A client comes to the emergency department (ED) complaining of a painful injury to the right knee received while playing basketball. Which examination techniques will the nurse include during the physical assessment of this client?
Select all that apply.
1. Inspection.
2. Palpation.
3. Bulge sign testing.
4. Ballottement.
5. Percussion.
Correct Answer: 1, 2, 3, 4
The assessment of a client presenting with an injury to the knee would include inspection, palpation, bulge sign testing, and ballottement. The nurse would visually inspect the knee's general appearance, including the presence or redness, swelling and dislocation. The knee's appearance would be contrasted with the unaffected knee. The area would be palpated for tenderness and warmth. The bulge sign test is used to detect the presence of small amounts of fluid (4 to 8 ml) in the suprapatellar bursa. The test involves placing the client in the supine position and then using firm pressure to stroke the medial aspect of the knee upward several times, displacing any fluid. As the pressure is applied to the lateral side of the knee the medial side is observed for bulging. Ballottement is a technique used to detect fluid, or to examine or detect floating body structures. The nurse displaces body fluid and then palpates the return impact of the body structure. Percussion is the use of tapping actions by the examiner. This tapping elicits sounds that can be evaluated for tone and depth to detect the presence of abnormalities. Percussion is normally utilized to assess the lungs and abdominal cavity. It is not used to assess for knee injuries.
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