Physical Examination Methods - Nursing

• İstinye University was founded in 2015 by the 21st Century Anatolian Foundation
• It is a continuation of the 25-year knowledge and experience of MLPCare Group, which combines three hospital brands under one roof: Liv Hospital, Medical Park, and VM Medical Park
• The university aims to be among the distinguished universities in Turkey and in the world by providing students strong equipment in their fields
• It also aims to expand the boundaries of science through the research of faculty members
• It seeks to implement findings from scientific developments for the welfare of society
• They aim to provide accessible health services to society.
• They seek to provide a learning and advancement environment for students that encompasses technology and art

Physical Examination Methods

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

Outline

• Infection control and related issues should be accounted for
• Hand hygiene is an important aspect
• Standard precautions need to be taken
• Inspection is a key physical assessment technique
• Palpation is a key physical assessment technique
• Percussion is a key physical assessment technique
• Auscultation is a key physical assessment technique
• The correct equipment is required

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
• You must document findings from the four basic examination modes: inspection, palpation, percussion, and auscultation

Infection Control and Related Issues

• Healthcare environments contain many 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 for preventing infection is hand hygiene
• Contact transmission
• Nails must be short; the use of artificial nails is not recommended
• Gloves should always be used when nurses touch blood, body fluids, secretions, excretions, and contaminated items
• Gloves must be changed regularly
• Health care personnel should never wear gloves from the room into the hallway

Standard Precautions

• They help reduce the transmission of pathogens
• They prevent disease transmission

Cardinal Techniques of Physical Assessment

• Inspection is a conscious observation of the patient's general appearance, physical characteristics and behavior, odors, and relevant details
• Palpation uses hands to feel the firmness of the body parts, such as the abdomen
• Percussion uses tapping motions to produce sounds that indicate solid or air-filled spaces over the lungs and other areas
• Auscultation, uses a stethoscope to hear movements of air or fluid in the body over the lungs and abdomen

General Considerations

• Draping is used to protect privacy
• Assessments must be individualized to account for the patient's cultural, religious, and social beliefs
• Anxious patients may be afraid to disclose private or uncomfortable information, or be worried about abnormal findings
• The patient's preferences need to be asked about before starting an assessment
• Less invasive assessments should be done first

Inspection

• This is the first technique used on the overall general survey and for each body part
• Initial inspections focus on the patients overall characteristics
• Including their age, gender, level of alertness, body size and shape, skin color, hygiene, and posture
• Inspection is the only technique performed for every body system
• The data helps nurses form an overall impression of the situation and its acuity
• Cues from the patient might indicate a problem that needs further assessment
• During it, adequate exposure of each body part is necessary
• The privacy of patients must be maintained using appropriate draping
• Adequate lighting is essential to observe color, texture, and mobility
• Nurses must ask patients for permission to examine body areas

Palpation

• This is used to assess texture, position, temperature, location, edema, moisture, shape, and size
• It should begin gently and slowly
• Nurses should observe potential nonverbal indicators of discomfort
• Such as furrowed brows or grimacing
• The finger pads facilitate fine discrimination
• The palmar surface of the fingers and joints best assesses firmness, contour, position, size, pain, and tenderness

Light Palpation

• Light palpation allows the patient to become familiar with the touch
• Tender or painful areas should not be palpated until the end
• Begin with ensuring correct draping and alerting the patient to what is going to happen
• Ensure you gain a patient's permission to proceed
• One may need to warm the hands under running water or gently rub them together
• Short and smooth nails are necessary to avoid causing discomfort
• It's more difficult if patients' muscles are tense
• A gentle, calm and easy touch can relax the patient
• Light palpation is appropriate for assessing surface character
• These include texture, surface lesions, or lumps, or inflamed areas of skin
• Using the finger pads of the dominant hand on the patient’s skin and slowly move fingers in circular areas approximately 1 cm in depth
• Breast self-examination

Moderate to Deep Palpation

• Both hands are used for this technique
• It facilitates the assessment consistency of the shape of abdominal organs and their size
• Use pressure that creates about 1 to 2cm depressions
• Places the extended fingers of the non-dominant hand over the dominant hand and uses the same circular motion to palpate 2 to 4 cm

Percussion

• To produce sound or determine tenderness
• It involves tapping the fingers on the patient, similar to that of a drumstick on a drum
• The vibrations that the fingers produce create percussion tones conducted into the patient's body
• If the vibrations travel through dense tissue, the percussion tones are quiet
• Percussion: Loud Tones
• If they travel through air, the tones are loud
• The loudest tones are over the lungs and empty stomach
• The quietest tones are over bone
• Direct percussion : Involves tapping the fingers directly on the patient’s skin
• Indirect Percussion: The examiner’s nondominant hand serves as a barrier between the dominant hand and patient -The nondominant palm is placed on the affected area and initiates a quick moderately strong tap with the dominant hand -The ulnar surface of the fist is used to percuss the kidneys, gallbladder, or liver for tenderness
• The motion of the striking finger should be quick, forceful, and snappy
• The snapping finger must be brisk for a loud sound
• Use the tip of the finger, nails must be short and smooth to avoid tenderness and to facilitate good contact
• The downward motion of the striking hand should be from the wrist, not the finger, elbow, or arm
• To avoid dampening the sound, immediately withdraw the snapping finger once the nondominant finger is struck
• Those with small hands and fingers needs to strike more forcefully than those with larger hands

Percussion Sounds

• Hyperresonant: Location: Emphysematous lungs
• Resonant: Typically heard in healthy lungs
• Tympanic: Gastric region
• Flat: Bone
• Liver tissue :Dull

Auscultation

• Reveals the sounds produced by the body, generally movement of organs of tissues
• Descriptors vary depending on the body part auscultated and the quality of assessment

Types of Auscultation sounds

• Blood pressure: Location: Arm
• Lung Vesicular Sounds: Location: Anterior and posterior thorax
• Abdominal Sounds: Location: Abdomen
• Heart Sounds: Location: chest

Auscultation Implementation

• This Requires a Stethoscope
• The bell is uses light skin contact to hear low frequency sounds
• The diaphragm is used with firm skin contact to hear high frequency sounds
• It must also be disinfected before or after to avoid infections
• the eartips must fit into the ear canal snugly and comfortably
• They are tilted slightly forward so that the point on the earpiece is forward in the same direction as the nose

Equipment

• All equipment needed for the physical assessment should be collected before the examiner enters the room
• This ensures the patient does not encounter any interruptions and is able to trust in the physician