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Physical examination
- 2. Objectives of Health Assessment Describe prehospital physical examination techniques Describe examination equipment Describe the general approach to the physical examination Outline the steps of the comprehensive physical examination www.drjayeshpatidar.blogspot.in
- 3. Objectives Detail the components of the mental status examination Identify abnormal findings in the mental status examination Outline steps in the general patient survey Distinguish between normal and abnormal findings in the general survey www.drjayeshpatidar.blogspot.in
- 4. Objectives Describe examination techniques for specific body regions Identify normal and abnormal findings in the body region examination Describe examination techniques specific to children and older adults www.drjayeshpatidar.blogspot.in
- 5. Health Assessment Component of Health assessment Health History Physical assessment www.drjayeshpatidar.blogspot.in
- 6. Purposes Establish a nurse- client relationship. Gather data about the client‟s general health status, integrating physiologic, psychological, cognitive, socio cultural, development and spiritual dimensions. Identify client‟s strengths. Identify actual and potential health problem. Establish a base for the nursing process. To evaluate the physiological outcome of care. www.drjayeshpatidar.blogspot.in
- 7. Techniques of Physical Examination www.drjayeshpatidar.blogspot.in
- 8. Health History Health history is a collection of subjective and objective data that provide a detailed profile of the client‟s health status. www.drjayeshpatidar.blogspot.in
- 9. History Taking IDENTIFICATION DATA OF THE PATIENT Patient's name:- Age: - Sex- Hospital Name:- File No./MLC No.:- Source providing history:- Date/ Time of admission- www.drjayeshpatidar.blogspot.in
- 10. OPD No.:- IPD No.:- Ward- Bed No.:- Doctor‟s Unit:- Provisional Diagnosis- Surgery done/Date of Surgery:- Name of the Surgery:- Residential Address- www.drjayeshpatidar.blogspot.in
- 11. Mother Tongue:- Marital Status- Educational Status: - Occupation- Monthly income www.drjayeshpatidar.blogspot.in
- 12. DETAILS OF ADMISSION:- Arrived via wheel chair / stretcher / ambulatory: - LOC – Conscious / Semiconscious / Unconscious From admitting room / emergency room.'' home / any others:- www.drjayeshpatidar.blogspot.in
- 13. ORIENTATION TO THE UNIT:- Use of telephone / TV / call lights:- Visiting hours:- No Smoking:- Patient is informed that hospital is not responsible for the personal belongings: - Yes/No Valuable handed over to (Write relationship With patient) Written consent:- www.drjayeshpatidar.blogspot.in
- 14. BASELINE DATA Weight:- Height:- Abdominal Girth:- Temperature: - Oral: - Axilla: - Rectal:- Respiration:- Pulse: - Blood Pressure:- www.drjayeshpatidar.blogspot.in
- 15. REASON FOR ADMISSION (Onset, duration, earlier treatments) ALLERGIES AND MEDICATIONS Drugs / Foods / dyes / Others:- Sign and symptoms:- www.drjayeshpatidar.blogspot.in
- 16. VICES Alcohol/ Tobacco/Cigarette/Drug Abuse:- Amount of intake/Day: Duration of intake (Since when) and frequency of intake (How often in a day?):- www.drjayeshpatidar.blogspot.in
- 17. LEISURE ACTIVITIES /RECREATIONAL ACTIVITIES (IN HOSPITAL) PATIENTS ROUTINES HABITS (IN HOSPITAL) www.drjayeshpatidar.blogspot.in
- 18. FAMILY INFORMATION -Name of Family Members -Relationship with patient -Age -Type of Family -Education -Occupation -Marital Status -Health Status www.drjayeshpatidar.blogspot.in
- 19. Family Income per Year: Family interpersonal relationship / Any Family Disharmony:- Family History of illness: (Hypertension, DM, Cancer, Arthritis, etc www.drjayeshpatidar.blogspot.in
