OBJECTIVE

• L.GO
• Preparing for the Examination


  • Preparing the Physical Setting
  • Preparing Oneself
  • Approaching and Preparing the Client
  • Physical Examination Techniques
• EQUIPMENT NEEDED FOR PHYSICAL EXAMINATION
• Equipment


  • Gloves and gown
  • Sphygmomanometer and stethoscope
  • Thermometer (oral, rectal, tympanic)
  • Watch with second hand
  • Pain rating scale
  • Skinfold calipers
  • Flexible tape measure
  • Skin-marking pen
  • Platform scale with height attachment
  • Examination light, penlight
  • Mirror
  • Metric ruler
  • Magnifying glass
  • Wood's light
  • Braden Scale for predicting pressure sore risk
  • Pressure Injury Scale for Healing (PUSH)
  • Stethoscope
  • Small cup of water
  • Penlight
  • Snellen E chart
  • Newspaper
  • Opaque card
  • Ophthalmoscope
  • Tuning fork
  • Otoscope
  • 4 x 4 in small gauze pad
  • Tongue depressor
  • Otoscope with wide-tip attachment
  • Metric ruler and skin marking pen
  • Two metric rulers
  • Flexible metric measuring tape
  • Doppler ultrasound device and conductivity gel
  • Two small pillows
  • Goniometer
  • Cotton-tipped applicators and substances to smell and taste
  • Reflex (percussion) hammer
  • Cotton ball and paper clip
  • Gloves and water-soluble lubricant
  • Specimen card
  • Vaginal speculum and water-soluble lubricant
  • Bifid spatula, endocervical broom
  • Large swabs
  • Liquid Pap medium
• PREPARING THE PHYSICAL SETTING
• Physical examination may take place in

  • hospital room
  • outpatient clinic
  • physician's office
  • school health office
  • employee health office
  • a client's home
• Physical examination setting should meet the following conditions

  • Comfortable, room temperature
  • Private area free of interruptions from others
  • Quiet area free of distractions
  • Adequate lighting
  • Firm examination table or bed at a height that prevents stooping
  • A bedside table/tray to hold the equipment needed for the examination
• PREPARING ONESELF


  • Assess and manage personal feelings and anxieties to prevent conveying unease to the client
  • Practice examination techniques with peers or relatives to build confidence
  • Seek feedback from experienced instructors or practitioners
  • Follow Standard Precautions to prevent transmission of infectious agents
• Standard Precautions


  • Hand Hygiene
  • Glove Use
• Using an Alcohol-Based Hand Sanitizer


  1. Put product on hands and rub hands together

  2. Cover all surfaces until hands feel dry

  3. This should take around 20 seconds
• Washing with Soap and Water


  1. Wet your hands first with water, apply the amount of product recommended by the manufacturer to your hands, and rub your hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers

  2. Rinse your hands with water and use disposable towels to dry

  3. Use towel to turn off the faucet

  4. Avoid using hot water to prevent drying of skin

  5. Cleaning your hands with soap and water should take around 20 seconds
• Glove Use


  • Wear gloves, according to Standard Precautions, when it can be reasonably anticipated that contact with blood or other potentially infectious materials, mucous membranes, nonintact skin, or potentially contaminated skin or contaminated equipment could occur
  • Gloves are not a substitute for hand hygiene
• How to Wash


  When cleaning your hands with soap and water, wet your hands first with water, apply the amount of product recommended by the manufacturer to your hands, and rub your hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers. Rinse your hands with water and use disposable towels to dry. Use towel to turn off the faucet. Avoid using hot water to prevent drying of skin. Other entities have recommended that cleaning your hands with soap and water should take around 20 seconds. Either time is acceptable. The focus should be on cleaning your hands at the right times.
• GLOVE USE


  • Wear gloves, according to Standard Precautions, when it can be reasonably anticipated that contact with blood or other potentially infectious materials, mucous membranes, nonintact skin, or potentially contaminated skin or contaminated equipment could occur. Gloves are not a substitute for hand hygiene. If your task requires gloves, perform hand hygiene prior to donning gloves, before touching the client or the client environment. Perform hand hygiene immediately after removing gloves. Change gloves and perform hand hygiene during client care, if gloves become damaged, gloves become visibly soiled with blood or body fluids following a task, moving from work on a soiled body site to a clean body site on the same client or if another clinical indication for hand hygiene occurs. Never wear the same pair of gloves in the care of more than one client. Carefully remove gloves to prevent hand contamination.
• SKIN AND NAIL CARE

  • Lotions and creams can prevent and decrease skin dryness that happens from cleaning your hands. Use only hand lotions approved by your health care facility because they will not interfere with hand-sanitizing products. Germs can live under artificial fingernails both before and after using an alcohol-based hand sanitizer and handwashing. It is recommended that health care providers do not wear artificial fingernails or extensions when having direct contact with clients at high risk (e.g., those in intensive care units or operating rooms). Keep natural nail tips less than ¼ in. long. Some studies have shown that skin underneath rings contains more germs than comparable areas of skin on fingers without rings. Further studies are needed to determine whether wearing rings results in an increased spread of potentially deadly germs.
• RESPIRATORY HYGIENE/COUGH ETIQUETTE


