Performing a physical assessment calls for four basic techniques: inspection, palpation, percussion, and auscultation. Performing these techniques correctly helps elicit valuable information about the patient’s condition.

Inspection requires the use of vision, hearing, touch, and smell. Special lighting and various equipment—such as an otoscope, a tongue blade, or an ophthalmoscope—may be used to enhance vision or examine an otherwise hidden area. Inspection begins during the first patient contact and continues throughout the assessment.

Palpation usually follows inspection, except when examining the abdomen or assessing infants and children. Palpation involves touching the body to determine the size, shape, and position of structures; to detect and evaluate temperature, pulsations, and other movement; and to elicit tenderness. The four palpation techniques include light palpation, deep palpation, light ballottement, and deep ballottement. Ballottement is the technique used to evaluate a flowing or movable structure. The nurse gently bounces the structure by applying pressure against it and then waits to feel it rebound. This technique may be used, for example, to check the position of an organ or a fetus.

Percussion uses quick, sharp tapping of the fingers or hands against body surfaces to produce sounds, detect tenderness, or assess reflexes. Percussing for sound helps locate organ borders, identify organ shape and position, and determine whether an organ is solid or filled with fluid or gas. Organs and tissues produce sounds of varying loudness, pitch, and duration, depending on their density. For example, air-filled cavities, such as the lungs, produce markedly different sounds from those produced by the liver and other dense organs and tissues. Percussion techniques include indirect percussion, direct percussion, and blunt percussion.

Auscultation involves listening to various sounds of the body—particularly those produced by the heart, lungs, vessels, stomach, and intestines. Most auscultated sounds result from the movement of air or fluid through these structures.

Typically, auscultation comes last after the other assessment techniques. When examining the abdomen, however, auscultation takes place after inspection but before percussion and palpation so that bowel sounds can be heard before palpation disrupts them. Auscultation is also best performed first on infants and young children, who may start to cry when palpated or percussed. Auscultation is most successful when performed in a quiet environment with a properly fitted stethoscope.