- 20. ENVIRONMENTAL BACKGROUND 1) HOUSING Type of house:- Lighting :- Ventilation:- Water facilities:- Sanitation:- 2) PETS/ANIMALS 3) FOOD HYGIENE PRACTICES: 4) PERSONAL HYGIENE PRACTICES: www.drjayeshpatidar.blogspot.in
- 21. 5) COMMUNITY RESOURCES a) Transport: - b) Health facilities:- c) Educational Facilities :- PAST MEDICAL HISTORY Hypertension, DM, Cancer, Respiratory, Arthritis, stroke and others: PAST SURGICAL HISTORY PRESENT MEDICAL HISTORY;- www.drjayeshpatidar.blogspot.in
- 22. CURRENT MEDICATION:- Current Medication Dose/Frequency Route Last Dose Taken LABORATORY/OTHER INVESTIGATION:- Date Investigations Name Normal Findings Patient’s Findings www.drjayeshpatidar.blogspot.in
- 23. SPECIAL ASSISTIVE DEVICES Wheel Chair / Braces / Crutches / Walkers / others:- Contact lenses / Hearing aid / Prosthesis / Glasses:- Dentures:- Total / Partial www.drjayeshpatidar.blogspot.in
- 24. PSYCHOSOCIAL HISTORY Any recent stress? Who is with the patient in the hospital? Does the patient have anybody who will give financial support if needed? Who will care for the patient at home? Calm: Yes / No Anxious: Yes / No www.drjayeshpatidar.blogspot.in
- 25. Skills of Physical Assessment Inspection Palpation Percussion Auscultation Olfaction www.drjayeshpatidar.blogspot.in
- 26. Inspection Visual assessment of the patient and surroundings Findings that may be significant: – Patient hygiene – Clothing – Eye gaze – Body language – Body position – Skin color – Odor . www.drjayeshpatidar.blogspot.in
- 27. Nurse observe body part Pay attention to client, watching all movement & looking carefully at any body part. It help to know physical characteristics. Quality of inspection depend on the nurse‟s willingness to spend time during a job. www.drjayeshpatidar.blogspot.in
- 28. If the emergency response was to the patient's home, make a visual inspection for – Cleanliness – Prescription medicines – Illegal drug – Weapons – Signs of alcohol use www.drjayeshpatidar.blogspot.in
- 29. Principles Make sure good lighting is available. Position and expose body parts so that all surface can be viewed. Inspect each area of size, shape, colour,symmetry, position and abnormalities. If possible, compare each area inspected with the same area on the opposite side of the body. Use additional light to inspect body cavities. Do not hurry inspection. Pay attention to detail. www.drjayeshpatidar.blogspot.in
- 30. Palpation A technique in which the hands and fingers are used to gather information by touch. Palmar surface of fingers and finger pads are used to palpate for – Texture – Masses – Fluid --And assess skin temperature Client should be relax and positioned comfortably because muscle tension during palpation impair its effectiveness. Asking the patient to take deep & slow breath.www.drjayeshpatidar.blogspot.in
- 31. Types of Palpation Light palpation Deep palpation Bimanual palpation www.drjayeshpatidar.blogspot.in
- 32. Light Palpation The nurse apply tactile pressure slowly, gentely and deliberately. The nurse‟s hand is placed on the part to be examined and depressed about 1-2cm. www.drjayeshpatidar.blogspot.in
- 33. Deep Palpation It is done after light palpation. It is used to detect abdominal masses. Technique is similar to light palpation except that the finger are held at a greater angle to the body surface and the skin is depressed about 4-5 cm. www.drjayeshpatidar.blogspot.in
- 34. Bimanual Palpation It involve using both hand to trap a structure between them. This technique can be used to evaluate spleen, kidney, breast, uterus and ovary. Sensing hand – Relax & place lightly over the skin. Active hand – Apply pressure to the sensing hand. www.drjayeshpatidar.blogspot.in
- 36. Percussion Percussion involve tapping the body with the fingertips to evaluate the size, border and consistency of body organs and to discover fluid in body cavity. www.drjayeshpatidar.blogspot.in