  Cover your mouth and nose with a tissue when coughing or sneezing. Use in the nearest waste receptacle to dispose of the tissue after use. Perform hand hygiene (e.g., handwashing with non–antimicrobial soap and water, alcohol-based hand rub, or antiseptic handwash) after having contact with respiratory secretions and contaminated objects/materials. Health care facilities should ensure the availability of materials for adhering to respiratory hygiene/cough etiquette in waiting areas for clients and visitors. Provide tissues and no-touch receptacles for used tissue disposal. Provide conveniently located dispensers of alcohol-based hand rub; where sinks are available, ensure that supplies for handwashing (i.e., soap, disposable towels) are consistently available.
• GENERAL PRINCIPLES WHILE PERFORMING A PHYSICAL ASSESSMENT

  • Wash hands before starting examination, after direct contact with body fluids, and post-examination or glove removal. Preferably wash hands in front of the client for reassurance. Wear gloves when encountering body fluids, open cuts, handling specimens, contaminated surfaces, or during specific examinations. Change gloves between contaminated and clean sites, and between clients. Dispose of sharp objects like pins after use and use a new one for each client. Wear a mask and eye goggles for examinations with potential blood or fluid splashes, like oral exams for clients with chronic coughs.
• APPROACHING AND PREPARING THE CLIENT

  Build rapport during the interview before the exam to ease tension. Explain the examination process and respect client preferences. Obtain consent if needed, especially for sensitive exams. Provide instructions for urine samples, if necessary. Ensure privacy during gowning and undressing. Start with less invasive procedures to alleviate anxiety. Continuously explain procedures during the exam. Approach the client from their right side. Explain position changes for thorough examination.
• POSITIONING THE CLIENT


  • Sitting Position
  • Supine Position
  • Dorsal Recumbent Position
  • Sims Position
  • Standing Position
  • Prone Position
  • Knee-Chest Position
  • Lithotomy Position
• GENERAL CONSIDERATIONS FOR EXAMINING OLDER ADULTS

  • Some positions may be very difficult or impossible for the older client to assume or maintain because of decreased joint mobility and flexibility. Therefore, try to perform the examination in a manner that minimizes position changes. It is a good idea to allow rest periods for the older adult, if needed. Some older clients may process information at a slower rate. Therefore, explain the procedure and integrate teaching in a clear and slow manner.
• PHYSICAL EXAMINATION TECHNIQUES - INSPECTION

  Make sure the room is a comfortable temperature. Use good lighting, preferably sunlight. Look and observe before touching. Completely expose the body part you are inspecting while draping the rest of the body.
• Inspection involves observing the appearance of what is being inspected, using the senses and sometimes special equipment
• Guidelines for inspection


  • Ensure comfortable room temperature
  • Use good lighting, preferably sunlight
  • Look and observe before touching
  • Completely expose the body part being inspected
  • Note characteristics like color, patterns, size, location, consistency, symmetry, movement, behavior, odors, or sounds
  • Compare symmetric body parts
• Palpation


  Using parts of the hand to touch and feel for characteristics like texture, temperature, moisture, mobility, consistency, pulse strength, size, shape, and tenderness
• Types of palpation


  • Light palpation
  • Moderate palpation
  • Deep palpation
  • Bimanual palpation
• Percussion


  Tapping body parts to produce sound waves that enable assessing underlying structures
• Uses of percussion


  • Eliciting pain
  • Determining location, size, and shape
  • Determining density
  • Detecting abnormal masses
  • Eliciting reflexes
• Types of percussion


  • Direct percussion
  • Blunt percussion
  • Indirect or mediate percussion
• Auscultation


  Using a stethoscope to listen for body sounds like heart, blood, bowel, and respiratory sounds
• How to use a stethoscope

  • Place earpieces snugly in ears
  • Angle binaurals down toward nose
  • Use diaphragm for high-pitched sounds, hold firmly
  • Use bell for low-pitched sounds, hold lightly
• Collecting objective data is essential for a complete nursing assessment and requires knowledge, skill, and practice
• Examination Equipment


  • Gloves and gown
  • Sphygmomanometer and stethoscope
  • Thermometer (oral, rectal, tympanic)
  • Watch with second hand
  • Pain rating scale
  • Skinfold caliper
  • Flexible tape measure
  • Pen
  • Penlight
  • Platform scale with height attachment
• Gloves and gown


  • Protect examiner in any part of the examination when the exam nor may have contact with blood, body fluids, secretions, excretions, and contaminated items, or when disease-causing agents could be transmittad to or from the client
• Sphygmomanometer and stethoscope


  • Measure diastolic and systolic blood pressure; stethoscope to auscultate blood sounds when measuring blood pressure
• Thermometer (oral, rectal, tympanic)


  • Measure body temperature
• Watch with second hand


  • Take heart rate, pulse rate
• Pain rating scale


  • Determine perceived pain level
• Skinfold caliper


  • Measure skinfold thickness of subcutaneous tissue
• Flexible tape measure


  • Measure midarm circumference
• Pen


  • Mark measurements