Physical Examination & Health Assessment

Front 1

The skills required for physical examination?

Back 1

Inspection,

Palpation,

Percussion,

Auscultation.

Front 2

What is inspection?

Back 2

concentrated watching of individual first as a whole, then of each body system.

take time, yields a surprising amount of data, compare L and R side of the body. The two parts are nearly symmetric. Inspection requires good lightning , and use of instruments: otoscope, ophthalmoscopes, penlight, nasal and vaginal specula to enlarge view.

Front 3

What is palpation?

Back 3

Palpation applies your senses of touch to assess these factors: texture, temperature, moisture, organ location, size, any swelling, vibration, or pulsation, rigidity, spasticity, crepitation, presence of lumps, masses, presence of tenderness or pain.

FINGERTIPS-best for skin texture, swelling, pulsation, presence of lumps.

A GRASPING ACTION OF FINGERS AND THUMB-to detect position, shape, consistency of an organ or mass

THE DORSA (BACKS) of hands or fingers- best for determining temperature, skin is thinner there

BASE OF FINGERS METACARPOPHALANGEAL JOINTS-or ulnar surface of the hand- best for vibration

Front 4

What is Percussion?

Back 4

Percussion is tapping the person's skin with short sharp strokes to assess underlying structures. The sound depicts the location, size, density of underlying organ. Percussing hands are available, easily portable, give instant feedback.

Front 5

what is percussion?

Back 5

is tapping the person's skin with short, sharp strokes to assess underlying structures. The characteristic sounds depicts ( show) the location, size, density, of the underlying organ. Percussing hands are always available, and give instant feedback.

Front 6

what are the uses of percussion?

Front 7

what is auscultation?

Back 7

Auscultation is listening to sounds produces by the body like heart, blood vessels, lungs, abdomen.

Front 8

is stethoscope magnify sounds?

Back 8

no, stethoscope does not magnify sounds, but does block out extraneous room sounds.

Front 9

How to use a stethoscope?

Back 9

* the slope of the earpiece should point forward toward your nose.

* choose a stethoscope whit two end pieces: a diaphragm and bell.

* bigger -diaphragm is used for high-pitched sounds like breath, bowel, normal heart sounds.

*smaller-bell is used for deep, hollow, cuplike shape and is used for soft, low-pitched sounds like extra heart sounds or murmurs.

*clean stethoscope with alcohol wipe before and after the patient.

*warm up by rubbing it in your palm.

*to minimize crackles from man's hairy chest, wet the hair before auscultating the area.

*never listen through a gown. Clothing may create artifactual sounds and muffles.

*avoid your own artifact such as breathing on the tube or bumping tubing together.

Front 10

How to set equipment in a clean field ?

Back 10

The examination room should be warm, comfortable, quiet and well lit. The natural daylight is best. Position the examination table, raise the person head 45 degrees.

Your equipment needs to be easy to reach for ex. sphygmomanometer- BP cuff, stethoscope with bell and diaphragm, thermometer, pulse oximeter, penlight, otoscope ( to see ear) / ophthalmoscope ( to view eye), tuning fork, reflex hammer, lubricant, gloves, fecal occult blood test material etc.

wash hands, clean your stethoscope due to preventing common vehicles for transmission of infection

distinguish the clean area by one or two disposable paper towels, where you will place your clean equipment.

after examination put your equipment to the other area, while tongue blades, gloves throw it the trash

Front 11

what are a nosocomial infections?

Back 11

Nosocomial infections are infections acquired in a hospital setting.

hospitals are reservoirs for virulent microorganisms and some of them are resistant to antibiotics for ex. methicillin resistant Staphylococcus aureus ( MRSA), vancomycin- resistant Enterococcus (VRE), or multidrug resistant tuberculosis or microorganism with no cure- human immunodeficiency virus (HIV).

Front 12

How to decrease risk of microorganism transmission?

Standard precautions for use with all patients.

Back 12

WASH YOUR HANDS PROMPTLY AND THOROUGHLY:

1) before and after every physical patient encounter

2) after contact with blood, body fluids, secretion, excretions ( discharge from the body, waste)

3) after contact with any equipment contaminated with body fluids

4) after removing gloves

20-30 sec. alcohol based hand rubs takes less time than soap-and-water, kills more organisms quickly, and less damaging to the skin because emollients added to the product.