- 37. Percussion Used to evaluate for presence of air or fluid in body tissues – Sound waves heard as percussion tones (resonance) www.drjayeshpatidar.blogspot.in
- 38. Methods of Percussion Mediate or Indirect Percussion Immediate Percussion Fist Percussion www.drjayeshpatidar.blogspot.in
- 39. Mediate or Indirect Percussion It can be performed by using the finger on one hand as a plexor (Striking finger) and the middle finger of the other hand as a pleximeter (the finger being struck). Used mainly to evaluate the abdomen or thorax. www.drjayeshpatidar.blogspot.in
- 40. Immediate Percussion Used mainly to evaluate the sinus or an infant thorax. It can be performed by striking the surface directly with the fingers of the hand. www.drjayeshpatidar.blogspot.in
- 41. Fist Percussion Used to evaluate the back and kidney for tenderness. It involves placing one hand flat against the body surface and striking the back of the hand with a clenched fist of the other hand. www.drjayeshpatidar.blogspot.in
- 42. Sounds Produced by Percussion Sound : Tympany Intensity : Loud Pitch : High Duration : Moderate Quality : Drumlike Common location : Air containing space, enclosed area, gastric air bubble, Puffed out cheek www.drjayeshpatidar.blogspot.in
- 43. Sounds Produced by Percussion Sound : Resonance Intensity : Moderate to Loud Pitch : Low Duration : Long Quality : Hollow Common location : Normal lungs www.drjayeshpatidar.blogspot.in
- 44. Sounds Produced by Percussion Sound : Hyper Resonance Intensity : Very Loud Pitch : Very Low Duration : Longer than resonance Quality : Booming Common location : Emphysematous lungs www.drjayeshpatidar.blogspot.in
- 45. Sounds Produced by Percussion Sound : Dullness Intensity : Soft to moderate Pitch : High Duration : Moderate Quality : Thudlike Common location : Liver www.drjayeshpatidar.blogspot.in
- 46. Sounds Produced by Percussion Sound : Flatness Intensity : Soft Pitch : High Duration : Short Quality : Flat Common location : Muscle www.drjayeshpatidar.blogspot.in
- 47. Auscultation Auscultation is listening to sound produce by the body. Through auscultation the nurse note the following characteristics of sound. Frequency or the number of oscillation generated per second by a vibrating object. Loudness – Loud or soft Quality – Blowing or Gurgling Duration – Length of time that sound vibration last. Short / medium / long. www.drjayeshpatidar.blogspot.in
- 48. Auscultation Best performed in a quiet environment Requires a stethoscope – Body sounds produced by movement of fluids or gases in patient's organs or tissues Note: – Intensity – Pitch – Duration – Quality www.drjayeshpatidar.blogspot.in
- 49. Stethoscope Used to evaluate sounds created by cardiovascular, respiratory, and gastrointestinal systems Position stethoscope between index and middle fingers www.drjayeshpatidar.blogspot.in
- 50. Olfaction While assessing a client, the nurse should be familiar with the nature and source of body odors. www.drjayeshpatidar.blogspot.in
- 51. Preparation for Examination Infection control : If patient have any open skin lesions and any drainage. Nurse has to maintained infection control and avoid infection. - use gloves - use apron - use mask - use gown www.drjayeshpatidar.blogspot.in
- 52. Environment Privacy Well equipped examination room Adequate lighting Sound proofed room Comfort environment Examination table www.drjayeshpatidar.blogspot.in
- 53. Equipment All necessary equipments for procedure. www.drjayeshpatidar.blogspot.in
- 54. Physical preparation Bladder and Bowel elimination Draped properly Dressed properly Positioning www.drjayeshpatidar.blogspot.in
