Health Assessment Physical Examination PDF

HEALTH ASSESSMENT PHYSICAL EXAMINATION SLIDES PREPARED BY Ms. Virgina Varghese PRESENTER Mr. Hamza Chehade COLLEGE / CENTRE COHS PROGRAM Nursing SEMESTER Fall 23-24...

HEALTH ASSESSMENT PHYSICAL EXAMINATION SLIDES PREPARED BY Ms. Virgina Varghese PRESENTER Mr. Hamza Chehade COLLEGE / CENTRE COHS PROGRAM Nursing SEMESTER Fall 23-24 1  Course Outcomes (From Course Specification) A1 - Discuss the concept of health assessment and its type A2 - Identify the steps used in performing selected examination procedures B1 - Perform comprehensive health assessment correctly and confidently B2 - Apply appropriate sequencing in conducting a physical health examination in a systematic manner. C1 -Analyze the relationship of nursing process health assessment and its implication in comprehensive health assessment C2 - Select examination techniques appropriate for clients of different ages. D1- Reflect on social and ethical responsibilities required to function as a professional. D2 - Demonstrate good understanding of the values and ethics of the profession 2 U N I V E R S I T Y O F B U R A I M I  Learning Objectives On completion of the session, students will be able to: Define health assessment List the components of health assessment Discuss the importance of health assessment. List the components of health history Perform a complete history collection of a client. Describe various types of physical assessment Elaborate on the techniques of physical assessment.  Health Assessment Health- WHO definition of Health Assessment- to find out Health Assessment involves collecting, validating, and analyzing: Subjective data (also called symptoms) Objective data (also called signs) Why???...........to determine the overall level of physical, psychological, sociocultural, developmental, and spiritual health of a patient. Components of Health Assessment 1. History collection 2. Physical Examination  Components of Health Assessment History Collection Health Assessment Physical Examination 5 U N I V E R S I T Y O F B U R A I M I  Importance of Health Assessment Health assessment is an integral component of nursing care and is the foundation of the nursing process. The information gathered is used: ❑ To formulate nursing diagnoses that require nursing care. ❑ To plan, implement, and evaluate teaching and care ❑ To promote an optimal level of health through interventions ❑ To prevent illness, restore health, and facilitate coping with disabilities or death. ❑ To identify health problems that require interdisciplinary care or immediate referral to other healthcare providers. ❑ To enhance the nurse- patient communication and therapeutic relationship.  The Health History It is a collection of subjective data that provides a detailed profile of the patient’s health status. Communication techniques are very important while interviewing a client. It is important to tell the client the time & place of the interview and that it will be followed by physical examination. Introduction and brief explanation of the nurse’s role. Explain the purpose of the interview and the duration. Ensure confidentiality of information.  The Health History Use open ended questions to get narrative information. Closed ended questions or direct questions asks for specific information. Components of Health History Biographic Data Reasons for seeking healthcare (Chief Complaint-CC) History of present illness (HPI) Past health History Family History Lifestyle Review of systems  History Collection Chief complaint – discuss first the problem that is most troublesome for the client. Present health status – include location, character, severity, timing, setting, aggravating or relieving factors & associated factors. Past health history- childhood illnesses, immunizations, accidents or traumatic injuries, hospitalizations, surgeries, mental illnesses, allergies, medical/chronic illnesses. History of menstrual cycle, no. of pregnancies, no. of births. Medication history. Family history Functional assessment Review of systems Physical Assessment/Examination Systematic collection of objective information Can either be a: head- to- toe sequence System sequence Techniques of Physical Examination ❑ Inspection ❑ Palpation ❑ Auscultation ❑ Percussion  Client Preparation Explain to the client. Be sensitive to the client’s physiological and psychological needs. Explain about both parts of the assessment. Be honest and provide direct answers to client concerns. Preparation of the Environment Ensure that the room is quiet. Prepare the examination table. Gather all the necessary equipment. Ensure privacy, adequate lighting, and comfortable temperature. Provide a gown and drape for the client (assist the client to change if needed). Instruct the client to empty his/ her bladder before the assessment. Be sensitive to cultural and religious beliefs.  Physical Examination- Equipment Stethoscope Sphygmomanometer Tongue depressor Tape measure Watch with a second hand Ophthalmoscope Otoscope Snellen vision chart Nasal Speculum Tuning fork Percussion hammer Clean or sterile Working condition Pen light Equipment that touches the client should be warmed.  