Physical Examination Methods: NUR012 - Health Assessment

İstinye University Overview

• Founded in 2015 by the 21st Century Anatolian Foundation, continuing the legacy of the MLPCare Group.
• Aims to be among the top universities in Turkey and the world through education and research.
• Focuses on student-centered education integrating science, research and community service with universal standards.

Physical Examination Methods Introduction

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

Outline of Physical Examination

• Infection control and related issues are important to consider
• Hand hygiene is very important
• Standard precautions should be followed
• Cardinal techniques include inspection, palpation, auscultation and percussion
• Equipment needed

Learning Objectives

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

Infection Control and Related Issues

• Healthcare environments harbor many threatening organisms
• Nurses must follow infection control principles before, during, and after physical assessments to limit the spread of pathogens
• Practices include diligent hand hygiene and utilizing standard precautions.

Hand Hygiene

• Hand hygiene is the most important action for infection control
• Contact transmission is a key route of infection

Hand Hygiene (Cont.)

• Nails must be kept short, artificial nails are not recommended
• Gloves should be used when contact with bodily fluids, secretions, excretions, or contaminated items is likely
• Change gloves before going to the next patient

Standard Precautions

• Standard precautions reduce the transmission of pathogens
• It prevents the spread of disease
• Perform hand hygiene before and after every patient contact
• Clean and reprocess shared patient equipment
• Use PPE when risk of body fluid exposure
• Follow respiratory hygiene and cough etiquette
• Use and dispose of sharps safely
• Perform routine cleaning
• Use aseptic technique
• Handle and dispose of waste and used linen safely

Cardinal Techniques of Physical Assessment

• Inspection involves conscious observation of the patient's general appearance, behavior, and any specific details.
• Palpation involves using hands to feel the firmness of body parts like the abdomen.
• Percussion involves tapping motions with the hands to produce sounds indicating the nature of underlying tissues such as air or solid.
• Auscultation involves the use of a stethoscope to listen to air or fluid movements in the body, especially within the lungs and abdomen.

General Considerations for Physical Assessment

• Draping protects patient privacy during the assessment.
• Assessments should be individualized, considering cultural, religious, and social beliefs.
• Address anxious patients, who may be afraid to disclose uncomfortable information due to potential findings
• Ask patients about their preferences, such as having a family member or same-gender examiner present.
• Perform less invasive assessments first, reserving more personal ones for the end.

Inspection

• Inspection is the initial technique involving an overall survey for each body part.
• Focus is on age, gender, alertness, body size and shape, skin color, hygiene, posture, and level of discomfort or anxiety
• Inspection is the only technique performed for every body system

Inspection (Cont.)

• This initial phase helps nurses form a global view of the acuity of the problem
• Cues might indicate a problem that require further assessment

Inspection (Cont.)

• Adequate exposure of each body part is necessary with permission from the patient

• Patient privacy is maintained using appropriate draping, especially over women's breasts and both genders' genitalia

• Adequate lighting is essential to observe color, texture, and mobility.

Palpation

• Used to assess texture, position, location and shape
• Can also find vibration, edema, pain, tenderness, temperature and moisture

Palpation (Cont.)

• Palpation should start slowly and gently
• Nurses should observe the non-verbal cues such as furrowed brows or grimacing

Palpation (Cont.)

• The finger pads facilitate fine discrimination
• The palmar surface of fingers and joints help assess for firmness, contour, position, size, pain and tenderness
• The back of the hand are most sensitive to temperature

Palpation (Cont.)

• Vibratory tremors are detected via the chest using the hand; ulnar or outside surface when the patient starts speaking

Palpation - Light

• Light palpation allows the patient to become familiar to touch
• You should not palpate painful areas until the end
• Always ensure correct draping, alert the patient what will happen and get permission

Palpation (Cont.)

• Light palpation may require warming hands
• Short and smooth nails should be used
• Assistance for patient relaxing include gentle, calm and easy touches

Light Palpation

• Light palpation is appropriate for assessing surface characteristics
• These include texture, surface lesions, lumps, or inflamed skin
• Use fingerpads of the dominant hand in a circular motion approximately 1 cm in depth

Moderate to Deep Palpation

• Moderate facilitates assessment consistency of abdominal organs and their shape.
• Can assess pain, tenderness, and pulsations.
• Apply palmar surfaces of the fingers.
• Apply pressure firm enough to depress approximately 1 to 2 cm.

Moderate to Deep Palpation

• Deep palpation applies pressure from both hands
• Place extended fingers of non-dominant had over the dominant hand
• Use circular motions and palpate 2-4 cm.

Percussion

• Used to detect sound or observe tenderness by tapping fingers.
• Process is similar to that of using a drumstick.
• Vibration produced by fingers creates percussion tones into patient body.

Percussion (Cont.)

• Quiet percussion tones travel through dense tissue
• Loud tones travel if they travel through air
• Loudest percussion tones are over the lungs and empty stomach
• Quietest tones are over bone

Percussion (Cont.)

• Direct Percussion: Involves tapping the fingers directly on the patient's skin
• Indirect Percussion: The examiner's nondominant hand serves as a barrier
• Use ulnar surface of the fist percuss the kidneys, gallbladder, or liver for tenderness

Percussion (Cont.)

• Striking motion should be forceful, snappy and quick.
• Briskness for a loud sound
• Nails must be smooth and short to facilitate good contact and avoid tenderness

Percussion (Cont.)

• Strike from the wrist instead of the arm
• To avoid dampening the sound, immediately remove finger after striking
• To generate the correct sound, those with short fingers and small hands need to make more force compared to those with large hands.

Percussion Sounds

Auscultation

• Reveals sounds produced via body by movements of organs of tissues.
• Different depending on the body parts auscultated
• The descriptors for quality are different.

Comparison of Auscultation Sounds

Auscultation (Cont.)

• The stethoscope is used
• Bell is used with light skin contact to detect low-frequency sounds
• Diaphragm is used to detect high-frequency sounds and should have firm skin contact
• Disinfection after used in important

Auscultation (Cont.)

• It is effective if the eartips are fit within war canal snugly and easily
• Slightly tilled so point on earpiece in same direction of the noise noise

Equipment

• All necessary equipment for the physical assessment should be gathered before entering the room to increase trust.

Equipment (Cont.)

• Appropriate equipment depends on examination.