Alcohol if highly effective against both gram-positive and gram-negative bacteria: Mycobacterium tuberculosis, most viruses, Hepatitis B and C, HIV, and enteroviruses.

Use the mechanical action of soap-and-water hand washing when hands are visibly solid or patient are infected with Clostridum difficile and noro-viruses. Rub all hand surface for 40-60 seconds.

wear: gloves, gowns, mask, protective eyewear, when you deal with body fluids.

wash hands after removing gloves due to possible undetectable holes or torn.

respiratory hygiene / cough etiquette cover education of staff, patients, visitors. Posting signs in languages appropriate to the population. Source control measures ( covering mouth, nose with tissue when coughing, using surgical mask on coughing person, hand hygiene after contact with respiratory secretions, and staying away more than 3 feet from people with respiratory infection in common waiting area.

Front 13

how to reduce anxiety in patient?

Back 13

Anxiety can be reduce by examiner who is confident and self assured, considerate, and unhurried.

Front 14

how to interact with your patient in a confident manner?

Back 14

begin by measuring person height, weight, blood pressure, temperature, pulse, respiration.

if needed, visual acuity done by Snellen eye chart.

perfect icebreaker about something irrelevant will help the patient being seen as individual. Complement the clothing, ask about baseball hat etc. This will show that we willing to have conversation.

Ask person to change into an examining gown, leaving underpants. Teens can remain in street clothes.

As you reenter room, clean your hands in person present, this will indicate that you protective of his/hers.

Explain each step in the examination, encourage the person to ask questions, keep your movements slow, methodical, deliberate.

begin by touching person's hands, checking skin color, nail beds, metacarpophalangeal joints.

Establish a system that works for you and stick to it to avoid omissions. The sequence of steps may differ, depending on age of a person, and your own preference.

Maintain a person privacy with curtain, drapes etc.

Occasionally offer some teaching about the person's body ex. everyone has two sounds for each heart beat, something like this---lub-dub. Your own beats sound healthy and normal. Some sharing of information builds rapport and increase the person's confidence in you as an examiner.

At the end of the examination, summarize your findings and share the necessary information with a person.

Lower the bed to avoid risk for falls, make patient comfortable and safe.

Front 15

How to examine the adolescent

Back 15

The adolescence is developing self-identity, they are increasingly self-conscious, peer group values and acceptance are important.

Position

The adolescent should sitting on examine table.

The adolescent should were street clothes, work around them as much as possible. Examine adolescents alone, without parents, sibling present.

Preparation

Their body is changing rapidly, during examination adolescence need feedback that his/hers body is healthy, and developing normally. Communicate with care, don't treat him/her like a child, or like adult either. Teach them how promote wellness.

Sequence

As with adult, head to toe approach is appropriate, examine GENITALIA LAST AND DO IT QUICKLY.

Front 16

HOW TO EXAMINE AGING ADULT?

Back 16

POSITION

The older adult should be sitting on the examine table, or need to be supine if frail.

Arrange the sequence to minimize position changing during examination.

Allow rest periods if needed.

PREPERATION

Adjust examination pace, slowed pace, break the examination to two parts if necessary.

Use physical touch, important with older people because other senses ( hearing, vision) may be diminished. Be careful with touch with other cultures.

Do not mistake diminished vision or hearing with confusion. Confusion may signify disease state. Short term memory loss, diminished thought process, diminished attention span, labile emotions. Aging is stressful, loss is inevitable, including changes in physical appearance of face, body, declining energy level, loss of job due to retirement, loss of financial security, loss of longtime home, death of friends, spouse, family.

How the person adapts to these losses significantly affects health assessment.

SEQUENCE

Use head to toe approach as in younger adult.

For ill person alter position during examination. For ex. person with shortness of breath (SOB) or ear pain may want to sit up, when person with faintness may want to be supine.

It may be necessary to examine the body areas appropriate to the problem, collecting a MINI-DATA. Complete assessment may be done after distress is resolved.