The techniques of physical examination

The techniques of physical examination

1. THE TECHNIQUES OF PHYSICAL EXAMINATION PREPARED BY: USHA RANI KANDULA, ASSISTANT PROFESSOR, DEPARTMENT OF ADULT HEALTH NURSING, ARSI UNIVERSITY,ASELLA,ETHIOPIA, EAST AFRICA.

2. TECHNIQUES OF PHYSICAL EXAMINATION The skills used in physical examination include inspection, palpation, percussion, auscultation, and sometimes olfaction.

3. will use these skills in that order, with one exception: When performing an abdominal assessment, perform auscultation before percussion and palpation to avoid disturbing the abdominal sounds.

4. INSPECTION Inspection is the use of sight to gather data. will begin to use inspection the moment you meet the client and continue as you observe the person’s gait, personal hygiene, and behavior during the general survey.

5. You will also use inspection and such abnormalities as- Edema, Masses, or Areas of tenderness.

6. -As we begin and move through the assessment of each body system, always inform the client that you are about to touch him, and use a gentle approach. -Be certain your hands are warm.

7. PALPATION Begin with light pressure to detect surface characteristics.

8. -Then move to deep palpation to assess the underlying structures. -Examine last any areas of discomfort or sensitivity.

9. Following is a list of the most common palpation techniques, using different parts of the hand.

10. FINGERTIPS : Use for fine tactile discrimination, including assessment of skin texture, swelling, and specific locations of pulsations and masses.

11. Dorsum of hand : Use for temperature determination. ■ Palmar surface of hand : Use for locating general area of pulsations.

12. Grasping with fingers and thumb: Use to detect the position, shape, and consistency of a mass.

13. PERCUSSION Percussion is tapping your fingers on the skin using short strokes.

14. INDIRECT PERCUSSION

15. - Tapping ( percussing ) produces vibrations, and the resulting sound allows you to determine location, size, and density of underlying structures.

16. Percussion is especially useful when assessing the abdomen and lungs. Percussion takes practice.

17. DIRECT AUSCULTATION -Direct auscultation is listening without using an instrument.

18. INDIRECT AUSCULTATION -If use of a stethoscope, you have already performed direct auscultation.

19. INDIRECT AUSCULTATION -Indirect auscultation is listening with the help of a stethoscope. -The stethoscope has two end pieces, the diaphragm and the bell.

20. -Use the diaphragm to listen to high-pitched sounds that normally occur in the heart, lungs, and abdomen.

21. - Press the diaphragm hard enough to produce an obvious ring on the patient’s skin.

22. -Use the bell to hear low-pitched sounds, such as extra heart sounds (murmurs) or turbulent blood flow, known as bruits .

23. - Apply the bell lightly with just enough pressure to produce an air seal with its entire surrounding.

24. OLFACTION - To improve your skill in indirect auscultation, Olfaction is the use of the sense of smell to gather data.

25. - Finally, unless this is an initial assessment, review the nursing plan of care and keep it in mind as you examine the patient.

26. -The assessment data may lead to modification or updating of the care plan.

27. -If the client is unable to sit, assist him to a position on his back with the head of the bed elevated.

28. - A patient with a cervical spine problem would need a neck roll when lying supine.

29. GENERAL EXAMINATION

30. DRESS, GROOMING, AND HYGIENE -A client’s ability to dress and perform personal hygiene is affected by physical and emotional well-being.

31. - An unkempt appearance may reflect chronic pain, fatigue, depression, or low self-esteem.

32. -Poor hygiene may indicate a self-care deficit of physical or mental origin, or lack of easily accessible bathroom facilities.

33. MENTAL STATUS - Mental state includes level of consciousness and capacity to interact.

34. -If the client has an altered mental status, ask a family member about the onset of the change.

35. - Lethargy may be due to medications; depression; or a neurological, thyroid, liver, kidney, or cardiovascular disorder.

36. - Confusion and irritability may indicate hypoxia or medication side effects.

37. -Inability to provide a health history or to recall information may indicate a neurological disorder.

38. VITAL SIGNS - You should assess vital signs as a part of the general survey and with subsequent assessments.

39. HEIGHT AND WEIGHT - Height and weight provide valuable information about your client’s growth and development, nutritional status, overall general health, and risk for various diseases such as diabetes and heart disease.

40. - These data are important for proper dosing of medication.

41. - For adults who can stand, measure height and weight using a platform scale with a sliding ruler.

42. - For growth charts for males and females from birth to 20 years of age, Body mass index (BMI) evaluates the relationship between height and weight.

43. - You can calculate the BMI for adults using a BMI calculator or table.

44. THANKING YOU