1. Physical Examination Techniques M. Rich, RN

2. 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?

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

4. 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

5. 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

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

7. 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

8. Role of the Nurse
Comprehensive physical examination vs. focused physical examination
Utilize Standard Precautions and Transmission-Based Precautions during examination
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9. Role of the Nurse Standard Precautions
Most important infection control practice is hand washing
CDC guidelines for hand hygiene
Utilize personal protective equipment
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10. Role of the Nurse Transmission-Based Precautions
Contact precautions (direct/indirect contact)
Droplet precautions (Large droplets – 3 feet)
Airborne precautions (small droplets)
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11. Role of the Nurse Legal issues Accurate, complete documentation
Ensure that patient is properly informed of examination procedures

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

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

14. 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
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15. 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
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16. 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

17. Percussion
Striking one object against another to cause vibrations that produce sound
Any part of the body can be percussed
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18. Percussion Most commonly used for abdomen and thorax
Analyze sounds by intensity, duration, pitch

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

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

21. 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

22. 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

23. Commonly Used Equipment
Pen and paper
Tape measure
Clean gloves
Penlight
Scale
Thermometer
Sphygmomanometer
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24. Commonly Used Equipment
Stethoscope
Otoscope
Ophthalmoscope
Visual acuity charts
Tuning fork
Reflex hammer
Lubricant

25. Preparing for a Physical Examination
Clean, professional appearance
Short fingernails
Warm hands and equipment
Ensure hair and jewelry will not interfere with the exam
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26. Preparing for a Physical Examination
Well-lit, warm, private, quiet room
Introduce self
Explain exam
Dress patient in gown, drape, and underpants
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27. Preparing for a Physical Examination
Have patient void before examination
Wash hands
Adhere to Standard and Transmission-Based Precautions
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28. 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
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29. Preparing for a Physical Examination
Proceed using a head-to-toe or other systematic approach
Thoroughly document findings
Thank patient when exam is concluded

30. 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
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31. Golden Rules for Physical Examination
Proceed from least invasive to most invasive
Use a systematic approach

32. 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)

33. Bell Work
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?

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

35. Role of the Nurse Transmission-Based Precautions
Contact precautions (direct/indirect contact)
Droplet precautions (Large droplets – 3 feet)
Airborne precautions (small droplets)
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36. Assessment Video Head to Toe
Form: