COLLECTION OF OBJECTIVE DATA

before you start with the collection of your objective data, there are a few steps that you need to take

in preparation for examination:

1. INFECTION CONTROL

- examination techniques cause the nurse to contact body fluids and discharge.

- standard precautions should be used throughout the examination as appropriate.

- it becomes necessary to wear gloves during palpation and percussion to reduce contact with microorganisms

 before you approach your patient like any other nursing procedure, there is a need for you to wash your hands
 if you will be in contact with body fluids and discharges, you can put on your gloves
 always make sure whether your patient has signs and symptoms or not, there is a need for you to put on your
mask

2. PREPARE THE ENVIRONMENT

PRIVACY

- this done you have to make sure that your patient's body parts will not be exposed
- in a ward, for example, you need to provide privacy by using drapes or using curtains if there are available, if
there are more than one person in a room then you can request like visitors then you can request the visitors to
go out of the room for a while you do your physical examination
- when the student nurse is a male and the patient is a female patient who feel comfortable if somebody else
would be with them, what you can do is you can ask if a patient is a female, then you can ask a female classmate
to accompany you when you do your physical assessment
- for privacy only, expose the part or the body part to be examined, the rest you need to properly drape your
patient

A WELL-EQUIPPED EXAMINATION ROOM

- to prepare the room with all the materials needed for examination

USE ROOM CURTAINS OR DIVIDERS AROUND THE BED

- you need to use room curtains or dividers around the bed so that your patient's body parts will not be exposed
to the other persons in the room

PROVIDE ADEQUATE LIGHTING AS NECESSARY FOR PROPER ILLUMINATION OF BODY PARTS

- there is a need to have proper lighting.

PRIMARY LIGHTING: daylight or artificial daylight meaning
 there is proper the sun or there are windows in the room for you to see the certain body part or you can
have artificial lighting which is with the use of the lights if the light is enough that they could reveal the
skin characteristics for example, without shadows
AN EXAMINATION ROOM IS SOUNDPROOF SO THAT THE CLIENTS FEEL COMFORTABLE DISCUSSING THEIR
CONDITIONS:
 you might also encounter patients when they have significant others or other people in their room, they
do not feel comfortable in discussing their condition, they would be more comfortable answering those
questions when it is just you and the patient in the room

ELIMINATE SOURCES OF NOISE SUCH AS RADIO OR TV:

  when the tv or the radio is on like let's say your patient is staying in a private room then there is a need
for you ask permission you can say it nicely to the patient and the significant others that because you
will be doing physical examination, there is a need for you to turn off the radio and the tv so that you
can do your proper examination if they will not allow that the tv and the radio be turned off then maybe
they can decrease the volume of the tv or the radio

TAKE STEPS TO PREVENT INTERRUPTIONS FROM OTHERS:

MAKE SURE THAT THE ROOM IS WARM ENOUGH FOR THE CLIENT'S COMFORT:

 you can open the windows, but you must put the curtain down or you can turn the fan on so that the
temperature would be appropriate for the patient as well
 if the patient would feel that the room is too cold then maybe you can increase the temperature for the
patient, you can provide blankets for your patient

3. EQUIPMENT

- Handwashing should be done before equipment preparation and before the examination.

before you prepare your equipment, you also need to do proper hand washing and then before the examination or even
after the examination, there's also a need to do proper hand washing for your equipment after, before using you can
alcoholize that equipment and then after using the equipment you can also alcoholize them

- equipment should be:

CLEAN

- you must check your equipment whether they're clean or not make sure that there are no stains or whatsoever
and then

READILY AVAILABLE

- it should be within your reach when you perform the procedure

ARRANGED IN ORDER FOR EASY USE

- you have trace with you when you will be doing the physical examination then you must arrange all the
materials in your tray in an orderly manner, it should not be disarranged because it is also a reflection of your
personality

