Bedside Physical Assessment in Medical-Surgical Nursing

Core Concepts

The four techniques

• Inspection: Look first — color, symmetry, movement, wounds, expression, and equipment. Inspection always comes before touching.
• Palpation: Touch — temperature, moisture, tenderness, texture, masses, and pulses. Use light palpation before deep palpation.
• Percussion: Tapping the body surface to produce sounds that reflect the density of the underlying structures. It takes practice and is used to evaluate organs and fluid or air in body spaces.
• Auscultation: Listening with a stethoscope to breath, heart, bowel, and vascular sounds.

Technique order matters. For the abdomen, auscultate before palpation and percussion, because touching the abdomen can change bowel sounds. For the chest, the usual sequence is inspection → palpation → percussion → auscultation. Facility and specialty practice vary, so the nurse follows the accepted sequence for the region being assessed.

The head-to-toe approach

A typical comprehensive bedside assessment moves through: general survey (appearance, behavior, mobility, hygiene, respiratory effort), vital signs, then head and neck, chest and lungs, heart, abdomen, extremities (pulses, edema, movement), skin, and neurological status (level of consciousness, orientation, speech, pupils, movement). An organized, repeatable sequence prevents omissions. Exact ordering varies by facility and unit, and a focused assessment (e.g., the surgical site, the lungs of a patient with breathing difficulty) targets one region or system.

Comprehensive versus focused assessment

A comprehensive assessment is the full head-to-toe, typically done on admission or per facility policy. A focused assessment is problem-directed: a patient who reports chest discomfort receives a focused cardiovascular and respiratory assessment; a patient two days after surgery receives a focused assessment of the surgical site, pain, bowel function, and mobility. The focused assessment is not "lesser" — it is targeted to the patient's current risk and complaint.

Preparation, privacy, and safety

Before starting, the nurse explains what will be done and why, provides privacy (curtains, draping), warms hands and the stethoscope, performs hand hygiene, and uses gloves per policy. The patient is kept in a safe, comfortable position, and never left unattended in an unsafe position (e.g., sitting on the edge of the bed without assistance). The patient may decline any part of the examination; the refusal is respected, documented, and reported. Which team member performs which parts of the assessment (registered nurse, licensed practical/vocational nurse, or unlicensed assistive personnel) is defined by state scope-of-practice rules and facility policy — the nurse practices within their own scope and delegates accordingly.

Vital signs and trends

Temperature, pulse, respirations, blood pressure, oxygen saturation, and pain are measured and, importantly, compared with the patient's baseline and prior readings. Reference ranges vary with age, condition, and facility; a single number outside a range is interpreted in context, and trends (rising or falling) often matter more than one reading. Unexpected or rapidly changing findings are reported to the provider per facility policy (SBAR from Topic 2 is a common format). Educational note: no specific ranges are quoted here because normal values depend on the patient and the setting.

Documentation and reporting

Findings are documented objectively, measurably, and in a timely manner ("incision edges pink, dry, and approximated; 3 cm of serous drainage on dressing" — not "incision looks fine"). The nurse never charts an assessment they did not perform. Unexpected findings are communicated immediately per policy and documented.

Common Confusions