PHYSICAL EXAMINATION IN ENGLISH
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PHYSICAL EXAMINATION-
} A health assessment is a process to identify specific health needs and level of health status of a person . Basically health assessment involves two steps-
} History taking and
} Physical examination
PHYSICAL EXAMINATION-
} The physical examination generally follows the health history. The physical examination provides a complete picture of the client’s physiological functioning and a data base on which a comprehensive plan of care is prepared.
OBJECTIVE OF PHYSICAL EXAMINATION-
} The physical examination fulfills all objectives complete assessment data such as
} To know the client’s level of health and physiological Function.
} To Identify factors placing the client at risk for problems.
} To Determine areas of preventive nursing
} To Confirm alterations, disease, or inability to perform the activities of daily living
} To Identify the need for additional testing or examination
} To Evaluate the outcomes of treatment and therapy
The techniques or skills required for the physical examination are-
} Inspection,
} Palpation,
} Percussion, and
} Auscultation
INSPECTION-
} This step is observation and visual examination. It is systematic, orderly, and purposeful for example, examining the skin for color and hair growth patterns. Inspection begins the moment you first meet the person and develop a “general survey.”
} Inspection requires good lighting, preferably natural daylight. The area to be inspected must be fully exposed and observable. Systematically observe color, size, shape, symmetry, and position of any lesions.
PALPATION-
} Palpation applies your sense of touch to assess these factors: texture; temperature; moisture; organ location and size; and any swelling, vibration or pulsation, rigidity or spasticity, crepitation, presence of lumps or masses, and presence of tenderness or pain
} Always explain reason for touch to client.
} Warm hands before touching the patient.
} Start with light palpation before deep palpation.
} Use pads of fingers to identify texture, size, shape, or movement (e.g.,pulse).
} Use dorsum of fingers for temperature assessment.
} Gently pinch skin to assess turgor on forehead or upper third of sternum.
} Use palms or ulnar side of hand to assess vibrations.
} Palpate painful areas last.
PERCUSSION-
} Percussion is tapping the person’s skin with short, sharp strokes to assess underlying structures. The strokes yield a palpable vibration and a characteristic sound that depicts the location, size, and density of the underlying organ.
} A basic principle is that a structure with relatively more air (the lungs) produces a louder, deeper, and longer sound because it vibrates freely; whereas a denser, more solid structure (the liver) gives a softer, higher, shorter sound because it does not vibrate as easily
AUSCULTATION-
} Auscultation is listening to sounds produced by the body, such as the heart and blood vessels and the lungs and abdomen. most body sounds are very soft and must be channeled through a stethoscope to evaluate them easily.
} while using the stethoscope the slope of the earpiece should point forward toward your nose. This matches the natural slope of your ear canal and efficiently blocks out environmental sound.
} You should use the diaphragm most often because its flat edge is best for high-pitched sounds—breath, bowel, and normal heart sounds. The bell end piece has a deep, hollow, cuplike shape. It is best for soft, low-pitched sounds such as extra heart sounds or murmurs.
STEPS OF PHYSICAL EXAMINATION-
} Provide a warm, comfortable, private environment with natural lighting, if possible.
}
Eliminate distractions and disruptions.
}
Check all needed equipment for proper
functioning, and place it within easy reach. Explain equipment as it is used.
} Have the client void before the examination; collect clean specimen if needed.
} Explain each step as the examination progresses. Tell the client how much time will be involved in the entire examination.
} Warm your hands and instruments before touching the client’s skin.
} Drape the client well, exposing only those areas that are being examined.
}
Be aware of your nonverbal communication during
the examination; avoid frightening, intimidating, or embarrassing the client.
}
Warn the client when any part of the examination
may be uncomfortable or painful.
} Start physical examination starting from
head-Inspect, palpate
}
Cranium
}
Eyes
}
Ears
}
Nose
}
Sinuses
} Mouth
}
Throat
}
Preauricular nodes
}
Postauricular nodes and
}
Occipital nodes
Neck -Inspect, palpate
}
Carotid pulses
}
Thyroid gland
}
Lymph nodes
}
Range of motion
}
Jugular veins
Back
- Inspect,
percuss, palpate, auscultate
- Fremitus,
respiratory excursion
- Symmetry,
spinal alignment
- Costovertebral
angle tenderness
- Mobility
Anterior Trunk
- Inspect
the breasts.
- Auscultate
breath sounds, heart sounds, carotid pulses, apical pulse
- Assess
ROM of upper extremities.
- Palpate
brachial pulses.
- Palpate
the breasts and axillary lymph nodes.
Abdomen
- Inspect
movement, color, contour.
- Auscultate
the four quadrants of abdomen.
- Auscultate
for bruits over abdominal aorta, renal artery, iliac artery, and femoral
artery.
- Percuss
the abdomen.
- Palpate
the abdomen.
Abdomen
- Palpate
and/or percuss for bladder distention.
- Measure
the size of the liver.
- Palpate
the inguinal nodes, femoral pulses.
- Assess
ROM of remaining joints in hands and legs.
- Inspect
hands and leg for deformities
Finally assess
- -Musculo skeletal system
- -Nervous system and
- -Genitourinary system
- By inspection and palpation
- Documentation of physical examination is an important step. Without adequate recording, the assessment is limited in its use and value. Documentation helps the health-care team exchange information and prevents the client from enduring needless repetitions.
Thank you sir
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