Istinye University: Overview and Physical Examination

• İstinye University was founded in 2015 by the 21st Century Anatolian Foundation
• Builds upon 25 years of knowledge from the MLPCare Group, which united three hospital brands
• Aims to be among the distinguished universities in Turkey and the world
• Focuses on creating a difference through education and research
• A successful academic staff relays existing knowledge to students while promoting new knowledge production

Educational Approach

• Applies a student-centered education
• Aims to expand the boundaries of science
• Strives to apply scientific developments for the welfare of society
• Aims to provide quality and accessible healthcare services to the community
• Offers learning and advancement opportunities encompassing technology and art
• Integrates teaching, research, and community service activities with universal standards

Physical Examination Methods

• Presented by Asst. Prof. Tuğba PEHLİVAN
• HSF/Nursing (English) Department
• Lecture: NUR012-Health Assessment

Lecture Outline

• Topics covered include infection control, hand hygiene, standard precautions, cardinal techniques, and equipment
• Cardinal techniques of physical assessment cover inspection, palpation, percussion and auscultation

Learning Objectives

• Demonstrate knowledge of 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 techniques of direct and indirect percussion.
• Describe qualities of auscultation with a stethoscope.
• Demonstrate knowledge of the equipment used during a physical exam.
• Document findings from the four basic examination modes.

Infection Control

• Healthcare environments contain threatening organisms
• Infection-control principles must be followed before, during, and after
• Practices include diligent hand hygiene and standard precautions

Hand Hygiene

• Prevents infection, especially via contact transmission
• Nails must be short; artificial nails are not recommended
• Gloves should be used when in contact with bodily fluids or contaminated items
• Change gloves before interacting with the next patient
• Health care personnel should never wear gloves from the room into the hallway

Standard Precautions

• Help reduce the transmission of pathogens and prevent disease
• Includes performing hand hygiene before and after patient contact
• Clean and reprocess shared equipment
• Use personal protective equipment when at risk of bodily fluid exposure
• Follow respiratory hygiene and cough etiquette
• Use and dispose of sharps safely
• Perform routine environmental cleaning
• Use aseptic techniques
• Handle and dispose of waste and used linen safely

Cardinal Techniques of Physical Assessment

• Includes inspection, palpation, percussion, and auscultation
• Inspection involves conscious observation of the patient's general appearance, behavior, odors, and specific details related to their body system, region, or condition
• Palpation involves using the hands to feel the firmness of body parts, such as the abdomen
• Percussion involves tapping motions of the hands to hear sounds indicating solid or air-filled spaces over the lungs and other areas
• Auscultation involves using a stethoscope to hear movements of air or fluid in the body over the lungs and abdomen

General Considerations

• Draping protects patient privacy
• Assessments must be individualized based on cultural, religious, and social beliefs
• Anxious patients may be afraid to disclose private or uncomfortable information
• Ask patients about preferences, such as having a family member or same-gender examiner
• Less invasive assessments should be done first

Inspection

• First technique in overall survey and for each body part
• Initial inspections assess age, gender, alertness, body size/shape, skin color, hygiene, posture, and comfort level
• It is the only technique performed for every body system
• Data helps nurses form an impression of the situation and its acuity
• Cues may indicate a problem for further assessment
• Adequate exposure of body parts is needed
• Maintain privacy with draping, especially for women's breasts and genitalia
• Adequate lighting is essential for observing color, texture, and mobility
• Nurses should ask to examine specific body parts

Palpation

• Begins with a gentle, slow technique
• Observe nonverbal indicators of discomfort, like furrowed brows or grimacing
• Finger pads facilitate fine discrimination
• The palmar surface of fingers/joints assesses firmness, contour, position, size, and pain
• The dorsal side of the hand is most sensitive to temperature
• Use the ulnar surface for vibratory tremors

Light Palpation

• Allows the patient to become familiar with touch
• Tender areas should be palpated last
• Include ensuring correct draping, alerting the patient to expected sensations, and gaining permission
• Warm hands and short, smooth nails may be needed
• A calm, gentle touch can assist in relaxing the patient
• Appropriate for assessing surface characteristics such as texture, lesions, or lumps
• Finger pads of dominant hand are placed on and moved across the skin in ~1 centimeter depths
• Example use for breast self-examination

Moderate to Deep Palpation

• Moderate palpation facilitates the assessment of consistency
• Used with palmar surfaces of the fingers
• Firm enough to depress approximately 1-2cm
• Deep palpation involves pressure from both hands
• Places extended fingers of the nondominant hand over the dominant hand
• Same circular motion is repeated to palpate 2-4cm

Percussion

• Used to find sound or tenderness
• Tap fingers on the patient, similarly to a drumstick
• Body conducts percussion tones from finger vibrations

Percussion Sounds

• Loudest tones are over the lungs and empty stomach
• Quietest tones are over bone
• The vibrations travel through air, the tones are loud
• If the vibrations travel through dense tissue the percussion tones are quiet
• Direct percussion taps fingers on the patient’s skin
• Indirect uses one hand as barrier while the dominant hand taps the other
• Ulnar surface of fist can percuss to find tenderness of kidneys, liver, or gallbladder
• Striking finger motion should be quick and forceful
• Use the tip of finger, nails must be short and smooth for contact

Percussion Technique

• Motion should come from the wrist
• Dampening can be avoided by immediately withdrawing the finger
• Smaller hands need to strike with more force than larger hands

Percussion Sound Types and Characteristics

• Hyperresonant: Location in Emphysematous lungs
• Resonant: Location in Healthy lungs
• Tympanic: Location over Gastric bubble (stomach)
• Flat: Location of Bone
• Dull: Location of Liver

Auscultation

• Reveals sounds produced by the body from movement of organs and tissues
• Descriptors vary depending on the body part
• Descriptors vary depending on the quality

Auscultation Sound Types and Location

• Blood pressure: Location in Arm
• Lung sounds vesicular: Location: Anterior and posterior thorax
• Abdominal sounds: Location in Abdomen
• Heart sounds: Location in Anterior thorax

Stethoscope

• Bell is used to hear low-frequency sounds with light skin contact
• Diaphragm is used to hear high-frequency sounds with firm skin contact
• The equipment needs to be disinfected
• Eartips must fit but be comfortable
• Tilted slightly forward so the point it is facing the nose

Equipment

• Needed for a physical assessment to avoid interruption and increase the patient’s trust