Physical Examination Techniques Inspection- Concentrated watching Inspection begins the moment the nurse sees the patient. This technique always comes first during an assessment. Inspection is a critical observation that should always occur first during an assessment (Jarvis, 2012) A focused inspection takes time and provides a lot of data. It is the most frequently used assessment technique- eyes, ears, or nose. Inspection requires good lighting, adequate exposure, and sometimes use of certain instruments such as otoscope, ophthalmoscope, penlight etc…) Used to assess general appearance of the patient, symmetry of body parts, characteristics of wound etc… Physical Examination Techniques- Palpation This follows & confirms those observations noted during inspection. Applies sense of touch to assess: temperature, texture, moisture, organ location, size, swelling, vibration, pulsation, rigidity, crepitation, lumps, masses, tenderness. Touching the patient with different parts of the examiner’s hand using different strength pressures. Part of the hand Assessment component Fingertips To assess skin texture, swelling, pulsation, presence of lumps Grasping action of the fingers & To detect position, shape and thumb consistency of organ or mass Dorsum of hands & fingers To determine temperature Base of fingers/ ulnar surface of To assess vibration the hand  Physical Examination Techniques Palpation Light palpation- press the skin about ½ - ¾ inch with the pads of your fingers. Helps to assess texture, tenderness, temperature, moisture, pulsations, and masses. Deep palpation- compress the skin with finger pads approximately 1½ - 2 inches. Performed to assess for masses and internal organs (Jarvis, 2012).  Physical Examination Techniques- Percussion Tapping the person’s skin with short, sharp strokes to assess underlying structures. It yields audible vibration & a characteristic sound that depicts the location, size, and density of the underlying organ. Sound occurs from vibration of some structures and are referred as “notes”. The stationary hand- hyperextend the middle finger and place its distal joint and tip firmly against the person’s skin. The stationary hand should not be placed over the ribs/ other bony prominences. The striking hand- Use the middle finger of the dominant hand as the striking finger. Use the tip of the finger to strike the nail bed or the distal interphalangeal joint of the stationary hand. Strong percussion strokes are required for obese persons.  Physical Examination Techniques- Percussion This technique requires skill and practice. Tympany- sounds like a drum and is heard over air pockets. Resonance- is a hollow sound heard over areas where there is a solid structure and some air Hyperressonance- booming sound heard over air such as in emphysema. Dullness- heard over solid organs or masses Flatness- heard over dense tissues including muscle and bone Underlying Structure Nature of Percussion note More air (lungs) Louder, deeper & longer sound Dense and more solid Softer, higher and shorter structure (liver) sound  Physical Examination Techniques - Auscultation Auscultation is listening to sounds produced by the body (heart, blood vessels, lungs, abdomen), using a stethoscope. ❑ Diaphragm- to evaluate high pitched sounds. Held firmly. ❑ Bell- to assess soft, low pitched sounds. The bell is held lightly. Auscultation is usually performed at the end, except during an abdominal assessment. Minimize environmental noises Stethoscope must be warmed Expose the body part to be auscultated. Familiarity with the wide range of normal sounds is very important in order to recognize abnormal findings during an auscultation.  https://www.youtube.com/watch?v=PE0SakAEhDs https://www.youtube.com/watch?v=CFmI2sGKTLg 19 U N I V E R S I T Y O F B U R A I M I  Types of Physical Assessment Type of Assessment Timing Purpose Comprehensive/ When a patient first enters a To obtain the baseline information for complete health healthcare later comparison assessment Setting (History & Physical Exam) Ongoing partial/ at regular intervals at OPD’s, To identify health problems. To interval/ abbreviated during change of shifts, transfer of monitor positive or negative patients from another unit, changes beginning of each home health To evaluate the effectiveness of visit interventions Problem Focused After identifying a problem during to assess a specific problem the comprehensive/ interval assessment. Emergency Emergency situations to determine potentially fatal situations Special Populations- Pregnant, Infants, Children, Elderly  Examination Techniques Mosby's Physical Examination: Examination Techniques (panopto.com) Introduction to Health Assessment Topic 1: Basics of Nursing Health Assessment (panopto.com) History Taking Topic 3: Health History Taking (panopto.com) 21 U N I V E R S I T Y O F B U R A I M I  References Jarvis. Physical Examination & Health Assessment (2020). 8th ed. Elsevier. Taylor, C. et.al (2008). Fundamentals of Nursing, The Art and Science of Nursing Care, 6th ed., Lippincott Williams & Wilkins. https://www.google.com/search?biw=1517&bih=730&tbm=is ch&sa=1&ei=AiuJXewFYeo1fAP6oWosAg&q=percussion+ha mmer&oq=percussion+hammer&gs https://www.google.com/search?q=tongue+depressor&sour ce https://www.google.com/search?biw=1517&bih=730&tbm=is ch&sa=1&ei=jSqJXaCbCeC01fAP7KC_kAQ&q=tape+measure &oq Thank You 23