Unit 1 Session 1. Introduction 2018.pdf

INTRODUCTION TO PHYSICAL ASSESSMENT DR ABB MENSAH  ABOUT THE COURSE  Course Title: General Nursing III (Physical Assessment)  Course Code: SSN 278  Lecturers: Dr ABB Mensah Mr P Amooba  Skills Lab Team  Mr. John Antwi  Mrs Ajaratu Lam  Link to students’ http...

INTRODUCTION TO PHYSICAL ASSESSMENT DR ABB MENSAH  ABOUT THE COURSE  Course Title: General Nursing III (Physical Assessment)  Course Code: SSN 278  Lecturers: Dr ABB Mensah Mr P Amooba  Skills Lab Team  Mr. John Antwi  Mrs Ajaratu Lam  Link to students’ https://www.dropbox.com/sh/zyp03xahfx433k6/AACyXEF aViSKsvvYefe8BUzNa?dl=0  Course Assessment  Marking:  10% Class Participation (Lectures/skills Lab)  20% Mid-semester Exam (80 MCQs in 60 mins)  70% Final Exam (120 MCQs 2 hours)  Course Description:  The course is designed to equip students with knowledge and skill for a thorough history taking and comprehensive physical assessment of each body system of the patient.  It also prepares the student to describe the various diagnostic procedures helpful in accurate patient diagnoses and holistic care.  The course is delivered in six (6) units with each having sessions and/or sub-sessions.  Course/Learning Objectives:  By the end of the course, students would be able to:  Take a detailed history of the various body systems of the patient.  Perform comprehensive physical examination of the various systems.  Describe the various secondary diagnostic procedures in relation to problems related to the various body systems.  Course Content  General Assessment:  Assessment of the body systems: Integumentary system; Head, Face, Neck, Eyes, Ears; Cardiovascular system; Respiratory system; Digestive (Gastro-intestinal) system; Neurologic system; Genito-urinary (renal) system; and Reproductive system.  Secondary diagnostic procedures used in the various systems of the body as listed above.  Course Outline  Unit 1: Introduction to physical assessment, integumentary system (skin), and pain assessment  Unit 2: Ears, eyes, head, face, and neck assessment  Unit 3: Respiratory system assessment  Unit 4: Cardiovascular system assessment  Unit 5: Abdominal/gastro-intestinal, renal, and reproductive systems assessment  Unit 6: Neurological, and Musculo-skeletal systems assessment, and Putting it all together (conclusion)  Course Presentation  Classroom lectures and skills lab sessions  Attendance is compulsory!  During skills lab sessions it is important to utilize the time with your partner and guidance of your instructor to ensure proper technique and positioning for the examination.  After lectures and skills lab sessions it is imperative to take additional time for repeat practice on the ward with your partner. Present report by Monday 12:oonoon  Repetition is necessary to refine skills and coordinate the techniques into a thorough examination.  Course delivery: PowerPoint slides and practical videos/audios of system  Recommended Textbooks: 1. Barkauskas VH, Stoltenberg-Allen K, Bauman LC, Darling- Fisher C (1998). Health Physical Assessment. 2nd Edition. Mosby, St. Louis, Missouri 2. Malasanos L, Barkauskas V, Stoltenberg-Allen K (1990). 4th Edition. Health Assessment. Mosby, St. Louis, Missouri 3. Sims KL, D’Amico D, Stiesmeyer JK, Webster JA (1995). Health Assessment in Nursing. Addison-Wesley Pub. Company, USA 4. Estes MEZ (2006). Health Assessment & Physical Examination. 3rd Edition. Thomas Delmar Learning, Canada 5. Bickley LS, Hogan-Quigley, Palm ML (2012). Bates' Nursing Guide to Physical Examination and History Taking. Lippincot (Wolters Kluwer Health)  Recommended Textbooks:  Macleod’s Clinical Examination. Munro & Edwards  Mosby’s Guide to Physical Examination. Seidel, Ball, Dains, Benedict  Physical Examination & Health Assessment. Jarvis  Davidson’s Principles & Practice of Medicine. Macleod & Edwards  Nurses Handbook of Health Assessment. Janet Weber  Hutchinson’s Clinical Methods. Swash & Glynn  Textbook of Physical Diagnosis. Swartz  Techniques in Clinical Nursing. Kozier, Erb, Blais, Johnson, & Temple  Study Hints:  Use your lecture notes as a guide (not sole source)  Read the recommended textbooks topic by topic  Focus on the assessment, describing your findings, differentiating normal from abnormal  Know a few examples of abnormal findings for common diseases (especially the ones discussed in class).  