Objective data are data that are directly observed by the nurse, measurements reported by other health care professionals, or observations noted by the family or significant others about the client. See Table 2-1 for a comparison of subjective data (discussed in Chapter 1) and objective data (discussed in this chapter).
The nurse obtains objective data by performing a physical assessment using four basic techniques: inspection, palpation, percussion, and auscultation. The definition and proper technique for each of these are described in the next section. Always use Standard Precautions as recommended by the Hospital Infection Control Practices Advisory Committee (HICPAC) and the Centers for Disease Control and Prevention (CDC).
Inspection is using the senses of vision, smell, and hearing to observe the condition of various body parts, including any deviations from normal.
Expose body parts being observed while keeping the rest of the client properly draped.
Use good lighting. Tangential sunlight is best. Be alert for the effect of bluish red-tinted or fluorescent lighting that interferes with observing bruises, cyanosis, and erythema.
Provide a warm room for examination of the client. (An environment that is too cold or hot may alter skin color and appearance.)
Observe for color, size, location, texture, symmetry, odors, and sounds.
Palpation is touching and feeling body parts with your hands to determine the following characteristics:
Use the most sensitive part of the hand to detect various sensations. See Table 2-2.
Use four different types of palpation, depending on the purpose of the examination. The purpose and technique for each are described in Table 2-3.
Percussion is tapping a portion of the body to elicit evidence of tenderness or sounds that vary with the density of underlying structures. The reliability of this technique is often questioned because of variations in the specificity and sensitivity of percussion.
Use three types of percussion depending on the purpose of the examination. The three types of percussion are explained in Table 2-4. Percussion notes elicited through indirect percussion vary with the density of the underlying structures. Five percussion notes are described in Table 2-5.
Auscultation is listening for various breath, heart, vasculature, and bowel sounds using a stethoscope.
Use a good stethoscope that has the following:
The diaphragm and bell are used differently to detect various sounds, as shown in Table 2-6.