SAS 3

• Physical examination is a process to obtain objective data from the patient.
• Each body system connects to another.
• AL Strategy: Turn and talk (Students turn to talk partner/s to – find out, summarize, clarify, share ideas, point of view or opinions)
• The purpose of the physical examination is to determine changes in a patient’s health status and how to respond to a problem as well as promote healthy lifestyles and wellbeing.
• The comprehensive adult physical examination begins with setting the stage, preparing for the physical examination, reflecting on your approach to the patient, adjusting the lighting and environment, making the patient comfortable, checking your equipment, and choosing the sequence of examination.
• During the physical examination, it's important to identify yourself as a nursing student, appear calm, organized, and competent, avoid interpreting your findings, adjust the lighting and environment to ensure patient safety and comfort, use tangential lighting for inspecting structures such as the jugular venous pulse, the thyroid gland, and the apical impulse of the heart, show concern for privacy and patient modesty, wash your hands, draping the patient, checking vital signs, and informing the patient of the results.
• Standard and Universal Precautions are based on the principle that all blood, body fluids, secretions, excretions except sweat, non intact skin, and mucous membranes may contain transmissible infectious agents.
• Hand hygiene, use of protective equipment, safe injection practices, safe handling of contaminated equipment are part of Standard and Universal Precautions.
• Auscultation also permits detection of bruits, ie, turbulence over arterial vessels.
• Auscultation in a physical examination involves the use of the diaphragm and bell of the stethoscope to detect the characteristics of heart, lung, and bowel sounds, including location, timing, duration, pitch, and intensity.
• During an abdominal examination, only the abdomen should be exposed.
• Percussion in a physical examination involves the use of the striking or plexor finger, usually the third, to deliver a rapid tap or blow against the distal pleximeter finger, usually the distal third finger of the left hand laid against the surface of the chest or abdomen, to evoke a sound wave such as resonance or dullness from the underlying tissue or organs.
• Cardinal techniques of examination include inspection, palpation, percussion, and auscultation.
• Protective barriers for potentially infectious fluids include gloves, gowns, aprons, masks, and protective eyewear.
• During a breast examination, uncover the right breast and keep the left chest draped.
• Inspection in a physical examination involves close observation of the details of the patient’s appearance, behavior, and movement such as facial expression, mood, body build and conditioning, skin conditions, eye movements, pharyngeal color, symmetry of thorax, height of jugular venous pulsations, abdominal contour, lower extremity edema, and gait.
• All health care workers should observe important precautions for safe injections and prevention of injury from needle sticks, scalpels, and other sharp instruments and devices.
• Palpation in a physical examination involves tactile pressure from the palmar fingers or fingerpads to assess areas of skin elevation, depression, warmth, or tenderness; lymph nodes; pulses; contours and sizes of organs and masses; and crepitus in the joints.
• The goal of draping the patient during an examination is to visualize one area of the body at a time.
• Fluids considered potentially infectious include all blood and other body fluids containing visible blood, semen, and vaginal secretions; and cerebrospinal, synovial, pleural, peritoneal, pericardial, and amniotic fluids.
• Patient privacy and comfort during an examination include closing nearby doors, drawing the curtains in the hospital or examining room, washing your hands thoroughly, and being aware of the patient’s feelings and any discomfort.