UNIT - VIII HEALTH ASSESSMENT

1. UNIT - VIIIHEALTH ASSESSMENT Prepared by Gireesh G.R

2. LEARNING OBJECTIVES • At the end of class the learner will be able to • Describe various methods used for physical examination • Elaborate on positions used for physical examination

3. PHYSICAL EXAMINATION • It is the systematic collection of objective information that is directly observed or is elicited through examination techniques. • Physical examination involves the use of one’s senses to obtain information about the structure and function of an area being observed or manipulated. • It is the thorough inspection or a detailed study of the entire body or some parts of the body to determine the general physical or mental conditions of the body.

4. Purpose • To understand the physical and mental well-being of the clients. • To detect diseases in its early stage. • To determine the cause and the extent of disease. • To understand any changes in the condition of diseases, any improvement or regression.

5. Contd… • To determine the nature of the treatment or nursing care needed for the client. • To safeguard the client and his family by noting the early signs especially in case of a communicable disease. • To contribute to the medical research. • To find out whether the person is medically fit or not for a particular task.

6. Role of the Nurse in Physical Examination • Preparation of the EnvironmentMaintenance of PrivacyA separate examination room is needed. • Keep the doctors closed. • The relatives are not allowed. • Drape the client according to the parts that are exposed. • LightingAs far as possible, natural light should be available in the examination room because if a client is jaundiced, it may not be detected in the artificial light. There should be adequate lighting.

7. Contd… • Comfortable Bed or Examination TableThe client should be placed comfortably throughout the examination. • There should be provision for the maintenance of a suitable position e.g., a lithotomy position may be maintained when examining the genitalia. • To maintain the position, a special examination table with stirrup rods is needed. • The room should be warm and without draughts

8. Preparation of the Client • Physical Preparation • Keep the client clean. • Shave the part if necessary. • Keep the client in a comfortable position which is convenient for the doctor to examine the client. • Empty the bladder prior to the examination. • Empty the bowels by an enema, if required. • Loosen the garments and change into the hospital dress, if it is the custom. • Drape the client with extra sheets and expose only the needed areas. • Avoid unnecessary exposure.

9. Contd… • Mental PreparationThe client may be quite new to the hospital situation and the may be anxious about his illness. • He may have false ideas about the medical examination. • It is the duty of the nurse to allay his anxieties and fears by proper explanation. • Explain the sequence of the procedure to gain his confidence and cooperation. • As far as possible a nurse should remain with a female client during the physical examination.

10. Contd… • Position patient as needed • Avoid negative or crude remarks • Be cognizant of facial expressions • Perform exam in head-to-toe or other systematic manner • Thank the patient when exam is concluded • Thoroughly document findings

11. Positioning for Physical Exam • Fowler’s • Used to assess skin, head, neck, eyes, ears, nose, mouth, throat, thorax, lungs, heart, peripheral vasculature, neurological system • Horizontal recumbent • Used to assess breasts, heart, peripheral vasculature, abdomen, musculoskeletal system

12. Contd… • Dorsal recumbent • Used to assess female genitalia • Lithotomy • Used to assess female genitalia • Knee-chest • Used to assess rectum and prostate • Sims • Used to assess rectum and female genitalia

13. Golden Rules for Physical Assessment • Stand on the right side of the patient to establish a dominant side for assessment • Use a head-to-toe approach • Compare right to left sides of the body for symmetry • Least invasive to most invasive • Systematic approach

14. METHODS OF PHYSICAL EXAMINATION • INSPECTION • PALPATION • AUSCULTATION • PERCUSSION 5) OLFACTION

15. METHODS OF PHYSICAL EXAMINATION • INSPECTION It is the first step in the physical examination process. It is a visual examination of the client that is done in a methodical and deliberate manner.

16. Inspection During inspection consider client’s -anatomic structure -any abnormalities -colour -shape -symmetry -movement -pulsations -texture

17. Contd… • PALPATION It is the examination of the body using the sense of touch. The pads of the fingers are used. Palpation is used to determine -texture (e.g.: hair) -temperature (e.g.. skin area) -vibration (e.g. joint) -Positions ,size , consistency , mobility (e.g. organs) -distension (e.g. urinary bladder) -pulsation -presence of pain

18. Contd… TYPES OF PALPATION • LIGHT • DEEP

19. Contd… • Light palpation Extend the dominant hand’s fingers parallel to the skin surface and presses gently while moving hand in a circle manner. • Deep palpation It is done with two hands or one hand. -it is done with extreme caution , because pressure can damage internal organs. - it is not indicated in clients with acute abdominal pain or pain that yet not diagnosed

21. Light palpation

22. Deep palpation

23. Contd.. • to test skin temperature , - use the dorsum or back of the hands and fingers • To test vibrations , use palmar surface of the hands

24. Contd… General guidelines for palpation include: • The nurse’s hands should be clean, warm and the finger nails short • Areas of tenderness should be palpated last. • Deep palpation should be done after superficial palpation.

25. Contd… • PERCUSSION It is the act of striking the body surface to elicit sounds that can be heard or vibrations that can be felt. There are two types of percussion. -Direct Percussion -Indirect Percussion

26. Contd… • Direct Percussion The nurse strikes the area to be percussed directly with the pads of two , three , or four fingers or with the pad of the middle finger. The strikes are rapid and the movement is from the wrist. • Indirect Percussion It is striking of an object against the body area to be examined. -In this technique the middle finger of the non dominant hand is placed firmly on the client’s skin.

27. Direct percussion

28. Indirect percussion

29. Indirect percussion

30. Contd… Percussion elicits five types of sounds -Flatness: It is an extremely dull sound produced by very dense tissue such as muscle or bone -Dullness : It is a thud like sound produced by dense tissue such as the liver , spleen , or heart. -Resonance-It is a hallow sound such as that produced by lungs filled with air. -Hyper resonance: It is not produced in the normal body. It is described as booming and can be heard over an emphysematous lung. -Tympany –it is a musical or drumlike sound , produced from an air filled stomach

31. AUSCULTATION • AUSCULTATION It is the process of listening to sounds produced within the body. Types: -Direct Auscultation -Indirect Auscultation

32. Contd… • Direct auscultation - use of the unaided air Eg: to listen to a respiration wheeze or the grating of a mixing joint

33. Indirect auscultation

34. Olfaction • helps to detect abnormalities that cannot be recognized by any other means • It help to detect serious abnormalities

35. Evaluation • Write short notes on methods of physical examination? • Various positions used for physical examination