RLE 7

• Respond to students’ feedback during the next class meeting or as soon as possible.
• Collect the responses as students file out.
• At the end of each session, ask students what questions they have.
• The subjective data in health assessment are gathered through interview, while the objective data are gathered through senses such as sight, smell, touch and hearing during the physical examination.
• To do the physical examination, the student nurse needs to develop technical skills and knowledge base.
• The examination room should be adequately ventilated, comfortable, quiet, and private, with sufficient lighting.
• Tangential lighting is optimal lighting for inspecting structures such as the jugular venous pulse, the thyroid gland, and the apical impulse of the heart.
• The examination table should be at a height that prevents the examiner from stooping and should be equipped to raise the head up to 45 degrees.
• A bedside stand or table should be available to lay out all equipment needed during the physical examination.
• Prior to the start of the physical examination, collect all necessary equipment and supplies and check all are in working order.
• To assess for deep tendon reflexes, the physical examination technique used is Palpation.
• The sequence of the techniques for examination of the abdomen is: Inspection → Auscultation → Percussion → Palpation (IAPP) because:
• Equipment used for measuring the oxygen saturation is a Pulse oximeter.
• When inspecting structures such as the jugular venous pulse, the best lighting to use is Tangential lighting.
• A cardinal techniques of examination that involves the use of the diaphragm and bell of the stethoscope is Auscultation.
• Equipment used to view the pharynx and cervix or to determine the reactions of the pupils of the eye is an Otoscope.
• The sequence of physical examination technique of the abdomen is: Inspection, Palpation, Percussion, Auscultation.
• The equipment and supplies needed for physical examination include hand sanitizer, examination gloves, alcohol swabs, paper and pen, or computer, draw sheet or drape, stadiometer, scale, examination light / gooseneck lamp, thermometer, watch with second hand, stethoscope, pulse oximeter, Doppler, ophthalmoscope, otoscope / speculums, nasal speculum, scents for testing sense of smell, Snellen chart or visual acuity card to test distant vision and near vision card, opaque card, penlight, tongue depressors, 2x2 - gauze pads, cup of water, ruler and flexible tape measure, preferably marked in cm.
• Goniometer, scoliometer, reflex hammer, tuning fork, Q - tips, paper clips, or other objects are needed for testing sense of touch.
• The patient should be prepared physically and psychologically to allay anxiety, provided privacy to prevent feelings of embarrassment, and provided adequate information about the procedure, what to expect during the procedure, and what is expected of the client, to gain his cooperation.
• The patient should be provided with a new, clean gown for the physical examination.
• Avoid abdominal palpation among patients with tumour of the liver and tumour of the kidneys.
• If a female patient must be examined by a male nurse or by a male physician, a female nurse must be in attendance to ensure that the procedure is done in an ethical manner and to prevent cases or issue of sexual harassment.
• If an ophthalmoscope is done, darken the room for better illumination.
• Palpation is done as the last technique on the abdomen as it may disturb the bowel sounds at the start of the procedure.
• Consider cultural beliefs and practice.
• The sequence of examining the quadrants of the abdomen is as follows: Right Lower Quadrant → Right Upper Quadrant → Left Upper Quadrant → Left Lower Quadrant.
• Explain each step in the examination and how the patient can cooperate.
• The sequence of the techniques for examination of the abdomen is as follows: Inspection → Auscultation → Percussion → Palpation.
• Organize the steps of physical examination so that the patient does not change position too often and to avoid omissions.
• Palpation is also done as the last technique on the abdomen because if the examiner happens to palpate a tender area, the patient may not be able to relax anymore and the patient may not want to finish the procedure.
• Begin physical examination procedure by measuring the person’s height, weight, blood pressure, temperature, pulse and respirations.
• The ideal situation is, female patient be examined by a female nurse.
• During the examination of the abdomen, it is important to flex the patient’s knees to relax the abdominal muscles.
• Touch the patient’s hands, check the skin colour, nail beds, metacarpophalangeal joints in a less threatening manner to ease a patient into being touched.
• Encourage the patient to ask questions.
• Do auscultation of the abdomen for 5 minutes before consulting absence of bowel sounds.
• Perform the procedure using head-to-toe sequence.
• The physical examination guidelines include washing hands before the procedure, the general sequence of performing the techniques of physical examination is as follows: IPPA (Inspection → Palpation → Percussion → Auscultation), and providing a new, clean gown for the physical examination.
• Students can ask questions and debate among themselves during the face to face interaction.