If you find information differing from what I presented, please let me know and be prepared to site the reference you used  Learning Objectives  By the end of this lecture, you will be able to:  Describe the importance of physical assessment  Mention why and when nurses should conduct assessment on a patient  Describe generally how physical assessment is done  Mention the skills and tools needed to assess the patient  Introduction  A patient is admitted to the hospital when he needs around-the-clock (24-hours a day) monitoring and care.  This monitoring and care is done primarily by the nurse, not the physician.  The nurse is the healthcare professional at the bedside 24-hours a day, and is therefore in the best position to identify and communicate signs of patient’s changing conditions to the rest of the healthcare team.  Introduction contd  If our goal is to give excellent care to our patients, then we must have the skills necessary to identify problems.  Nursing has been a task oriented profession – serving medications, wound dressing, taking vital signs, and assisting with toileting and hygiene needs.  While these tasks are important, many lives will still be unnecessarily lost until we nurses are able to assess and advocate for our patients.  Assessment is performed using similar techniques by nursing and medicine. The difference is the utilisation of findings.  Introduction contd  Medicine focus on diagnoses and treatment of the disease, while nursing focus on the diagnoses and treatment of the actual or potential human responses (physical, psychological, social, cultural and developmental needs)  Good physicians appreciate nurses who demonstrate that they are able to carefully monitor patients and communicate pertinent findings.  Nurses need to know how to find the signs and make sure nothing is overlooked.  The lives of our patients are at stake.  Thus, nursing assessment is a KEY component of clinical investigation and providing care.  Why are nursing assessments done?  Why are nursing assessments done? Nursing assessments are done to: 1. Ensure the correct medical diagnosis 2. Create appropriate nursing diagnoses 3. Monitor patient’s status 4. Ensure efficacy of treatment 5. Prevent/minimize injury (e.g. bed sores, medication/blood reaction) 6. Ensure timely appropriate interventions  When should nurses do physical assessment?  When should nurses do physical assessment? Nurses should perform assessment at: 1. EVERY shift for every patient 2. New admission 3. Before and after an intervention (e.g. lumbar puncture) 4. Frequently with a rapidly changing condition (e.g.: emergent situation, shock, hemorrhage, etc.)  How should nurses conduct assessment?  How should nurses conduct assessment?  A comprehensive assessment of the patient starts with: 1. A detail history taken where the patient is able to give relevant information that help to deduce the cause or extent of the problem 2. Then physical examination where the nurse inspect, palpate, percuss and auscultate the patient to find systemic problem (both anatomical and physiological) 3. Before ending with other secondary diagnostic investigations that apply to the body system in focus.  How to proceed?  General impression  Introduce self, request permission, take history  Ensure privacy and wash hands  Progress systematically - head to toe  Least invasive to most invasive: OBSERVE/INSPECT AUSCULTATE PALPATE/PERCUSS  Don’t forget pain!  Thank the patient  What you will need to conduct assessment?  Stethescope  Diaphram – high pitched sounds  Bell – low pitched sounds  Watch  Measuring tape  Reflex hammer  Tuning fork  Penlight  Good lighting (tangential)  Keen observation skills  Conclusion  Nurses are placed crucially in time and space with the patient to identify pertinent patient’s problems, plan, implement and evaluate care which starts from a keen assessment skills and techniques.  By equipping him/herself with the relevant skills and instruments, the nurse is better placed to assess the patient.  It is every nurse’s responsibility to assess patients all round the clock and communicate findings for timely intervention.  Reading Assignment  Read on the basic skills needed to do the following: 1. Inspection 2. Palpation 3. Percussion 4. Auscultation