1. DEFINATION: An evaluation of the health status of an individual by performing a physical examination after obtaining a health history

2. Four health assessment techniques - Inspection - Palpitation - Percussion -Auscultation Inspection is the use of two senses of vision and smell to consciously observe the patient.

3. Assessment Techniques  Inspection - critical observation Take time to “observe” with eyes, ears, nose Use good lighting Look at color, shape, symmetry, position Odors from skin, breath, wound Develop and use nursing instincts  Inspection is done alone and in combination with other assessment techniques

5. Palpation The second assessment technique is palpation, which is the act of touching a patient in a therapeutic manner to elicit specific information basic principles: -You should have short fingernails to avoid hurting

6.  should warm your hands to placing the on the patient Encourage the patient to continue to breathe normally throughout the palpation If pain is experienced during the palpation, discontinue the palpation immediately  Most significantly, inform the patient where, when, and how the touch will occur

7. Assessment Techniques  Palpation - light and deep touch Back of hand to assess skin temperature Fingers to assess texture, moisture, areas of tenderness Assess size, shape, and consistency of lesions

10. Percussion  is the technique of striking one object against another to cause vibrations that produce sound.The density of underlying structures produces  characteristic sounds. These sounds are diagnostic of normal and abnormal  findings. The presence of air, fluid, and solids can be confirmed

11. Immediate percussion

12. indirect percussion

13. Technique of Direct Left Kidney Fist Percussion

14. Technique of Indirect Fist Percussion Left Kidney

15. Auscultation Auscultation is the act of active listening to body organs to gather information on a patient's clinical status. Auscultation includes listening to sounds that are voluntarily and involuntarily produced by the body

16. Physical Assessment Techniques Inspection Vision Smell Palpation Light palpation Deep palpation Percussion Immediate, or direct, percussion Mediate, or indirect, percussion Direct fist percussion Indirect fist percussion Auscultation Immediate, or direct, auscultation Mediate, or indirect, auscultation

17. Golden Rules for Physical Assessment Stand on the right side of the patient; establishing a dominant side for assessment will decrease your movement around the patient. Perform the assessment in ahead-to-toe approach. Always compare the right- and left-hand sides of the body for symmetry.

18. Proceed from the least invasive to the most invasive procedures for each body system. Always perform the physical assessment using a systematic approach are less likely to forget some part of the assessment

19. EQUIPMENT

20. Positioning  Positions used during nursing assessment, medical examinations, and during diagnostic procedures: Dorsal recumbent Supine Sims Prone Lithotomy Genupectoral  See Table 28-2 for client positions

22. Complete History and Physical  Nursing history is subjective - includes things like biographic data, history of present illness, past medical history, immunization history, allergies, habits (tobacco), stressors, family history, patterns of health care, and a review of the body’s systems

23. History of Present Illness Must get details of the problem, therefore must be systematic OLFQQAAT (one system – there are others): onset, location, frequency, quality, quantity, associated symptoms, treatments tried (include all treatments)

24. Pain, quality/quantity, radiation, setting, timing Rate pain from 1 to 10 Use age appropriate tools Culturally appropriate care

25. Exam Order and Documentation Date and identifying data - name, age, sex, race, place of birth, marital status, occupation, religion Source and reliability of history client complaint = reason for visit

26. Order & Documentation (subjective head-to-toe review) General - recent wt. change, fatigue, fever Skin - rashes, lesions, changes, dryness, itching, color change, hair loss, change in hair or nails Eyes - change in vision, floaters, glasses, HA, pain

27. Order & Documentation Genitalia - lesions, discharge, sexual orientation, sexual function, menstrual history, contraception, pregnancy history, TSE Peripheral vascular - intermittent claudicating, varicose veins, blood clots muscle or joint pain, redness, stiffness, warmth, swelling, family history Neuro - fainting, blackouts, seizures, weakness

28. Order & Documentation Endocrine - sweats, skin change, heat or cold intolerance, excessive thirst (polydipsia), excessive urination (polyuria), weight change, menstrual changes Psychiatric - mental illness, thoughts of harming self or others

29. Complete H&P - Objective  Physical assessment is objective Objective portion of exam begins with the general survey; Each body system reviewed in text has nursing history at the beginning of the procedure for the objective exam In actual practice, you get most of the history before ever touching the client, but there are usually additional history questions to ask during the exam

30. General Survey  General appearance, gait, nutrition status (NOT to be confused with nutrition history), state of dress, body build, obvious disability, speech patterns, affect (mood), hygiene, body odor, posture, race, gender, height, weight, vital signs  Height up to age 2 is recumbent Add head circumference if child is less than 2 years old

31. Integumentary System Integument includes skin, hair, and nails  Inspect: skin color and uniformity of color, moisture, hair pattern, rashes, lesions, pallor, edema  Palpate: temperature, turgor, lesions, edema  Percussion and auscultation: rarely used on skin  Terminology: pallor, cyanosis, edema, ecchymosis, macule, papule, cyanosis, jaundice, types of edema, etc.

