Reflective Essay on Physical Assessment Techniques

This reflective essay discusses the physical assessment techniques used in airway and cardiac assessment. The author describes the steps taken during the assessment and reflects on their performance. The essay also includes an action plan for improvement.

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Running head: REFLECTIVE ESSAY
REFLECTIVE ESSAY
Name of student:
Name of university:
Author note:

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Description
Physical assessment like inspection, palpation, percussion and palpation. These
assessments are generally the important steps of airway assessment or cardiac assessment
(Ashcheulova, Kovalyova & Demydenko, 2017). Being an airway nurse, I was instructed to
perform this assessment in one of my colleagues, whose name is tracy.
At first I entered the room and greeted my collegue and explained her about the
procedure and the importance of doing this examination. I asked for the consent before
touching the patient. Before examining the patient, I washed my hands thoroughly with the
soap or an antibacterial wash. Handwashing is an important step to prevent infection (Longtin
et al., 2013). I requested the patient to sit in the examination table and assisted her to lie down
on the examination table. I generally observed my concerned patient to look for any signs of
distress. I asked the patient to hold her hands up and I pressed the thumbnail with the help of
my first finger while holding the other side of the finger with the help of my thumb. This is
how I noted the pheripheral circulation. Clubbing should be noticed, which can be reerred to
as the decrease in the angle between the nail bed and the nail (Ashcheulova, Kovalyova &
Demydenko, 2017). Then I performed auscultation by placing the stethoscope above Tracy’s
chest and tried to listen to the lund sounds. Airflow normally sounded differently in case of
blocked airways or wheezing can be heard (Sarkar, Madabhavi, Niranjan & Dogra, 2015).
The radial pulse is palpated with the help of the middle finger and the index finger and the
rhythm, regularity, rate per minute, rhythms and the volumes are measured (Estes, 2013). I
tried to assess the apex beat, corresponding to the lower left borer of the heart. Next I
palpated for the heaves and thrills. I inspected the head of the patient for signs of any cardiac
diseases like bobbing head movement, that is linked to aortic regurgitation or flushing skin
(Lehrer, 2018). I made it sure to inspect the skin around the eyes for any yellow coloration.

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Then I performed percussion by placing my hand firmly over the chest wall along the
intercostal space and tapped over the distal interphalageal joint. I was mindful about the
positioning of my fingers as the tapping should be done with the wrist and the percussion
finger would not be left in the chest, as that would dampen the sound.
I inspected that patient’s chest anteriorly for searching evidence of any median sternotomy
scar.
Feelings
I was a bit nervous about the assessment, although I have performed this assessment
for a number of times, but this time I had to perform this in front of the supervisor, hence I
was tensed, whether, I was performing all the steps correctly. I considered if the patient is
uncomfortable with the examination or whether she was hurt at the time I was performing the
percussion. However, my nurse supervisor had assured ne in the beginning that he would be
assisting me throughout the procedure and so I felt a bit relived.
Evaluation
There were few mistakes that I did during the procedure. I did not position my patient
at an angle of 45 degree or 30 degree, which is an important step at the time of inspecting my
patient (Estes, 2013). I was also forgetful about the inspection of cornea for the presence of
corneal arcus to inspect for any hyperlipidaemia or even did not check the colour of the
tongue to inspect for the central cyanosis. However, I was mindful about the rest of the
procedures and the patient also expressed that she had been comfortable throughout the
procedure. However, my supervisor also confirmed that I have performed the procedure
excellently, except that I could have been more prompt and confident during the procedure.

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Analysis
The whole procedure made me understand that real life procedures can be entirely
different and if not conducted correctly might lead to improper diagnosis of the problems. I
have learnt how observation of skin can help in the diagnosis of infections like bacterial
endocarditis or detection of clubbing can be used to determine right to left shunt disease. I
have also learnt how the correct positioning of the stethoscope can help in the detection of
unusual crackles or lung sounds.
Conclusion
However, I would not say that the airway examination experience was negative. I
conducted all the procedures mindfully and could assess all the lung sounds and other
physical examination techniques that I have learned in my course study. However, I need to
be more careful about the different parameters that has to be examined during the palpation
and the percussion as I often feel confused with the positioning of my fingers. Hence, I intend
to follow my peers and consult my educator for giving me more in –hand opportunities like
this to facilitate kinaesthetic learning.
Action plan
I plan to confront to such kind of examination with more difficult real life scenarios as
I think that would boost up my confidence level and would allow me in my future practice.
As I have told earlier that there were many aspects that has to be taken care of at the time of
palpating the pulses, such as locating the manobriosternal joint and using the vertically
positioning ruler to measure the angle of Louis and then calculating the jugular venous
pressure. There are some other inspection procedures that I should learn from my seniors and

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the educators. I also intend to brainstorm through the recent nursing articles to remain
updated about the medical world.

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References
Ashcheulova, T., Kovalyova, O., & Demydenko, G. (2017). Respiratory system examination.
Lungs percussion. Technique of comparative and topographic percussion: mеthodical
instruction for students.
Estes, M. E. Z. (2013). Health assessment and physical examination. Cengage Learning.
https://books.google.co.in/books?
hl=en&lr=&id=wTcXAAAAQBAJ&oi=fnd&pg=PR6&dq=physical+examination+of
+lungs&ots=00lJDymerz&sig=AlOvfetGHED_R5lO97i1TwJmtZk#v=onepage&q=p
hysical%20examination%20of%20lungs&f=false
Lehrer, S. (2018). Understanding lung sounds. Steven Lehrer.
https://books.google.co.in/books?
hl=en&lr=&id=eFFUDwAAQBAJ&oi=fnd&pg=PA1&dq=physical+examination+of
+lung+sounds&ots=E8gXjBCURs&sig=xfAbUtfRV8mdnu0pcYF9HmOXtm4#v=on
epage&q=physical%20examination%20of%20lung%20sounds&f=false
Longtin, Y., Schneider, A., Tschopp, C., Renzi, G., Gayet-Ageron, A., Schrenzel, J., & Pittet,
D. (2014, March). Contamination of stethoscopes and physicians' hands after a
physical examination. In Mayo Clinic Proceedings (Vol. 89, No. 3, pp. 291-299).
Elsevier. https://books.google.co.in/books?
hl=en&lr=&id=g0Ao61hGAloC&oi=fnd&pg=PP2&dq=physical+examination+of+lungs&ots=gF
TbO1hqjp&sig=iyIfhN733ul1OIjZkWSqsh82Chk#v=onepage&q=physical%20examination
%20of%20lungs&f=false

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Macherey, S., Doerr, F., Heldwein, M., & Hekmat, K. (2015). Is manual palpation of the lung
necessary in patients undergoing pulmonary metastasectomy?. Interactive
cardiovascular and thoracic surgery, 22(3), 351-359.
Sarkar, M., Madabhavi, I., Niranjan, N., & Dogra, M. (2015). Auscultation of the respiratory
system. Annals of Thoracic Medicine, 10(3), 158–168. http://doi.org/10.4103/1817-
1737.160831