Physical Examination Lecture Notes

Field of Nursing Nursing Science Program Lecture II : (physical examination) Dr. : (Zizi Fikry Mohamed) Date : 15/10 /2024  Learning objectives: Up on completion of this lecture, the...

Field of Nursing Nursing Science Program Lecture II : (physical examination) Dr. : (Zizi Fikry Mohamed) Date : 15/10 /2024  Learning objectives: Up on completion of this lecture, the student will be able to: Physical Examination ❖Define of physical examination ❖Discuss Component of physical examination ❖Demonstrate Techniques of physical examination  Physical examination: Definition: Physical examination is a systematic approach of collecting objective data about health status. It employs through detailed evaluation of patient’s all body structures, organs, or systems by use of examiner’s senses (visual, tactile, olfactory and auditory). Possible Client Position During an Examination 4 5  STEPS OF ASSESSMENT Prepare Environment: Prepare equipment needed ( clean surface & should be clean &well functioning equipment) Room : should be quiet, warm & well lit Maintain privacy 6 Component 1. General Survey of Physical Examination 2. Vital Signs Measurement. 3. Height and Weight Measurement. 4. Body System Examination. 8  Techniques of physical examination 1. Inspection -Is the systematic and thorough observation of the client and specific areas of the body. Inspection includes examining the client for changes in skin color, temperature, or both; observing a wound for signs of healing or infection; or generally noting color, size, location, texture, symmetry, odors, and sounds.  Be systematic Guidelines for Fully expose the area to be inspected; cover Effective other body parts to respect the patient’s Inspection dignity Use good light, preferably natural light. Maintain comfortable room temperature. Observe color, shape, size, symmetry, position, and movement Compare bilateral structures for similarities and differences. 2. Palpation ✓ Is assessing the characteristics of an organ or body part by touching and feeling it with the hands or fingertips. ✓ The process of palpation provides information about texture, temperature, moisture, motion, and consistency or firmness of structures (solid vs. fluid). ▪ Palpation detects abnormal conditions, such as enlarged organs, tumors, or fluid in a cavity  PALPATIONS Fine : Pulse, Texture, Moisture, Masses, Size, Consistency, Shape, Crepitus Pulmer Surface: Vibration Dorsal (Back) Surface: Temperature  Types of Palpation 1- light palpation: To feel for pulses, check muscle tone , assess for tenderness, surface skin texture, temperature and moisture Moderate Palpation (Depress the skin surface from 1-2 cm. ) To palpate the body organs and masses note the Size, Consistency and mobility of the structure.  Types of palpation 3. Deep Palpation surface depression between 2.5-5 cm. To identify abdominal organs or structures that are covered by thick muscles and abdominal masses. 4. Bimanual Palpation use two hands, placing one on each side of the body part (eg, uterus and breast). Use one hand to apply pressure and other to feel the structure  Principles for Accurate Palpation Examiner finger nails should be short. Start with light then deep palpation Tender area are palpated last Client must relax during palpation. Tell client to take slow deep breath to enhance muscle relaxation. 15  Texture: rough / smooth Temperature: warm / cold The following Moisture: dry / wet characteristics Mobility: fixed / movable / vibrating could be found Consistency: soft / hard / fluid filled Strength of pulse: strong / weak / bounding Size: small / medium / large Shape: well defined / irregular Degree of tenderness  Physical examination techniques 3. Percussion: 1)Is tapping the person's skin with short sharp strokes to assess underlying structures. ✓ It is done by placing the index or middle finger of the non-dominant hand firmly on the surface to be percussed. Only the finger should have contact with skin surface. Raise the other fingers and heel of the hand off the surface. Deliver one to three tapes and then move the non-dominant finger to another area. Percussion Sounds - Resonance: Heard over part air and part solid. A hollow sound. Over normal lung - Hyper resonance: Heard over mostly air as Lung with emphysema. - Tympany: Heard over air. A musical sound or drum sound like that produced by the stomach. Puffed out cheek, gastric bubble. - Dullness: Heard over more solid tissue. Thud sound produced by dense structures such as diaphragm, liver, and enlarged spleen, or a full bladder. - Flatness: heard over very dense tissue. An extremely dull sound like that produced by very dense structures such as muscle or  Percussion Sounds Percussion sounds Origin Sound Examples Tympany Enclosed air Drum like Puffed-out cheek, air in bowel Resonance Part air and part solid tissue Hollow Normal lung Hyper-resonance Mostly air air Booming Lung with emphysema Dullness Mostly solid tissue ‘‘Thud’’ sound Liver, spleen, heart Flatness Very dense tissue Flat Muscle, bone  Auscultation Is listening with a stethoscope to the sounds produced by organs such as the heart, lungs, blood vessels, and intestines. Auscultation is listening to sounds produced inside the body. It is used to - detect the presence of normal and abnormal sounds and to assess them in terms of loudness, pitch, quality, frequency and duration. Auscultation Auscultation of the lungs N.B: Use the diaphragm of the stethoscope to listen to pitched sounds, such as normal heart sounds, breath, bowel sounds, press the diaphragm firmly on the body part being auscultate. Use the bell of the stethoscope to listen for low pitched sounds, such as abnormal heart sounds and bruits, or murmuring sounds hearts during auscultation.  Olfaction Another skill that used during assessment, is smell body odors, smelling can detect abnormalities in body system. 24  Assessment of abnormal Odors Alcohol odor from oral mouth → ingestion of alcohol. Ammonia from urine → urinary tract infection. Bad odor from skin, ( under arms and beneath breasts) means poor hygiene. Halitosis‫ رائحة كريهة‬from oral cavity means poor dental hygiene. 25  Laboratory and diagnostic data: Results of laboratory and diagnostic test can be useful objective data as these values often serve as defining characteristics for various altered health states; these can also be helpful in ruling out certain suspected problems. For example, diabetic patients usually have an elevated blood glucose level. In addition, the effectiveness of nursing and medical interventions and progress toward health restoration. 26