32. SKIN

33. Inspect and palpate the skin & note -Color Look for increased pigmentation Redness Pallor Cyanosis Yellowing of the skin -Moisture Ex. Dryness.sweating,and,oiliness

34.  Temperature :  Assessment generalized warmth and coolness of the skin note temperature of any red area.  Texture :  Roughness and smoothness.  Mobility and turgor:  lift a fold of skin note the ease with which it lifts up (mobility) and the speed with which it returns into place (turgor)

35.  Lesions:  Anatomic location and distribution.  Pattern and shapes. Annular (in ring) linear,clusterd  The type of skin lesion eg. Macules,papules Evaluating the bed bound patient.

36. HEAD EXIMINATION The hair :  Quantity.  Distribution.  Texture.  Pattern of loss.  If you may see loose flakes of dandruff.

37.  The scalp.  Part the hair in several place and look for scaliness, lumps, nevi,or other lesion.  The skull:  General size, note any deformities, depression, lumps,or tenderness  The face:  Facial expression and contours  A symmetry, involuntary movements, edema, and mass

38. Anatomy of eye

39. Examination of The eye  Visual acuity.

40.  with Snellen chart: ○ 20/20 - first number (numerator) is distance from chart ○ Second number is distance at which a normal eye could have read that line (OU, OD, OS) ○ Always record if tested cc (with correction

41.  Visual field by confrontation :  Screening  Position and A ligment of the eye:  Eyebrows : quantity and distribution and any scaliness of under ling skin.  Eye lid : color,edema, width of the palpebral fissures condation and direction of eyelashes.  Lacrimal Apparatus: swelling,excessive tearing or drayness of the eyes.

42.  Conjunctiva and sclera:  Color, vascular pattern against white sclera nodules or swelling.  Cornea and lens. Opacities  Iris:  Pupils: size(0.5-0.3mm), shape, and symmetry of the pupils  Pupillary reaction to light  Direct reaction(pupillary construction in the same eye)

43.  The consensual reaction(pupillary construction in the opposite eye)  Extra ocular muscles: normal conjugate movement of the eye in each direction, or any devotion of normal  nystagmus

44. Ear Anatomy of ear

45. Techniques of examination  The uricle and surrounding tissue for deformatities,lumps,and lesion.  Ear canal and drum by otoscop

46. Normal ear drum

47.  Auditory acuity  Air and bone conduction: Test for lateralization (weber test) Compare air conduction (AC) bone conduction(BC)(rinne test)

48. The nose and par nasal sinuses

49. Techniques of examination  Inspect the anterior and inferior surfaces of the nose:  Note any asymmetry or deformity of the nose  Test for nasal obstruction.  Inspect the inside of the nose with an otoscope  The nasal mucosa that covers the septum and any abnormalities  The nasal septum : perforation deviation or any inflammation.  Any abnormalities such as ulcers or polyps.  Palpate for sinus tenderness.

50. Mouth and pharynx

51. Techniques of examination The lips: color and moisture, and note any lumps, ulcers, cracking or scaling. The oral mucosa: Color, ulcers, white patches, and nodules The gums and teeth : Color of the gums normally pink,patchy brownnes may be present, The roof of the mouth: inspect the color and architecture of the hard palate.

52.  The tongue and the floor of the mouth : Color texture, and symmetry Inspect the side of the tongue, and palpate it with your gloves. Pharynx: Color,symmatry and look exudates,swelling,ulceration,tonsillar enlargement

53. The neck

54. Techniques of examination  Inspect the neck noting (symmetry and any masses or scars. Look for enlargement of the parotid or submandibular glands, and note any visible lymph nodes  The lymph nodes.

56. Neck  Inspect Thyroid gland for enlargement Any visible lymph nodes and masses

57. REFERENCES Boyce, J. M., & Pittet, D. (2008). Guideline for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory.