İstinye University Physical Exam Methods

İstinye University Overview

• İstinye University was founded in 2015 by the 21st Century Anadolu Foundation
• It is an extension of the MLPCare Group's 25 years of knowledge, uniting three 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 through education and research, while equipping students strongly in their fields.
• The university aims to expand the boundaries of science, implement scientific advancements for the welfare of society, and provide quality and accessible healthcare services
• It offers a learning environment encompassing technology and art, in addition to a broad knowledge base.

Physical Examination Methods

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

Outline of Physical Examination

• Infection control and related issues
• Hand hygiene
• Standard precautions
• Cardinal techniques of physical assessment
  • Inspection
  • Palpation
  • Percussion
  • Auscultation
• Equipment

Learning Objectives

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

Infection Control and Related Issues

• Healthcare environments contain threatening organisms
• Nurses must follow infection control principles before, during, and after physical assessments
• Practices include diligent hand hygiene and standard precautions

Hand Hygiene

• The single most important action to prevent infection is hand hygiene
• Contact transmission can be reduced through proper hand hygiene

Key Points for Hand Hygiene and Glove Usage

• Nails must be short, artificial nails are not recommended.
• Gloves should be used when touching blood, body fluids, secretions, excretions, and contaminated items
• Changing of gloves is necessary
• Healthcare personnel should never wear gloves from the room into the hallway.

Standard Precautions

• Standard precautions help reduce the transmission of pathogens and prevent disease transmission

Cardinal Techniques of Physical Assessment

• Inspection involves conscious observation of the patient's general appearance, physical characteristics, behavior, odors, and specific details related to the body system, region, or condition.
• Palpation involves using the hands to feel the firmness of body parts, such as the abdomen
• Percussion involves using tapping motions with the hands to produce sounds that indicate 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 for Physical Assessment

• Draping is important to protect privacy
• Each assessment must be individualized according to the patient’s cultural, religious, and social beliefs
• Anxious patients may be afraid to disclose private or uncomfortable information or worried about abnormal findings
• Ask patients about their preferences, such as having a family member or same-gender examiner
• Less invasive assessments should be done first, with the most personal assessments at the end

Inspection Technique

• Inspection is the first technique of the general survey and for each body part.
• Initial inspections focus on overall 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 performed for every body system
• Data helps nurses form an impression of the situation and its acuity.
• Cues might indicate a problem that needs further assessment
• Adequate exposure during inspection is necessary

Important Factors for Inspection

• Patient privacy can 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 for permission to examine patient's body areas

Palpation Techniques

• Palpation assesses texture, position, temperature, edema, location, moisture, shape, size, pain, and vibration

• Palpation should begin with a gentle and slow technique

• Nurses should observe nonverbal indicators of discomfort

• Finger pads facilitate fine discrimination due to their mobility

• The palmar surface of fingers and joints are best for assessing firmness, contour, position, size, pain, and tenderness

• The back of the hand (dorsal) is most sensitive to temperature

• Vibratory tremors can be felt with the ulnar surface of the hand

Light Palpation

• Light Palpation allows the patient to become familiar to the touch
• Tender or painful areas should not be palpated until the end
• Preparing before beginning the palpation will ensure correct draping, alert the patient to what will happen, and ensure permission to proceed
• Warmed hands, short and smooth nails, a calm and gentle touch, and relaxation of patients will ease palpation

Application of Light Palpation

• Light Palpation with ~1 cm depth uses finger pads on skin during breast self-examination
• It is appropriate for assessing surface characteristics like texture, surface lesions, inflamed skin, or lumps

Moderate to Deep Palpation

• Facilitates assessment consistency and determines if there is tenderness or pulsations
• Palmar surfaces of the fingers are used

Details of Deep Palpation

• Pressure deep, approximately 1-2 cm
• Involves pressure from both hands
• Extended fingers of one hand are placed over nondominant, and work to palpate up to 2-4 cm

Percussion Method

• Percussion determines tenderness by tapping in the area
• Similar to tapping drum
• Vibrations create tones that indicate the composition of the body mass

Percussion Sounds

• The quietest tones occur over bone
• The loudest tones are over the lungs and empty stomach
• If vibrations travel through the air, tones are loud
• If vibrations travel through dense tissues the percussion tones are quiet.

Technique Details for Percussion

• Direct percussion involves tapping the fingers directly on the patient’s skin
• Indirect percussion involves the examiner’s nondominant hand serving as a barrier
• Use the ulnar surface of the fist for kidneys, gallbladder, or liver to assess tenderness
• Striking fingers should create quick, forceful and snappy motion and sounds

Physical Factors for an Effective Percussion

• Since you must use the tip of the finger, nails must be short and smooth, and contact should be good to avoid tenderness
• Downward motion is driven at the wrist; not the finger, elbow, or arm.
• Upon striking the area, quickly withdraw to capture sound, which may be dampened by lingering fingers
• Someone with small hands or digits will require a more assertive tapping

Percussion Sound Analysis

• Hyperresonant sounds are associated with emphysematous lungs
• Resonant sound are usually healthy lungs
• Tympanic- Gastric bubble, such as what is found naturally in the stomachs
• Flat- Commonly over bone
• Dull: Over the Liver

Auscultation Technique

• Auscultation helps reveal sounds produced by organs or tissues by movement
• Descriptors vary by body part
• Descriptors for qualities differ

Auscultation Application

• Blood pressure auscultates in the arm
• Abdominal sounds auscultate typically over the abdomen
• Heart and lung sounds auscultate over the anterior thorax

Stethoscope

• The bell detects low frequency components by soft or direct contact; the diaphragm detects high frequency sounds

Key Guidelines for Stethoscope

• Eartips must fit snugly to enhance effective sound detection
• Ear pieces are intended to tilt in direction of noise

Equipment needed for Physical Assessment

• All equipment should be gathered prior to facilitate trust and increase patient comfort