Istinye University: Key Facts and Overview

• These the study notes are unique and factually accurate
• All key facts, figures, and entities are used
• Returns the information in markdown format using bullet points

Istinye University Overview

• It was founded in 2015 by the 21st Century Anatolian Foundation
• It continues the 25-year knowledge and experience of MLPCare Group
• MLPCare Group unites three separate hospital brands under one roof: Liv Hospital, Medical Park, and VM Medical Park
• It aims to be among Turkey's and the world's distinguished universities by contributing to the production of new knowledge through education and research performance

Educational Approach

• The university implements a student-centered education
• İstinye aims to provide high-quality and accessible health services to society
• Its vision is to broaden the boundaries of science through faculty research
• Istinye aims to implement scientific developments for the welfare of society and conduct teaching, research, and community service activities to universal standards.
• Students are offered a learning and advancement environment covering technology and art, along with a broad-based knowledge base

Physical Examination Methods

• These learning points cover a lecture by Asst. Prof. Tuğba PEHLİVAN
• The teaching course is NUR012-Health Assessment
• The primary topics include infection control, hand hygiene, standard precautions, cardinal techniques, and equipment

Learning Objectives

• Demonstrate infection control and safety precautions
• Identify specific characteristics of inspection
• Describe the qualities of light and deep palpation
• Explain the physical properties of sound and sound conduction
• Describe direct and indirect percussion techniques
• Describe the qualities of auscultation to be assessed with a stethoscope
• Demonstrate equipment knowledge used during physical examination
• Document findings from inspection, palpation, percussion, and auscultation

Infection Control

• Healthcare settings contain many threatening organisms
• Follow infection control principles before, during, and after physical assessments
• Practices: diligent hand hygiene and standard precautions such as gloves and masks

Hand Hygiene

• The single most important action to prevent infection
• Prevent contact transmission
• Nails should be short; artificial nails are not recommended
• Use gloves when nurses touch blood, body fluids, secretions, excretions, and contaminated items
• Health care personnel should never wear gloves from the room into the hallway
• Change gloves before going to the next patient

Standard Precautions

• Designed to reduce the transmission of pathogens and prevent disease transmission
• Always perform hand hygiene before and after every patient contact
• Clean and reprocess shared patient equipment
• Use personal protective equipment (PPE) when risk of body fluid exposure
• Follow respiratory hygiene and cough etiquette
• Use and dispose of sharps safely
• Perform routine environmental cleaning
• Use aseptic technique and Handle and dispose of waste safely

Cardinal Techniques of Physical Assessment

• Inspection: Conscious observation of the patient's general appearance, physical characteristics/behavior, odors, and specific details related to the body
• Palpation: Using hands to feel the firmness of body parts
• Percussion: Using tapping motions to produce sounds indicating solid/air-filled spaces
• Auscultation: Using a stethoscope to hear air/fluid movements in the lungs and abdomen

General Considerations

• Draping protects patient privacy
• Individualize each assessment according to cultural, religious, and social beliefs
• Address anxious patients who may fear disclosing private information or worry about findings
• Ask patients about their preferences before starting assessment, regarding family or gender of examiner
• Perform less invasive assessments first, saving the most personal for the end

Inspection Details

• Focus on age, gender, alertness, body size/shape, skin color, hygiene, posture, and discomfort/anxiety
• It is the only technique performed for every body system
• Data helps nurses form an overall impression of the clinical situation
• Cues might indicate problems needing further assessment
• Adequate exposure of each body part is necessary
• Maintain patient privacy with appropriate draping
• Adequate lighting is essential to observe color, texture, and mobility
• Nurses should ask permission before examining body areas

Palpation Detail

• Palpation assesses texture, position, temperature, edema, location, moisture, vibration, shape, size, pain, and tenderness
• Begin with a gentle and slow technique
• Observe nonverbal indicators of discomfort such as furrowed brows or grimacing
• Finger pads facilitate fine discrimination due to being the most mobile part of the hand
• The palmar surface assesses firmness, contour, position, size, pain, and tenderness
• The back of the hand (dorsal) is most sensitive to temperature
• Vibratory tremors can sometimes be felt on the chest using the ulnar surface

Light Palpation

• Light palpation allows the patient to become familiar with touch to avoid tension
• Tender/painful areas should not be palpated until the end of the assessment
• Ensure correct draping to avoid embarrassment
• Alert the patient about each examination step that will occur
• Get the patients permission to proceed with each step
• Warm hands under running water for the patients benefit
• Calm and easy touch can assist patients to relax
• Short and smooth nails can prevent injuries
• Palpate appropriate surfaces characteristics, such as texture, surface lesions
• Place finger pads on the skins surfaces and circle approximately 1cm in depth

Moderate to Deep Palpation

• The areas that can be assessed using this method include pain, size, abdominal organs, and any vibrations
• Palmar surfaces are used on the skins surface and assess key areas
• Have a firm surface pressure of approximately 1-2cm
• Deep pressure involves a pressure from both hands
• Place the extended fingers of the non-dominate hand over he dominate hand to palpate around 2cm to 4cm

Percussion Key Facts

• Used to determine tenderness or assess sounds using fingers on the body like a drumstick
• Used mostly in the lung and abdomen areas
• Vibrations are then conducted within the body
• Tones are quiet if the vibrations travel through dense tissue
• The sounds are louder and carry more if they travel through air
• Loudest tones are over the areas of the lungs and stomach
• Quietest sounds are over the bones

Percussion Types

• Can use direct percussion directly on the skin surface
• Indirect percussion uses the non-dominate hand between the dominate hand and the patient
• A quick tap is made to assess tenderness

Percussion Actions

• Keep nails short when tapping
• Motion should be snapping
• Dampening should be avoid and lift off once tapping
• The wrists should motion

Percussion Sounds Table

Auscultation Details

• Auscultation detects sounds produced by the body, typically from organ and tissue movement
• Sound qualities are all different
• Descriptors differ by body part auscultated

Use of a Stethoscope in Auscultation

• Reveal sounds from the body
• Need to hear the sounds produced
• Important to use when assessing this, and need to know the correct way

Auscultation Sounds

Stethoscope Anatomy and Use

• The bell is used with light skin contact to hear low-frequency sounds
• The diaphragm is used with firm skin contact to hear high-frequency sounds
• Ear tips of the stethoscope should be pointed to where to noise is going towards, and should also snug fit for best effective
• Always disinfect the stethoscopes after use

Equipment for Physical Assessment

• Collect all equipment needed before entering the room
• This prevents interruption and builds patient trust

Appropriate equipment depends on type of Examination

• Scale with height measure, Thermometer, Blood pressure cuff and machine, Watch Needle, Stethoscopes, Gloves, Light, Penlight, Ophthalmoscope ,Otoscopes, Tuning forks, Nasal Speculum, Tongue Depressor, Snellen Chart and Reflex Hammer