Unit#03-Physical-Examination-1 free for all nurses

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1. Unit # 03 HEALTH ASSESSMENT-I Introduction to Physical Examination ( PE) and the General Survey 1

2. Objectives By the end of the unit, learners will be able to Identify the general principles of conducting an examination. 2 . Identify the equipment needed to perform a physical examination. 3 . Describe the appropriate use & technique of inspection, palpation, percussion & auscultation. 4. Discuss the procedure & sequence for performing a general assessment of a client. 2

3. Cont.… 5. Discuss the guidelines for documenting physical examination. 6 . Document the PE findings of patients in PE documentation sheet on an ongoing basis. 3

4. A systemic approach of using five senses applying different techniques to gather data base to identify and manage health problem. 4 Physical Examination

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6. Principles of Physical Examination Set the stage Environment Brief explanation in start Head to toe approach Standing on right side External then internal Normal to affected area Body symmetry from both sides 6

7. Principles of Physical Examination Self Preparation Equipment Preparation Patient Preparation Environment Preparation 7

8. Equipment Required for Physical Examination 8

9. Position of Patient During Physical Examination Positioning Positions used during nursing assessment, medical examinations, and during diagnostic procedures: Dorsal recumbent Supine Sims Prone Lithotomy Genupectoral 9

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11. INSPECTION PALPATION PERCUSSION AUSCULTATION 11 Techniques of Physical Examination

12. Inspection Critical observation Take time to “observe” with eyes, ears, nose Use good lighting Look at color, shape, symmetry, position Odors from skin, breath, wound Develop and use nursing instincts Inspection is done alone and in combination with other assessment techniques 12

13. General Survey General appearance, gait, nutrition status, state of dress, body build, obvious disability, speech patterns, affect (mood), hygiene, body odor, posture, race, gender, height, weight, vital signs. 13

14. Palpation Touch with different parts of hands Dorsum / finger / ball of hands With different degree of pressure Light: 1-2 cm Deep: 4-5 cm Bimanual: using both hands to trap organ To identify size, shape, texture, mobility, mass, quality of pulses, joints & bones condition, tenderness, temperature, moisture, fluid & edema, & chest wall vibrations 14

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17. Percussion Striking the body surface sharply to create sound waves Sound produced determines the feature of underlying organ Useful to identify organ position, size and density Useful to detect fluid or air in a cavity Types of percussion Mediate Immediate Fist Percussion notes: Flatness Dullness Resonance Hyper resonance Tympany 17

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19. Auscultation Listening to sounds produced by the body Direct auscultation – sounds are audible without stethoscope Indirect auscultation – uses stethoscope Know how to use stethoscope properly (practice) Fine-tune your ears to pick up subtle changes (practice) Describe sound characteristics (frequency, pitch intensity, duration, quality) (practice) Flat diaphragm picks up high-pitched respiratory sounds best Bell picks up low pitched sounds such as heart murmurs, bruits, aortic aneurysm Practice using BOTH diaphrag m 19

20. Breath sounds Bronchovesicular N ormal breath sound Wheezing Narrowing/spasm of bronchioles Asthma, COPD Crackles F luid accumulation > PE, Pneumonia Friction rub I nflammation of pleura > pleuritis, pneumonia 20

21. 21 Important Land marks

22. Lymph nodes 22

23. Landmark for Lung auscultation 23

24. Lung Auscultation 24

25. Breast Examination 25

26. 4 Abdomen quadrants 26

27. 4 Abdomen quadrants 27

28. 9 Abdomen Regions 28

29. 9 Abdomen Regions 29

30. Anthropometric Measurements Height Weight Head circumference (children) Upper arm measurement Skin fold BMI 30

31. Height and weight measurement 31

32. Head Circumference Skin fold 32

33. BMI 33 The body-mass index (BMI) is calculated by dividing weight (in kg) by the square of height (in meters). A BMI greater than 25 may indicates overweight, while a BMI greater than 30 generally indicates obesity .

34. BMI and Risk of Morbidity 34 Men   Women   <20.7  <19.1  20.7 to 26.4 19.1 to 25.8  26.4 to 27.8 25.8 to 27.3  27.8 to 31.1 27.3 to 32.2  31.1 to 45.4 32.3 to 44.8  > 45.4  > 44.8 Underweight. Normal, very low risk Marginally overweight, some risk Overweight, moderate risk Severe overweight, high risk Morbid obesity, very high

35. Documentation of Physical Examination findings Specific – avoid vague terms Concise – use short simple words Complete entry with date & sign Describe observation clearly Use standard abbreviations only Record exact size, position of lesions Use illustration Use black pen 35

36. General survey documentation Elderly women, oriented to person and place only, appears weak, unable to stand, guarding abdomen, skin flushed, pt is shivering. A 45 years old male, looks younger than his age, skinny, alert, oriented to x3. appears healthy and in no acute distress, well groomed, respond appropriately and cooperative. No gross abnormalities apparent. Young lady of 25 years old seated on wheel chair, constantly shifting position and picking at the paper on the table. Disoriented to time, place and person (require frequent orientation to the examination process). Is thin and unkempt. Eye contact minimal. Talked throughout the examination. 36

37. 37 Thank you