- 55. Psychological preparation Explain procedure If both are opposite sex then third person is necessary. Observe facial expression Client should free from anxious feeling. Clarify client doubt. www.drjayeshpatidar.blogspot.in
- 56. General examination 1.Gender and race : Example – Skin cancer is 20% higher in white than black people. Prostate cancer is higher in African American than white American. 2. Age : old age people and children's are more prone to get infection. www.drjayeshpatidar.blogspot.in
- 57. 3. Signs of distress : Pain, Difficulty in breathing 4. Body type : Thin, Fat 5. Posture : Standing. Upright position, Knee flexed 6. Gait : Co-ordination proper or not, person normally walk with the arms swinging freely at the sides, with the head and face leading the body. www.drjayeshpatidar.blogspot.in
- 58. 7. Body movement : - Movement are purposefully. - If any part is immobile. 8. Hygiene and grooming : - Personal hygiene maintain or not. - Cosmetic used or not www.drjayeshpatidar.blogspot.in
- 59. 9. Dress : culture, life style, socio economic status. It should be appropriate according to weather condition. 10. Body odor : - Unpleasant odor - Poor hygiene - Bad breath - Poor oral hygiene www.drjayeshpatidar.blogspot.in
- 60. 11. Affect and mood : - Feeling‟s to other - Emotionally expression - Mood appropriate as per situation 12. Speech : Pressure, tone, speed. www.drjayeshpatidar.blogspot.in
- 61. 13. Client abuse : any problem during growing and serious health problem during childhood. 14. Substance abuse : - Drugs - Alcohol - Smoking - Ganja www.drjayeshpatidar.blogspot.in
- 62. Vital signs Temperature Pulse rate Respiratory rate Blood pressure www.drjayeshpatidar.blogspot.in
- 63. Temperature Measurement Oral temperature Hold thermometer firmly under tongue Tell child to “kiss” Caution to avoid biting www.drjayeshpatidar.blogspot.in
- 64. Axillary Temperature Hold arm down firmly Should be approximately 1 F less than core temp www.drjayeshpatidar.blogspot.in
- 65. Rectal Temperature Risk of perforation Avoid in uncooperative, or immuno-suppressed patient Stabilize thermometer www.drjayeshpatidar.blogspot.in
- 67. Respirations Adult rate – 16-24 breaths per minute Observe Feel for chest movement Auscultate www.drjayeshpatidar.blogspot.in
- 69. Blood Pressure Cuff Sphygmomanometer Measures systolic and diastolic blood pressure Manual or electronic www.drjayeshpatidar.blogspot.in
- 70. Anthropometry Height Weight Abdominal girth Mid arm circumference www.drjayeshpatidar.blogspot.in
- 71. Height and Build Descriptions include: – Average, tall, short, lanky ( long & thin ), muscular May also be affected by age and lifestyle www.drjayeshpatidar.blogspot.in
- 72. Weight Observe general appearance – Obese to emaciated Recent changes may be key finding – Recent weight loss or gain www.drjayeshpatidar.blogspot.in
- 73. Head to toe Examination Hair: Hair type : Terminal Hair : long, thick, found on axilla and pubic area. Vellus Hair : small, soft, found all over body except palm or sole. www.drjayeshpatidar.blogspot.in
- 75. Bittle hair With puberty hair colour, distribution and amount change. Hirsutism Lubrication of hair www.drjayeshpatidar.blogspot.in
- 77. Dandruff Reaction with shampoo Wig Using chemical for pediculosis treatment Using chemical to color www.drjayeshpatidar.blogspot.in
- 79. Eyes Visual activity: Visual field: Eye movement: Eye structure: Shape: Symmetry: Reactive to light Redness and swelling Eye chart reading ( snellen‟s chart ) www.drjayeshpatidar.blogspot.in
- 80. Discharges: Eye alignment: Eye brows: Eye lids: Use of glasses or contact lenses: Corneal reflex Lacrimal function Ophthalmoscope used to see any abnormalities in eyes www.drjayeshpatidar.blogspot.in
- 81. Ears Structure: Symmetry: Obstruction: Position and alignment: Size: www.drjayeshpatidar.blogspot.in
