Percussion

Percussion is that the act of putting one object against another to supply sound. The sound
waves created by the putting action over body tissues are referred to aspercussion tones.
Percussion is used to assess the location, shape, size, and density of tissues. Both hands are
used to produce sound waves.

There are two types of percussion:

a. Direct – the nurse strikes the area to be percussed directly with the pads of two, three or
four fingers or with the pad of the middle finger. The strikes are rapid, and the movement is
from the wrist.

Figure 1. Direct percussion. Using one hand to strike the surface of the body.

b. Indirect – is the striking of an object held against the body area to be examined. The middle
finger of the nondominant hand, referred to as the pleximeter, is placed firmly on the client’s
skin.

Figure 2. Indirect percussion. Using the finger of one hand to tap the finger of the other hand.

Five types of sound in percussion:

a. Flatness – is a totally dull sound produced by very dense tissue (muscle, bone)

b. Dullness - is a pulse like sound produced by dense tissue (liver, spleen heart)
c. Resonance – is a deep sound such as that produced by lungs filled with air

d. Hyper resonance – is not produced in the normal body. It is described as booming and can
be heard over an emphysematous lung.

e. Tympany – is a musical or drum like sound produced from an air-filled stomach

Palpation

It is the examination of the body using the sense of touch. The pads of the fingers are used
because their concentration of nerve endings makes them highly sensitive to tactile
discrimination.

Palpation is used to determine:

 texture
 temperature
 vibration
 position
 size
 consistency
 mobility of organs or masses
 distention
 pulsation
 presence of pain upon pressure.

Types of palpation:

Light (gentle), moderate, or deep palpation to control the amount of pressure applied.

Light palpation is depressing the skin and underlying structures for about less than 1
cm (0.5) and appropriate for surface characteristics.

Figure 3.
Moderate palpation is depressing the skin surface 1 to 2 cm (0.5 to 0.75), assessing
abdominal organ characteristics.
 Deep palpation is pressing inward about 2 cm (1) and done with two hands (bimanually)
or one hand, Deep palpation carries the risk of internal injury, deep palpation is done
with extreme caution because pressure can damage internal organs and it should be
perform by experienced practitioner. Applying intermittent pressure to a specific area
allows assessment of surface characteristics and underlying structures. Two hands are
used for bimanual palpation (e.g., palpating breast tissue); one hand applies pressure
and the other hand feels the tissue or structure.

Figure 4. The position of the hands for deep bimanual palpation.

Figure 5. Deep palpation using the lower hand to support the body while the upper hand palpates the
organ.

To test for temperature, the back hand is used; to test for vibration, the palmar surface of the
hand.

General guidelines for palpation in checking patient’s skin temperature:

• The nurse’s hands should be clean and warm, and the fingernails short.

• Areas of tenderness should be palpated last.

• Deep palpation should be done after superficial palpation.

PPT

Korotkoff sounds

It is the five phases of blood pressure sounds and is the series of sounds for which the
nurse listens when assessing the blood pressure.

Five phases of blood pressure sounds:

Phase 1: The appearance of the clear "tapping" sounds as the cuff is gradually deflated.
The first clear "tapping" sound is defined as the systolic pressure.

• Phase 2: The period where you hear the sounds have a muffled, whooshing, or
swishing quality.

• Phase 3: The period in which the sounds become crisper and more intense thumping
quality but softer than in phase 1.

• Phase 4: The time when the sounds become muffled and have a soft, blowing quality.

• Phase 5: The pressure level when the last sound is heard. The last audible sound is
defined as the diastolic pressure.