Physical Examination Methods & Infection Control

• Istinye University was established in 2015 by the 21st Century Anadolu Foundation.
• The university aims to be among the top universities in Turkey and the world.
• Focus is on student-centered education, science, and research.
• Aims to provide quality healthcare and offer a wide range of knowledge.

Physical Examination Methods

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

Infection Control

• Health care settings have many threatening organisms.
• Nurses must adhere to infection control principles before, during, and after assessments.
• Hand hygiene and standard precautions are essential.

Hand Hygiene

• Hand hygiene is the most important action to prevent infection achieved through contact transmission prevention.
• Nails should be kept short.
• Artificial nails not recommended.
• Gloves are used when touching blood, body fluids, secretions, excretions, and contaminated items.
• Gloves should be changed before going to the next patient.
• Wear gloves from the room into the hallway is not health and safety regulation

Standard Precautions

• Help reduce the transmission of pathogens and prevent disease.

Cardinal Techniques of Physical Assessment

• Inspection entails conscious observation of the patient's appearance, behavior, odors, and specific details of the body.
• Palpation involves using the hands to feel the firmness of body parts like the abdomen.
• Percussion uses tapping motions with the hands to produce sounds indicating the composition of underlying spaces.
• Auscultation employs a stethoscope to hear movements of air or fluid in the body, especially in the lungs and abdomen.

General Considerations

• Draping ensures the patient's privacy.
• Assessments must be individualized, respecting cultural, religious, and social beliefs.
• Anxious patients might be afraid to share personal information.
• The patient's preferences should be considered before the assessment, and less invasive assessments should be performed first.

Inspection Specifics

• Inspection is the first technique of an overall general survey
• Initial inspections focus on characteristics like age, gender, alertness, body size, shape, skin color, hygiene, posture, and discomfort or anxiety.
• Inspection is the only technique performed for every body system.
• Data from inspection helps nurses form an overall impression of the situation.
• Patient cues may indicate the need for further assessment.
• Adequate exposure is vital, maintaining privacy with draping.
• Good lighting is necessary to observe color, texture, and mobility.
• Ask patients for permission before examining body areas.

Palpation Guidelines

• Palpation assesses texture, position, temperature, location, moisture, edema, shape, size, pain, and vibrations.
• Palpation should start gently and slowly.
• Watch for nonverbal discomfort signs.
• Finger pads aid fine discrimination.
• The palmar surface assesses firmness, contour, position, size, and pain.
• The back of the hand assesses temperature.
• Use the ulnar hand surface to feel vibratory tremors, especially on the chest.

Light and Deep Palpation

• Light palpation helps patients become familiar to touch.
• Avoid palpating tender or painful areas first.
• Light palpation includes ensuring correct draping, is alerting the patient and gaining permission
• Can be done correctly by warming the hands, maintaining short nails, and ensuring the patient is relaxed.
• Appropriate for assessing surface characteristics like texture, lesions, or lumps.
• Places finger pads and gently moves fingers in circular motions about 1cm in depth.
• Deep palpation involves the use of two hands, exerting pressure deep enough to assess shape and consistency
• Places extended fingers and uses circular motions about 2-4 cm.

Percussion Particulars

• Percussion involves tapping fingers to produce sound and determine tenderness.
• Vibrations create percussion tones.
• Quiet tones indicate dense tissue and Loud tones indicate air.
• Loudest tones located near lungs and stomach, quietest tones are over bone.

Forms of Percussion

• Direct percussion taps fingers directly, while indirect percussion uses the nondominant hand as a barrier.
• Perform indirect percussion by placing the palm on the patient initiates a quick moderately strong tap
• Ulnar surface of the fist assesses the kidneys, gallbladder or liver of tenderness.
• The motion should be quick, forceful, and snappy.
• Short, smooth nails needed to avoid tenderness.
• Use the fingertip and strike from the wrist swiftly to ensure that you achieve the best results
• Withdraw the snapping finger immediately after striking the non-dominant finger when performing indirect percussion.
• Small hands need to use more force.

Percussion Sounds

• Hyperresonant sounds over emphysematous lungs.
• Tympanic sounds found over gastric bubbles.
• Dull sounds indicate the liver.
• Resonant tones are over healthy lungs.
• Flat tones are over bone.

Auscultation

• Reveals sounds produced by the body from organ and tissue movement.
• The type of descriptor that is used varies by body part.
• Descriptors for the quality are different with auscultation.

Auscultation Sounds

• Blood pressure auscultation location is in the arm.
• Abdominal sounds auscultated in the abdomen.
• Heart sounds auscultated in the anterior thorax.
• Lung sounds auscultated is anterior and posterior thorax.
• The bell of stethoscope hears low frequency sounds, while the diaphragm is used for high frequency sounds.
• Stethoscope must be disinfected after each use.

Stethoscope Usage

• Eartips must fit comfortably with the point forward in same direction of the nose.

Required Equipment

• Collect equipment before entering the room to increase patient trust.
• Includes platform scale with height measure, thermometer, blood pressure cuff/machine, watch with second hand, stethoscope, clean gloves etc.