DIAPHRAGM OF THE STETHOSCOPE MUST BE BRISKLY RUBBED BEFORE THE HANDS BETWEEN THE HANDS BEFORE IT IS
APPLIED TO THE PATIENT'S SKIN

- you would use a stethoscope to your patient, make sure that you rub the diaphragm with your palm or in
between your hands so that it will be warm enough because if you will not do that, your examination using a
stethoscope that part the diaphragm will also be cold, and it will startle your patients
- for ex. vaginal examination, if there is a need to use the vaginal speculum you must run warm water on the
speculum before you give it to the doctor for examination because the vaginal speculum is made of metal and
when it is placed in a cold room for a long period of time.

ALL EQUIPMENT SHOULD BE CHECKED TO ENSURE THAT IT FUNCTIONS PROPERLY

- before you perform your procedure, there is a need for you to check whether your materials or your equipment
are properly functioning
- for ex. you will be using a pen light to check on the eyes and the pupils of your patient before the start of your
examination, make sure that the battery is working well and that the pen light is working that the light will be on
when you before you use it to your patient
 - you must make sure that your stethoscope is working well check on your step and other materials

4. PHYSICALLY PREPARE YOUR CLIENT

Client’s comfort is VITAL for a successful examination

Before starting, ask client to VOID

 before the start of your examination, you must ask your patient to void. you must explain to them the reason
why there is a need to urinate
 if your patients will have a hard time ambulating or walking from the bed to the to the cr then you can offer
them urinals for male and bedpan for females
 assess first whether your patients can walk from the bed to the cr

Explain the proper method of collecting specimen

 if there is a need to collect a specimen, give them proper instructions on how to do the urine specimen
collection
 infection control practices should be observed when collecting specimen yeah
 if you will be the one to collect a specimen, you need to put on clean gloves to protect your hands

Ensure that each specimen is properly labeled.

Infection control practices should be observed when collecting specimen

Make sure that your client is dressed and properly draped

- so, there is a need for you to check or to if your patient is just wearing his normal clothes then there is a need to
offer them or give them the patient's gown, to make the procedure or to make examination of body parts easier
for us

Make sure that the client stays warm:

a. eliminating draft - if you feel that the room is a bit windy then you can close the windows

b. control the room temperature - if the room is air conditioned, increase the temp

c. provide warm blankets - if the patient still feels cold

IMPORTANT: Ask if client is comfortable throughout the procedure

- there actually is no need to check or ask from time to time bc you can also look at the patient's expression to
participate in the procedure

5. POSITIONING

 client’s ability to assume positions depend on:

a. physical strength

b. mobility

c. ease of breathing
d. age

e. degree of wellness

 explain the position and assist client in attaining them

 drapes should be properly adjusted
 more than one position can be assumed for the same body part, the nurse first chooses the position that
provides greater accessibility and accuracy

DIFFERENT POSITIONS

1. SITTING

 the client should sit upright on the side of the examination table

- areas assessed: this position is good for evaluating the head, the neck, lungs, anterior and posterior thorax, breasts
axilla, heart, vital signs, upper and lower extremities

- rationale: this position is also useful because it permits full expansion of the lungs, and it allows the examiner to assess
symmetry of upper body parts

2. SUPINE

 you must ask your patients to lie down with the legs together on the examination table or on the bed a small
pillow may be placed under the head to promote comfort especially for those who have difficulty in breathing
 when you have observed that your patients increased, you should let them stay in the supine position then
there is a need to place pillow under his head, this position allows the abdominal muscles to relax, and it
provides easy access to peripheral fall sites
- areas assessed: with the client in this position may include head, neck, anterior thorax ,and lungs, breast
axilla heart abdomen extremities and of course our pulses
- rationale: the most normally relaxed position. It provides easy access to pulse sites.

