Physical Examination

Introduction to Physical Examination in Primary Health Care

Physical examination is a systematic data collection method used by nurses to evaluate a patient's health status. In Nigerian primary health care centres, it serves as a critical frontline tool for detecting abnormalities, monitoring chronic conditions, and making timely clinical decisions where diagnostic laboratory equipment may be limited. Assessment findings combine with the health history to form the complete clinical picture, guiding nursing care plans and referrals.

Preparation of the Patient and Environment

Successful physical assessment requires careful preparation of both the physical setting and the patient.

• Environment: Ensure adequate lighting, privacy using screens or curtains, comfortable room temperature, and minimal noise to allow proper auscultation.
• Patient: Explain every procedure clearly to reduce anxiety, obtain informed consent, ask the patient to empty their bladder, and provide appropriate draping to maintain dignity.

Standard Precautions and Infection Control

Infection control protects both the nurse and the patient during physical contact. Nurses must apply standard precautions for every patient encounter, regardless of their known infection status.

1. Hand Hygiene: Wash hands with soap and water or use alcohol-based rub before and after patient contact.
2. Personal Protective Equipment: Wear clean gloves when touching blood, body fluids, mucous membranes, or non-intact skin.
3. Equipment Decontamination: Clean stethoscopes and other reusable tools with appropriate disinfectant wipes between patients.

Basic Techniques: Inspection, Palpation, Percussion, and Auscultation

Physical assessment relies on four core techniques performed in a specific sequence, except during abdominal examinations where auscultation precedes palpation to avoid altering bowel sounds.

• Inspection: Concentrated visual observation of the body, noting symmetry, color, and movement.
• Palpation: Using the sense of touch to evaluate texture, temperature, moisture, swelling, and tenderness.
• Percussion: Tapping body parts to produce sound waves that reveal the density of underlying structures.
• Auscultation: Listening to sounds produced by the body using a stethoscope, such as heart, lung, and bowel sounds.

Vital Signs Measurement and Anthropometric Assessment

Vital signs provide baseline objective data regarding cardiovascular, respiratory, and thermoregulatory function. They include temperature, pulse, respiration, and blood pressure, often accompanied by oxygen saturation. Anthropometric measurements quantify body size and composition; key parameters include height, weight, mid-upper arm circumference, and body mass index. Accurate measurement is essential for detecting physiological distress or nutritional disorders common in the community.

Systemic Examination: Head-to-Toe Approach

The head-to-toe approach provides an organized framework that ensures no body system is overlooked. The nurse begins at the head, assessing the skull, face, eyes, ears, nose, and mouth, then moves downward to the neck, chest, abdomen, extremities, and back. This structured progression minimizes position changes for the patient and standardizes documentation across clinical shifts.

Documenting and Reporting Physical Examination Findings

Documentation translates clinical observations into a permanent legal record. Nurses must record findings objectively, avoiding vague terms like 'normal' or 'fine' in favor of descriptive measurements and factual details. Immediate reporting is mandatory for any critical finding, such as severe hypotension, respiratory distress, or acute neurological deficits, ensuring prompt multidisciplinary intervention.