger can be omitted and the bone is tapped directly. The process of percussion can produce five distinct sounds in the body: flatness, dullness, resonance, hyper-resonance, and tympani. Specific parts of the body elicit distinct percuss-able sounds.

Auscultation:  Auscultation is the act of active listening to body organs to gather information on a patient’s clinical status. Auscultation includes listening to sounds that are voluntarily and involuntarily produced by the body. A deep inspiration a patient takes with the lung assessment illustrates a voluntary sound, and heart sounds illustrate involuntary sounds. A quiet environment is necessary for auscultation. Auscultated sounds should be analyzed in relation to their relative intensity, pitch, duration, quality, and location. Auscultation is done for heart sounds breath sounds and bowl sounds. There are two types of auscultation: direct and indirect.  Direct auscultation involves listening with ear without any amplifier while indirect use stethoscope.