- 82. Shape: Discharge: Inflammation: Hearing AID: Otoscope is used to see internal ear structure Hearing activity: Weber‟s test: Rinne test: www.drjayeshpatidar.blogspot.in
- 84. Mucus colour: Patency of Nair: Epistaxis: Discharge: Polyp‟s: DNS: Pen light and nasal speculum is used to see nose www.drjayeshpatidar.blogspot.in
- 86. Lips Colour: -Cherry :carbon-monoxide poisoning -Pallor: Anemia -Cyanosed: Respiratory or cardiac problem www.drjayeshpatidar.blogspot.in
- 87. Dryness Smoothness Crack lips With mouth closed the nurse view the lips from end to end. Remove lipstick before examination of lips. www.drjayeshpatidar.blogspot.in
- 88. Teeth Arrangement: Dental hygiene: Loose teeth: Colour of teeth: Halitosis: Dentures www.drjayeshpatidar.blogspot.in
- 89. Upper molar should rest directly on the lower molar with upper incisors slightly overriding the lower incisors. Dental caries – discoloration of the enamel www.drjayeshpatidar.blogspot.in
- 90. Gums Colour: Edema: Gingivitis: Ulcer: Healthy gums are pink, smooth and moist. Spongy gums bleed easily ( vit-c deficiency ) www.drjayeshpatidar.blogspot.in
- 91. Oral mucosa Color: Pinkish red moist/dry: Ulcer: Lesion: Leuckoplakia: thick white patches because of smoking and alcohol. www.drjayeshpatidar.blogspot.in
- 92. Tongue The client first relax the mouth and sticks the tongue out halfway. Slightly rough on the top surface and smooth along the lateral margin. Under surface of the tongue and floor of the mouth are highly vascular. Observe for cyst, lesions, swelling and nodule on the back side of tongue. Examination of tongue : Protrude the tongue, grasp the tip and gently pulls it to one side. www.drjayeshpatidar.blogspot.in
- 93. Movement: Shape: Ulcer: Lesions: Protrude of tongue: Taste of tongue: Colour: Moist: Glossitis: www.drjayeshpatidar.blogspot.in
- 94. Palate Extend the Head backward and open the mouth and inspect hard palate & soft palate Hard palate: Anterior part of palate Shape: Dome shape Colour: Whitish Soft palate: Posterior part of palate Shape: „C” shape Colour: Light pink www.drjayeshpatidar.blogspot.in
- 95. Pharynx Procedure : Extend his neck slightly, open the mouth widely and say „ah‟. Place tongue depressor on the middle third of tongue. Use penlight for inspection. Inspect for edema, ulcer, inflammation, lesions. Gag reflex Dysphagia www.drjayeshpatidar.blogspot.in
- 96. Neck Examine the anatomical position of neck. Function of sternocleidomastoid muscle : the nurse ask the client to flex the neck with the chin to the chest. Function of the trapezius muscles : movement of the head sideway so that the ear moves toward the shoulder. Neck should move freely without any pain. www.drjayeshpatidar.blogspot.in
- 97. Movement of neck : Stiff ness: Swelling: Neck muscle: ROM: Lymph nodes : With the client‟s chin raised and head tilted slightly, the nurse first inspect the area where lymph nodes are distributed. Inspect for size, shape, inflammation and mobility. www.drjayeshpatidar.blogspot.in
- 98. Thyroid gland It lies anterior lower neck, in front of neck and both side of trachea. Inspect for visible mass of thyroid gland, symmetry and fullness at the base of neck. Give water then see for bulging of the gland. Palpation : Client flex the neck forward and laterally toward the side being examined. The client hold a cup of water and take a sip to swallow. www.drjayeshpatidar.blogspot.in
- 99. Anterior Part : using the pads of the index and middle finger, the nurse palpate the left lobe with the right hand and right lobe with left hand. Posterior Part : Both hand of the nurse are keep around the neck with two finger of each hand on the side of trachea. www.drjayeshpatidar.blogspot.in
