Assessment and Physical Examination
Systematic Technique and Normal Findings
Assessment questions reward a consistent head-to-toe approach and correct technique. The classic order is inspection, palpation, percussion, and auscultation - except the abdomen, where auscultation follows inspection and precedes palpation and percussion so bowel sounds are not altered. Know normal ranges and what each finding means: vesicular breath sounds over most lung fields, bronchovesicular centrally, and bronchial over the trachea. S1 and S2 heart sounds, with S3 sometimes normal in children and pregnancy, and a split S2 that varies with respiration. Assess skin turgor, capillary refill, and mucous membranes for hydration. Document findings objectively, and know which findings are urgent: new unequal pupils, absent bowel sounds with rigidity, or a sudden change in mental status.
Traps to Watch
Questions often reverse the order of techniques or place palpation before auscultation in the abdomen. Another trap is mistaking a normal variant for pathology, such as an S3 in a child or a systolic murmur that is innocent. Focused assessment comes before a complete one in an emergency. Also, subjective data (what the patient reports) differs from objective data (what you observe and measure).
Rule of Thumb
In an emergency, assess airway, breathing, and circulation first and defer the full examination. For the abdomen, remember "inspect, auscultate, percuss, palpate."
Worked Example
A patient reports abdominal pain. The nurse inspects the abdomen, listens to bowel sounds in all four quadrants, then percusses and finally palpates the painful area last, so guarding does not obscure later findings.