Istinye University: Physical Examination Methods

• Istinye University was established in 2015 by the 21st Century Anatolian Foundation.
• The MLPCare Group, which combines three hospital brands under one roof, created Istinye University based on 25 years of knowledge and experience.
• It aims to be among Turkey's and the world's top universities by providing a strong background and contributing to creating new knowledge.
• The university aims to serve the community with quality and accessible healthcare, integrating technology and art.

Physical Examination Methods

• This lecture is taught by Asst. Prof. Tuğba PEHLİVAN.
• Email is [email protected].
• The department is HSF /Nursing (English), and the lecture is NUR012-Health Assessment.

Outline of Topics

• Infection control and related issues are covered.
• Also covered are the cardinal techniques of physical assessment include Inspection, Palpation, Percussion, and Auscultation.
• Also covered are hand hygiene, standard precautions, and equipment.

Learning Objectives

• Demonstrate 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

• Healthcare settings harbor various threatening organisms.
• Nurses adhere to infection control before, during, and after assessments.
• Hand hygiene and standard precautions are necessary.

Hand Hygiene

• Hand hygiene is the most important step to prevent infection.
• Contact transmission must be avoided through hand hygiene.
• Use artificial nails is not recommended. Nails must be short.
• Use gloves when touching blood, body fluids, secretions, or contaminated items.
• Change gloves before attending to the next patient.
• Healthcare staff should not leave rooms wearing gloves.

Standard Precautions

• Standard precautions help to prevent the transmission of pathogens.
• It helps to prevent disease tranmission.

Cardinal Techniques of Physical Assessment

• Inspection is about observation of the patient's appearance, behavior, odors, and specific details related to the body.
• Palpation involves using hands to feel the firmness of body parts, such as the abdomen.
• Percussion uses tapping motions with the hands to produce sounds, indicating solid or air-filled spaces, especially over the lungs.
• Auscultation employs a stethoscope to hear air or fluid movement in the lungs and abdomen.

General Considerations

• Draping protects patient privacy during the examination.
• Each assessment is tailored according to the patient's cultural, religious, and social beliefs.
• Patients may be worried or embarrassed so disclose any findings during examination.
• Before assessments, ask patients about their preferences, example having a family member inside the room during examination.
• Start with less invasive assessments, concluding with the most personal ones.

Inspection Techniques

• Inspection is the initial technique for the general survey and each body part.
• Initial inspections focus on physical characteristics such as age, gender, alertness, body size, shape, skin color, hygiene, and posture.
• Inspection is the only technique performed for every body system.
• Form an impression of the patient's acuity.
• Cues during inspection might point to problems needing further assessment.
• Ensuring sufficient body part exposure is necessary during inspection.
• Privacy is maintained with draping, mainly over the breasts in women and genitalia in both sexes.
• Proper lighting is essential to see color, texture, and mobility.
• Patient permission is needed before examining body areas.

Palpation Techniques

• Palpation can assess texture, position, location, moisture, shape, temperature, edema, size, pain, and vibration
• Start with a gentle and slow technique.
• Nurses monitor for nonverbal signs of discomfort like furrowed brows.
• The most mobile parts of the hand are the finger pads which allows fine discrimination.
• Assessing firmness, contour, position, size, and pain is best done on the palmar surface of the fingers and joints.
• Use the back of the hand to assess temperature.
• Use the ulnar surface of the hand to feel for chest tremors when the patient speaks.

Light Palpation

• Light palpation lets the patient get used to being touched.
• Avoid palpating tender locations.
• Check draping and tell the patient what will happen during palpation.
• Obtain permission.
• Warm the hands and keep short nails to prevent discomfort.
• It works well for surface features such as texture, lesions, or inflammation.
• Use light palpations about 1 cm deep and move the fingers in a circular motion.
• E.g. breast self-examination

Moderate to Deep Palpation

• Moderate palpation looks at the consistency of shape and size of organs or for tenderness.
• Direct pressure about 1 to 2 cm, using the palmar sides of the fingers
• Involves pressure by both hands to depths of 2 to 4 cm and use a circular motion.

Percussion

• Percussion is used to produce sound or check tenderness by tapping on the patient and feels like tapping on a drum
• Vibrations from tapping produce percussion tones throughout the patient's body.
• The vibrations of the fingers produce create percussion tones conducted into the patient's body.

Percussion Analysis

• Quiet tones are heard if vibrations travel through dense tissue.
• Loud tones indicate vibrations traveling through air.
• Loudest tones are over the lungs and empty stomach.
• Soft tones are over bone.

Types of Percussion

• Direct percussion involves tapping directly on the patient's skin.
• Indirect percussion uses the examiner's nondominant hand as a tap.
• Strike with ulnar surface of the fist to examine the kidneys, gallbladder, or liver for tenderness.
• The snapping fingernails should be short and smooth to avoid tenderness.
• Move the striking finger quickly and forcefully from the wrist.
• After striking, pull the finger away immediately to avoid dampening the sound.
• Use more force if using small hands or fingers.

Percussion Sounds

• Hyperresonant sounds indicate Emphysematous lungs.
• Resonant sounds indicate healthy lungs.
• Tympanic sounds indicate gas bubbles in the stomach.
• Flat sounds indicate bone.

Auscultation

• Auscultation finds sounds the body makes as organs and tissues move.
• Descriptors vary depending on the body part auscultated, and also those of quality.

Auscultation Sounds

• Blood pressure can be assessed in the arm.
• Lung sounds can be anterior and posterior thorax.
• Heart tones are in the anterior thorax.
• Abdominal sounds can be auscultated in the abdomen.
• Use a stethoscope to perform it.
• Using the bell to hear low frequency sounds
• Diaphragm for high frequency ones, and disinfect it.
• Eartips must fit and point forward snugly in the ear canal.

Equipment

• Gathering all necessary equipment before the examination is crucial for efficiency and gaining the patient's trust.