Istinye University Overview

Istinye University

• Istinye University was established in 2015 by the 21st Century Anatolian Foundation.
• It evolved from the 25-year knowledge and experience of the MLPCare Group, which united three hospital brands, Liv Hospital, Medical Park, and VM Medical Park, under one roof.
• Aims to be among Türkiye's and the world's leading universities, known for its education and research
• Aims to widen the boundaries of science through faculty research.
• Aims to implement findings from scientific developments for the welfare of society.
• Offers quality and accessible healthcare services to the community.
• It delivers teaching, research, and community service activities at universal standards.
• Offers students a learning and advancement environment that includes technology and art, along with a broad foundation of knowledge.

Physical Examination Methods

• Instructor: Asst. Prof. Tuğba PEHLİVAN
• Email: [email protected]
• Department: HSF/Nursing (English)
• Lecture: NUR012-Health Assessment

Outline

• Topics covered are:
• Infection control and related issues
• Hand hygiene
• Standard precautions
• Cardinal techniques of physical assessment
• Equipment

Learning Objectives

• Demonstrate knowledge of infection control and safety precautions.
• Identify specific characteristics of inspection.
• Describe light and deep palpation qualities and characteristics.
• 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 knowledge of physical examination equipment
• Document findings from inspection, palpation, percussion, and auscultation.

Infection Control and Related Issues

• Healthcare environments can contain many threatening organisms.
• Nurses must adhere to infection control principles before, during, and after physical assessments.
• Practices include thorough hand hygiene and using standard precautions.

Hand Hygiene

• The single most important action for preventing infection is hand hygiene.
• Contact transmission is a key concern.

Hand Hygiene Details

• Having short nails is a must
• Artificial nails not recommended.
• Gloves are used when nurses touch blood, body fluids, secretions, excretions, and contaminated items.
• Gloves get changed before moving to the next patient.
• Health care workers should never wear gloves from the room into the hallway.

Standard Precautions

• Standard precautions help to reduce the transmission of pathogens.
• Standard precautions implemented to prevent disease transmission
• Always practice good hand hygiene
• Clean and reprocess Shared equipment
• Use Personal protective equipment
• Follow the hygiene etiquette for coughs
• Routinely clean the environment
• Use aseptic techniques
• Safely handle and dispose of supplies

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 system, region, or condition.
• Palpation: Using hands to feel the firmness of body parts, such as the abdomen.
• Percussion: Using tapping motions with the hands to produce sounds that indicate solid or air-filled spaces over the lungs and other areas.
• Auscultation: Using a stethoscope to hear movements of air or fluid in the body over the lungs and abdomen.

General Considerations Before Assessment

• Employ draping to protect privacy.
• Individualize each assessment according to the patient’s cultural, religious, and social beliefs.
• Be aware that anxious patients may be afraid to disclose private or uncomfortable information, be embarrassed about being touched or looked at, or be worried about abnormal findings.
• Ask patients about their preferences before starting the physical assessment, regarding having a family member or same-gender examiner in the room.
• Perform less invasive assessments first, with the most personal assessments at the end.

Inspection Details

• Inspection is the initial technique for the overall general survey and for each body part.
• Inspections focus on characteristics such as age, gender, level of alertness, body size and shape, skin color, hygiene, posture, and level of discomfort or anxiety.
• It is the only technique used for every body system.
• Data gathered during this phase helps nurses form an overall impression of the patient's situation and acuity.
• Patient cues during inspection may indicate a problem needing further assessment.
• Adequate exposure of each body part is needed during inspection.
• Patient privacy must be maintained with appropriate draping, especially over the breasts in women and genitalia in both men and women.
• Adequate lighting is essential to observe color, texture, and mobility.
• Nurses should ask patients for permission to examine body areas.

