NCM 101 LEC OBJECTIVE DATA

• General principles for conducting a physical examination:
• Conducted following a comprehensive or problem-related history
• Conducted in a quiet, well-lit room with consideration for patient privacy and comfort
• Begin with the patient in a sitting position to examine both the front and back
• Examine systematically from head to foot to observe all systems or body parts
• Compare findings on one side of the body with the other due to bilateral symmetry
• Explain procedures to the patient during the examination to avoid alarming them
• Objective data:
• Includes information directly observed by the nurse during interaction with the client
• Information elicited through physical assessment techniques
• Basic knowledge:
• Types of equipment needed for examination (e.g., penlight, sphygmomanometer, otoscope)
• Preparation of setting, oneself, and the client for the physical assessment
• Performance of assessment techniques: inspection, palpation, percussion, and auscultation
• Equipment:
• Gloves and gowns to protect examiner during examination
• Equipment for taking vital signs: sphygmomanometer, thermometer, watch with second hand, pain rating scale
• Equipment for eye examination: penlight, Snellen chart, ophthalmoscope, cover card, newspaper
• Physical setting:
• Examination may take place in various settings like hospital rooms, clinics, or client's home
• Setting should be comfortable, private, quiet, well-lit, with necessary equipment
• General principles to keep in mind:
• Wash hands before and after examination, wear gloves when necessary
• Discard sharp objects after use, wear mask and eye goggles if at risk of splashes
• Approaching and preparing the client:
• Establish nurse-client relationship before examination
• Explain the examination to the client, respect their desires and requests
• Begin with less intrusive procedures to help the client feel comfortable
• Physical examination techniques:
• IPPA: Inspection, Palpation, Percussion, Auscultation
• IAPP: Assessing the bowel - Inspection, Auscultation, Percussion, Palpation
• Inspection involves using vision, smell, and hearing to observe findings
• Palpation involves feeling for characteristics like texture, temperature, and mobility
• Different types of palpation: light, moderate, and deep
• Guidelines for inspection: ensure comfortable room temperature, good lighting, compare symmetric body parts
• Guidelines for palpation: use different parts of the hand, follow standard precautions, proceed from light to deep palpation
• Bimanual palpation:

  • Use two hands, placing one on each side of the body part being palpated
  • Use one hand to apply pressure and the other hand to feel the structure
  • Note the size, shape, consistency, and mobility of the structures being palpated
• Percussion:

  • Involves tapping body parts to produce sound waves
  • Sound waves or vibrations enable the examiner to assess underlying structures
  • Different assessment uses of percussion include:
  • Eliciting pain to detect inflamed underlying structures
  • Determining location, size, and shape of organs
  • Determining density of underlying structures
  • Detecting abnormal masses
  • Eliciting reflexes using a percussion hammer
• 3 types of percussion:

  1. Direct percussion:

  • Tapping a body part with one or two fingertips to elicit possible tenderness

  2. Blunt percussion:

  • Used to detect tenderness over organs by striking the back of the flat hand on the body surface

  3. Indirect or mediate percussion:

  • Most commonly used method
  • Tapping produces a sound or tone that varies with the density of underlying structure
  • Techniques to develop proficiency in indirect percussion
• Auscultation:

  • Requires the use of a stethoscope to listen for various body sounds
  • Sounds detected classified by intensity, pitch, duration, and quality
  • Guidelines for auscultation:
  • Eliminate distracting noises
  • Expose the body part being auscultated
  • Use diaphragm for high-pitched sounds and bell for low-pitched sounds