In this article we will:
1. Explain the significance of health assessment in making clinical judgments and ensuring high-quality patient care
2. Describe the various types of health assessments
3. Distinguish between objective and subjective data
4. Apply physical assessment techniques
Health assessments are conducted by nurses and other healthcare providers using their knowledge of anatomy, physiology, therapeutic communication, and pathophysiology.
Precise patient assessment is crucial for implementing suitable interventions. This assessment entails identifying relevant cues not only from direct patient evaluation but also from environmental factors, health history, and laboratory results.
This step is vital for clinical judgment, enabling the nurse to analyze these cues, develop hypotheses about their relationships, and prioritize issues to address. See Prompts for clinical judgement tasks in the table below:
Types of health assessments include:
- Comprehensive Head-to-Toe Assessments: Performed upon patient admission (nursing admission assessment) and at the start of each shift or as needed based on the patient's condition.
- Brief Physical Assessments: Conducted to identify changes in a patient's status and compare with previous assessments.
- Focused Assessments: Targeted evaluations in response to a specific problem identified by the nurse.
- Emergency Assessments: Modified assessments in urgent situations to gather essential information for immediate care.
- Routine Physical Assessments: Regular evaluations to update a patient’s database, documented per agency policy, with unusual findings reported to the healthcare team.
Ongoing, thorough, and objective assessments ensure continuity in patient care.
Types of Data:
Subjective Data:
- Information reported by the patient or a knowledgeable historian, organized into a health history.
- Health history is taken and updated as needed with each patient encounter, informing patient care.
Objective Data:
- Observable and measurable data obtained through systematic physical assessment, vital signs measurement, and correlation with lab and diagnostic findings.
- Observation: Uses senses to assess (e.g., heart sounds, moisture, wound odor).
- Measurement: Compares assessment values to normal standards (e.g., pain scale, weight, tenderness).
Techniques of Physical Assessment:
The standard physical examination includes:
- Inspection: Observing visual clues, such as appearance, demeanor, and expressions.
- Palpation: Gathering information through touch, noting what the patient feels during palpation.
- Percussion: Listening to and interpreting different percussion sounds related to the patient's condition.
- Auscultation: Using a stethoscope to listen to internal body sounds.
These techniques rely on understanding normal conditions to identify abnormalities and require knowledge of common patterns associated with various conditions. Information from these techniques helps nurses formulate nursing diagnoses and identify functional health problems.
How to Perform the Techniques of Physical Examination:
The typical sequence for physical assessment techniques is: inspection, palpation, percussion, and auscultation. For abdominal assessments, the sequence changes to: inspection, auscultation, percussion, and palpation to avoid altering bowel sounds.
Inspection: Use vision, smell, and hearing to assess each body system, noting color, size, location, movement, texture, symmetry, odors, and sounds.
Palpation:
- Touch the patient with different parts of your hands, applying varying degrees of pressure.
- Keep fingernails short, hands warm, and wear gloves when palpating mucous membranes or areas in contact with body fluids.
- Palpate tender areas last.
Types of Palpation:
- Light Palpation:
- Used to feel surface abnormalities.
- Depress the skin ½ to ¾ inch (about 1 to 2 cm) with finger pads.
- Assess for texture, tenderness, temperature, moisture, elasticity, pulsations, and masses.
Deep Palpation:
- Used to assess internal organs and masses for size, shape, tenderness, symmetry, and mobility.
- Depress the skin 1½ to 2 inches (4 to 5 cm) with firm pressure.
- Use one hand on top of the other for firmer pressure if needed.
Percussion
- Involves tapping fingers or hands against the patient's body to locate organ borders, identify shape and position, and determine if an organ is solid or filled with fluid or gas.
Types of Percussion
- Direct Percussion:
- Reveals tenderness, commonly used for assessing adult sinuses.
- Tap directly on the body part with one or two fingers.
- Ask the patient to indicate painful areas and observe their facial expressions
Indirect Percussion:
- Elicits sounds that provide clues about the underlying tissue composition.
- Here’s how to do it: Press the distal part of the middle finger of your nondominant hand firmly on the body part. Keep the rest of your hands off the body surface. Flex the wrist of your nondominant hand. Using the middle finger of your dominant hand, tap quickly and directly over the point where your other middle finger touches the patient’s skin. Listen to the sounds produced.
References:
Introduction to Patient Assessment: https://opentextbc.ca/clinicalskills/chapter/introduction-2/
Shinnick, M.A. and Cabrera-Mino, C. ( 2021). Predictors of nursing clinical judgment in simulation. Nursing Education Perspectives. Vol 42, No 2; pp 107-109.
Learning Clinical ( Free) 2006. Assessing patients effectively: Here’s how to do the basic four techniques
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