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Percussion question


Specializes in Pediatrics. Has 13 years experience.

I am currently an LVN and RN student through Excelsior. Since becoming an LVN I have worked in an office setting only, Allergy & Asthma and now GI.

Physical assessments are not something I do on a regular basis and want to know how often percussion is actually done by the RN? Percussion makes me quite nervous since there are many different sounds, etc. The physician I work for does it during every assessment and I know will be willing to let me observe and likely practice.

Thanks in advance

From what my instructors have told me and from RN's I have asked, Almost never... What you can get by percussion (or tactile fremitus) you can also get other ways, primarily auscultation. My argument against it (besides being Deaf) is that it is a skill that is used so rarely that you would probably not know a normal from an abnormal finding anyway. If you have a suspicion of a problem that is detected via percussion, you would probably just order an xray, CT, ultrasound anyway as percussion is never used for a definitive diagnosis that I am aware of. It is still taught because it's on the NCLEX. If you work in a speciality that actually uses it, I am sure the other nurses can teach you how to do it right and interpret the findings.

When physicians, NP, PA's etc use it, it's often related to more of an advanced practice application. If the MD you work for does share it with you, please post back as I would love to know what assessment data he gains and is looking for with the procedure and how he thinks that would be used and interpreted as a nurse. Ask if there is other options to gain the same info or what tests he would order based on a positive finding.

Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro. Has 16 years experience.

I've never done it on a patient. Like Southpaw said, any abnormal finding that percussion could suggest, can be definitely diagnosed with an x-ray.

NurseCard, ADN

Specializes in Med/Surge, Psych, LTC, Home Health. Has 13 years experience.

Never done it. Ever. Not in 14 years as an RN.

tyvin, BSN, RN

Specializes in Hospice / Psych / RNAC.

We were taught percussion in my nursing program and expected to employ it. It's part of the total examination of the client/patient and lots of info can be gleaned from percussion; create a baseline as well. I liken it to a skill of listening to the heart. Like everything else; if you don't know what it's used for or weren't taught, than you probably don't understand it's significance.

Percussion was expected to be employed during our final physical before graduating as well (the one you do in front of your instructor for a grade). Auscultation, palpation, percussion, the history, objective and subjective analysis.; etc... It's all part of a physical and at other times apporpriate most definately. Isn't the point of a physical or assessment to detect possible conerns that further testing can determine. Percusussion and palpation aren't used enough in my opinion. :)

I was always taught percussion was done by advanced practice RNs. I have never done it.

From what my instructors have told me and from RN's I have asked, Almost never... What you can get by percussion (or tactile fremitus) you can also get other ways, primarily auscultation.

It's true that RNs never need to perform percussion. It is not true, though, that the same information is gained with auscultation.

Percussion is for distinguishing solid structures and fluid filled structures vs. air-filled. If you can do that with auscultation, then good on you!

I'll grant you that the percussion assessment is not relied upon - but in the past it provided useful information in the decision whether or not to obtain imaging aka expose pt to radiation. In the "way past" it was part of an assessment needed to decide whether to take the patient to surgery or not, without the benefit of imagining or advanced imaging. Anyone who has had the chance to observe an "experienced" general surgeon would see that they are gaining particular info by percussing; it's not rare that they're able to predict the CT results - the CT is merely a necessary formality in some of the very common cases. It's kind of a neat thing to see. Somewhat archaic appearing? Yeah, probably. But still pretty impressive.

Anyway, here's a not-fancy-but-maybe-interesting page...

Scroll about half way down to the percussion section

A Practical Guide to Clinical Medicine

Edited by JKL33