3. DORSAL RECUMBENT (higda nga ga bilingkad)

 you to let the patient assume this position instruct the client to lie down on the examination table or bed with
the knees bent
 they must be bent, and the legs should be separated and the feet flat on the table or bed
 this position may be more comfortable than the supine position for clients who are experiencing abdominal pain
or even back pains

- areas assessed: head and neck anterior thorax lungs breast axilla hearth and the abdomen

- rationale: this position is used for abdominal assessment because it promotes the relaxation of the abdominal muscles

4. LITHOTOMY POSITION (katong murag manganak)

- areas assessed: in this position would be female genitalia and the genital tract

- rationale: this position provides maximal exposures of genitalia and facilitates insertion of vaginal speculum.

 in this position, the client lies on the back with the hips at the edge of the examination table and the feet
supported by stirrups (the metal and or under the heel of the patient)
 this position is an exposed position and most of our clients may feel embarrassed
 elderly clients may not be able to assume this position for a long time
5. SIMS (akong fave)

 the client lies on the right or the left side with the lower arm placed behind the body at the back and the lower
arm is flex at the shoulder and elbow the lower leg is slightly flexed at the knee while the upper leg is flexed at
the sharper angle and pulled forward
 this is quite a difficult position so your patients would need your assistant patients with joint problems and
elderly clients may have more difficulty in assuming this position

- areas assessed: this position is useful for assessing the rectum and the vagina

- rationale: flexion of hip and knee improves exposure of rectal area

6. PRONE

 This position the client lies down on the abdomen with the head on the side
 this position is used primarily to assess the hip joint and the back can also be assessed with a gland in this
position but clients with cardio and respiratory problems cannot or have a hard time tolerating
- areas assessed: musculoskeletal system
- rationale: this position is used only to assess extension of the hip joint

7. LATERAL RECUMBENT (side-lying)

- areas assessed: in this position would be the heart

- rationale: this position aids in detecting murmurs/reverse of the heart

8. KNEE-CHEST

the client kneels on the examination table with the weight of the body supported by the chest and the knees there's a
90-degree angle which should exist between the body and the hips, and the arms are placed above the head with the
head turned to one side a small pillow may also be used for comfort

- areas assessed: rectum

- rationale: this position provides maximal exposure of rectal area

PSYCHOLOGICAL PREPARATION OF THE CLIENT

 Clients are easily embarrassed when forced to answer sensitive questions about bodily functions or when body
parts are exposed
 The possibility that the examiner will find something abnormal also creates anxiety, so reduction of this anxiety
may be the nurse’s highest priority before the examination.
 The nurse should convey an open, receptive, and professional approach
 a stiff, formal demeanor may inhibit the client's ability to communicate, but a style that is too casual may fail to
instill confidence.
 a thorough examination lets clients know what to expect and what to do so that they can cooperate
 the nurse first explains the examination in general terms. Then, as the nurse examines each body system, a
more detailed explanation is given
 the nurses use simple terms when describing the steps of the examination
 complicated terminology confuses clients and adds to their fears.
 The nurse’s manner should be professional, but the voice tone and facial expressions should be relaxed to put
clients at ease.
 The nurse encourages clients to ask questions and mention any discomfort they feel during the assessment.
 When the client and nurse are of opposite gender, it may be necessary to have a third person of the client’s
gender in the room, especially when examination of the sexual organs is required.
 The presence of a third person assures the client that the examiner will behave ethically, and the third person
acts as a witness to the examiner’s proper conduct.
 During the examination the nurse watches the client’s emotional responses.
 The nurse observes whether the client’s facial expression convey fear or concern and whether body movements
reveal anxiety, such as frequently pulling the drape around the body or tensing up as the examiner touches the
body.
 The nurse must remain calm and clearly explain each step of the assessment.
 it may be necessary to stop the examination or ask whether the client feels anxious afraid or uncomfortable
 the client should not be forced to continue
 postponing examination until a later time may be advantageous because the findings will be more accurate
when the patient is cooperative and is relaxed
 if the fears result from misconceptions, then you as a nurse can clarify the purpose of the examination and how
it is performed