- 100. Breast Female: – Symmetry – Pain: – Lump: – Discharge: – Swelling: – Trauma: – History of breast disease: – Surgery: www.drjayeshpatidar.blogspot.in
- 102. Thorax & Lung Thorax size: Thorax shape: Chest movement: Respiratory rate: Rhythm: Breathing pattern: www.drjayeshpatidar.blogspot.in
- 103. Breathing sound: Chest pain with breathing: Cough: Productive & Nonproductive: Hemoptysis: www.drjayeshpatidar.blogspot.in
- 104. Cardio vascular system Apical pulse: To find the apical pulse the nurse locate the 5th ICS just to the left to the sternum and move the fingers laterally, just medial to the left mid- clavicular line. Redial: Rt…………….. Lt……………. Heart rate: Rhythm: www.drjayeshpatidar.blogspot.in
- 105. Perfusion: Edema: because of heart failure Site of edema: Cyanosis or Pallor: Because of MI Fatigue: Because of decrease cardiac output www.drjayeshpatidar.blogspot.in
- 106. Gastro- intestinal system Abdomen Size: Shape: Abdomen distention: Surgical mark: www.drjayeshpatidar.blogspot.in
- 107. Stool frequency / Character: Last movement : Ostomy present: Bowel sound www.drjayeshpatidar.blogspot.in
- 108. Reproductive system Urinary complain: Discharge: Anuria: Haematuria: Dysuria: Urinary Incontinence: Urinary Retention: www.drjayeshpatidar.blogspot.in
- 109. Urine last voided: Catheter present: Any other: Male – Opening of penis: – Penile Discharge: If „Yes‟ describe www.drjayeshpatidar.blogspot.in
- 110. Female -LMP: -Vaginal discharge: -If „Yes‟ describe www.drjayeshpatidar.blogspot.in
- 111. Skin Colour: Rashes: Lesion: Surgical scar: Abnormal growth: Secretion: If „Yes‟ then describe: www.drjayeshpatidar.blogspot.in
- 112. Musculoskeletal ROM: Weakness / paralysis / contracture / joint swelling / pain /other: Extremity strength: www.drjayeshpatidar.blogspot.in
- 118. Spine Curvature of spine observe for: Lordosis: Increase lumber curvature Scoliosis: Lateral spinal curvature Kyphosis: Exaggeration of posterior curvature of thoracic spine www.drjayeshpatidar.blogspot.in
- 121. Neurological Examination Orientation – To place / person / time Level of conscious - confused / alert / restless / lethargic / comatose Co-ordination to walk: Equilibrium test: Sensation test: Pain Temperature Vibration Touch www.drjayeshpatidar.blogspot.in
- 124. Reflexes Biceps: Triceps: Patellar: Achilles: Planter: Gluteal: www.drjayeshpatidar.blogspot.in
- 125. Biceps Identify biceps tendon have patient flex elbow against resistance while you palpate antecubital fossa Place arm so it‟s bent ~ 90 degrees Place one of your fingers on tendon and strike it. Reflex : Flexion of arm at elbow. www.drjayeshpatidar.blogspot.in
- 127. Triceps Flex client‟s arm at elbow, holding arm across chest or hold upper arm horizontally. Strike triceps tendon just above elbow. Reflex : Extension at elbow. www.drjayeshpatidar.blogspot.in
- 129. Patellar Have client sit with leg hanging freely over side of table. Tap patellar tendon just below patella. Reflex : Extension of lower leg. www.drjayeshpatidar.blogspot.in
- 131. Achilles Have client assume same position as for patellar reflex. Slightly dorsiflex client‟s ankle by grasping toes in palm of your hand. Strike Achilles tendon just above heel at ankle malleolus. Reflex : Planter flexion of foot. www.drjayeshpatidar.blogspot.in
- 133. Planter: Have client lie supine with legs straight and feet relaxed. Take handle end of reflex hammer and stroke lateral aspect of sole from heel to ball of foot, curving across ball of foot toward big toe. Reflex : Planter flexion of all toes. www.drjayeshpatidar.blogspot.in
- 135. Gluteal: Have client assume side lying position. Spread buttocks apart and lightly stimulate perineal area with cotton applicator. Reflex : Contraction of anal sphincter www.drjayeshpatidar.blogspot.in