Physical Examination Techniques M. Rich, RN

Bell Work 12-4-17 Name the three types of muscles What is the difference between osteoarthritis and rheumatoid arthritis? What is the abnormal curvature of the spine called?

Answers Cardiac, Smooth and Skeletal Rheumatoid Arthritis is an autoimmune disorder Scoliosis

Arthritis Osteoarthritis: inflammation, breakdown, eventual lose of cartilage Rheumatoid Arthritis: Autoimmune condition, immune system attacking healthy body tissues Treatment: Ice, Anti- inflammatory drugs, Immunosuppressive drugs, steroids

Standard 10) Demonstrate an understanding of basic medical terminology in order to monitor patient/client status through: History and Physical including but not limited to: family, environmental, social, and mental history b. Brief Head to Toe Assessment noting normal vs. abnormal findings c. Vital Signs Assessment (VS) d. Height/weight, BMI /Calculation e. Specimen Collection

Objective Understand the components of a health assessment: Inspection (I) Palpation (P) Percussion (P) Auscultation (A)

Aspects of Physical Examination Purposes of physical examination Screening of general well-being Validation of complaints that caused patient to seek health care Monitoring of current health problems Formulation of diagnoses and treatments

Role of the Nurse Comprehensive physical examination vs. focused physical examination Utilize Standard Precautions and Transmission-Based Precautions during examination (continues)

Role of the Nurse Standard Precautions Most important infection control practice is hand washing CDC guidelines for hand hygiene Utilize personal protective equipment (continues)

Role of the Nurse Transmission-Based Precautions Contact precautions (direct/indirect contact) Droplet precautions (Large droplets – 3 feet) Airborne precautions (small droplets) (continues)

Role of the Nurse Legal issues Accurate, complete documentation Ensure that patient is properly informed of examination procedures

Examination Techniques Inspection (I) Palpation (P) Percussion (P) Auscultation (A) Usually follow order IPPA, except for the abdomen (IAPP)

Inspection Use of one’s senses of vision and smell to consciously observe patient Careful observation Tangential lighting if necessary

Palpation Act of touching patient in a therapeutic manner to elicit information Tips Warm hands Short nails Inform patient of when, where, and how the touch will occur (continues)

Palpation Light palpation Superficial, delicate, gentle Use finger pads Depress 1 cm below surface Use to examine skin texture, moisture, masses, fluid, muscle guarding, and tenderness (continues)

Palpation Deep palpation Use to determine position of organs, masses, and their size, shape, mobility, and consistency Use hands Depress 4 to 5 cm below skin surface Use to examine abdominal and reproductive structures

Percussion Striking one object against another to cause vibrations that produce sound Any part of the body can be percussed (continues)

Percussion Most commonly used for abdomen and thorax Analyze sounds by intensity, duration, pitch https://www.youtube.com/watch?v=P4Ryk5IKf_4

Quality of Sounds Flatness Dullness (unhealthy lung) Resonance (bowel and health lung) Hyperresonance Tympany

Percussion Techniques Direct or immediate Indirect or mediate Direct fist Indirect fist

Auscultation Act of actively listening to organs to hear voluntary and involuntary sounds Quiet environment is needed Analyze sounds in relation to intensity, pitch, duration, quality, and location

Types of Auscultation Direct or immediate Indirect or mediate Listening with the unaided ear Indirect or mediate Listening with an amplification or mechanical device Examples: acoustic stethoscope, Doppler stethoscope

Commonly Used Equipment Pen and paper Tape measure Clean gloves Penlight Scale Thermometer Sphygmomanometer (continues)

Commonly Used Equipment Stethoscope Otoscope Ophthalmoscope Visual acuity charts Tuning fork Reflex hammer Lubricant

Preparing for a Physical Examination Clean, professional appearance Short fingernails Warm hands and equipment Ensure hair and jewelry will not interfere with the exam (continues)

Preparing for a Physical Examination Well-lit, warm, private, quiet room Introduce self Explain exam Dress patient in gown, drape, and underpants (continues)

Preparing for a Physical Examination Have patient void before examination Wash hands Adhere to Standard and Transmission-Based Precautions (continues)

Preparing for a Physical Examination Position patient as needed Create a therapeutic environment Explain examination Be cognizant of verbal and nonverbal communication Avoid making negative or crude remarks Avoid offensive facial expressions (continues)

Preparing for a Physical Examination Proceed using a head-to-toe or other systematic approach Thoroughly document findings Thank patient when exam is concluded

Golden Rules for Physical Examination Stand on the right side of patient to establish a dominant side for examination Use a head-to-toe approach Compare right to left sides of the body for symmetry (continues)

Golden Rules for Physical Examination Proceed from least invasive to most invasive Use a systematic approach

Heat to Toe Assessment Check Mental Status/Emotional Status Vital Signs/Pain Assessment Height/Weight, BMI Heat to Toe: Inspection (I) Palpation (P) Percussion (P) or Auscultation (A) except for the abdomen (IAPP)

Bell Work 12-5-17 What are the four techniques to implement in a head to toe assessment What order would you do an abdominal assessment? What is the difference between a droplet and an airborne transmission based precaustion?

Examination Techniques Inspection (I) Palpation (P) Percussion (P) Auscultation (A) Usually follow order IPPA, except for the abdomen (IAPP)

Role of the Nurse Transmission-Based Precautions Contact precautions (direct/indirect contact) Droplet precautions (Large droplets – 3 feet) Airborne precautions (small droplets) (continues)

Assessment Video Head to Toe https://www.youtube.com/watch?v=gG8kh8MfnGY&t=20s Form: https://www4.stanbridge.edu/e/downloads/vnForms/Term%203/Head%20to%20Toe%20Patient%20Assessment.pdf