Palpation Details

• Palpation assesses texture, position, temperature, edema, location, moisture, shape, and size; and pain.
• Palpation begins with gentle and slow techniques.
• Nurses should observe for nonverbal indicators of discomfort, e.g., furrowed brows or grimacing.
• The finger pads aid fine discrimination, as they are the most mobile parts.
• The palmar surface of the fingers and joints best assesses firmness, contour, position, size, pain, and tenderness.
• The back (dorsal) side of the hand is most sensitive to temperature.
• Vibratory tremors can sometimes be felt on the chest as the patient speaks, by using the ulnar, or outside, surface of the hand.

Light Palpation Characteristics

• Enables the patient to become familiar with touch.
• Tender or painful areas get avoided until the end.
• Always ensure draping.
• Alert the patient about what happening.
• Gain their permission

Palpation - Preparation

• Warmed hands under running water or gently rubbing them together may be necessary
• Short and smooth nails also avoid discomfort.
• It can be difficult when the patient's muscles are tense.
• A gentle, calm, and easy touch can assist patients to relax.

Light Palpation

• It is appropriate for assessing surface characteristics–texture, surface lesions, lumps, or inflamed areas of skin.
• The finger pads of the dominant hand are placed on the patient’s skin and slowly move in circles of approximately 1 cm in depth.
• Breast self-examination is a good example!

Moderate to Deep Palpation

• Moderate palpation facilitates the assessment of the consistency of abdominal organs.
• Use the palmar surfaces of the fingers and steady pressure, firm enough to depress approximately 1 to 2 cm.

Deep Palpation Technique

• Deep palpation involves pressure from both hands.
• the extended fingers of the non-dominant hand get placed over the dominant hand.
• Then using the same circular motion is implemented, palpating 2 to 4 cm.

Percussion Details

• It produces sound or determines tenderness with tapping fingers on the patient, like a drumstick on a drum.
• Vibrations from tapping fingers create percussion tones conducted into the patient's body.

Percussion Tones

• If vibrations travel through dense tissue, percussion tones are quiet.
• If they travel through air, the tones are loud.
• The loudest tones are over the lungs and empty stomach.
• The quietest are over bone.
• The motion of striking finger should be both quick and forceful

Types of Percussion

• Direct percussion: Tapping the fingers directly on the patient's skin.
• Indirect percussion: The examiner's nondominant hand serves as a barrier between the dominant hand and the patient. Then tap the nondominant and with the dominant
• Places the nondominant palm on the patient and initiates a quick tap with the dominant
• The ulnar surface of the fist is used to percuss tenderness in the kidneys, gallbladder, or liver.

More Percussion Details

• The motion of the striking finger should be quick, forceful, and snappy, for a loud sound
• You must use the tip of the finger, nails must be short and smooth to avoid tenderness and facilitate good contact.
• Downward motion of the striking hand comes from the wrist, not finger, elbow, or arm.
• To avoid dampening sound, immediately withdraw the snapping finger, once it strikes.
• Those with smaller hands and fingers will need to strike more forcefully.

Percussion Sounds and Characteristics

• Hyperresonant sounds are percussed over emphysematous lungs.
• Tympanic sounds are percussed over gastric bubble (stomach).
• Dull sounds are percussed over the liver.
• Resonant sounds are percussed over healthy lungs.
• Flat sounds are percussed over bone

Auscultation Details

• Auscultation reveals the body's sounds, usually from the movement of organs and tissues.
• Descriptors vary, depending on the body part auscultated.
• Sound quality descriptors are different with auscultation.

Auscultation Sounds and Characteristics

• Blood pressure auscultated at arm.
• Abdominal sounds auscultated at abdomen.
• Heart sounds auscultated at the anterior thorax.
• Lung sounds are auscultated at anterior and posterior thorax.

Stethoscope 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.
• Requires disinfection
• Eartips must fit into the ear canal snuggly and comfortably.
• They are tilted slightly forward, so that the point on the earpiece is forward in the same direction as nose.

Equipment

• All needed equipment should be collected before the entry of examiner, to avoid interruption and improve patient trust.