Main Body

6 Inspection

Inspection is the technique of purposeful and systematic observation of the client – note that this does not involve touching, only careful visual observation. It begins as soon as the client walks in the room or you enter the client’s room and ends when you or the client leaves the room: you should maintain inspection constantly throughout the examination.

Clinical Tip

Good overhead lighting is important to help you see the client. Tangential lighting with a penlight is also effective to help you see specific body areas or lesions, as it focuses the light and highlights contours and protrusions on a relatively flat surface. Tangential lighting involves using the penlight at a low angle and to one side of the area that you are viewing. For example, tangential lighting is often used to inspect the thyroid, the jugular pulsation, the apical impulse, and skin lesions. A magnifying glass may also be helpful to let you get a better look at a specific area.

While inspecting, you should note both normal and abnormal findings. When doing so, you should complete a bilateral comparison in which you compare the left side of the body to the ride side for comparison. For example, if you notice that the upper left eye lid is drooping, is this the same for the upper right eye lid? This comparison is helpful because symmetry is usually a good thing, whereas asymmetry should draw your attention as a potential cue for an abnormal finding.

The systematic process involves inspecting the client overall to gain a general impression, and then inspecting specific body areas and body systems to focus your assessment. For example, when inspecting the client overall, you may assess the following:

  • Body position and posture
    • Are they standing or sitting upright or are they bent/slumped over or leaning to one side? For example, findings may include “client sitting erect in chair” or “leaning to right side.”
  • Gait (i.e., balance and movement of limbs while walking)
    • Is it coordinated and balanced? Do they limp, stagger, shuffle, or is their gait uncoordinated or rigid? For example, findings may include “balanced gait” or “slow, shuffling feet with rigid movement of body and limbs.”
  • Symmetry
    • Are facial features symmetrical and are limbs symmetrical in length? Do you notice any bony protrusions or deformities on one side of the body, but not the other? For example, findings may include “symmetrical facial features with no deformities” or “asymmetrical facial features with left-sided facial droop.”
  • Skin
    • Do you notice any discolouration, bruising, , swelling, perspiration? It is important to note that not all discolouration is a cue for concern; hyperpigmentation, which is when patches of skin can become darker – this is common as people age and common in people with darker skin tones. For example, findings may include “redness and swelling on left .”
  • Behaviour
    • Is their disposition and affect appropriate for the environment? Or does their facial expression and behaviours display cues that you should be concerned about (e.g., laughing or crying uncontrollably, unable to sit still)? Appropriate behaviour varies based on a client’s developmental age, so you should take this into consideration. For example, findings may include “client constantly moving in chair, fidgeting with hands, moving right leg up and down.”
  • Dress and hygiene
    • Is the client dressed appropriately for the environment? Are there any body odours or concerning scents? Be aware that clothing style and its appropriateness varies based on a client’s age, their geographical or cultural background, and their style preferences. For example, findings may include “client dressed appropriately for the weather.”

You will need to inspect specific body areas as you assess specific body systems. For example, you will inspect the chest area when you assess the cardiac system (i.e., the heart). Doing so in this systematic manner will allow you to only expose the area that you are assessing, while ensuring appropriate draping. It will also help you keep track of what you have and have not yet done.

Voices of Experience

Always consider what you are inspecting in the context of the overall presentation of the client. With infants, when exposing parts of their body, cover them up quickly to keep them warm; you should try to keep them covered as much as you can to prevent heat loss. This can also be an opportune time to inspect children while they are playing or interacting with their care partner. For toddlers, use a calm soothing voice and let them gradually get acquainted with you while inspecting. It is important to address the client’s developmental stage; for example, toddlers are more likely to be engaged and respond to your direction if you make them feel important.

Activity: Check Your Understanding

 

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Physical Examination Techniques: A Nurse's Guide by Jennifer Lapum; Michelle Hughes; Oona St-Amant; Wendy Garcia; Margaret Verkuyl; Paul Petrie; Frances Dimaranan; Mahidhar Pemasani; and Nada Savicevic is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

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