Name: Frances Nicole D.

Flores Date: 01/14/2022

Program &Section: BSN1C Clinical Instructor: Ms. Joenalyn Calapatia

Course: Health Assessment-RLE Term: 1st year – 2nd Sem

Assignment #2

I. Different Positions of the Patient

Patient Positioning
- involves properly maintaining a patient’s neutral body alignment by
preventing hyperextension and extreme lateral rotation to prevent
complications of immobility and injury.
Why is it essential to nursing practice?

- Positioning patients is an essential aspect of nursing practice and a responsibility of

the registered nurse. In surgery, specimen collection, or other treatments, proper
patient positioning provides optimal exposure of the surgical/treatment site and
maintenance of the patient’s dignity by controlling unnecessary exposure. In most
settings, positioning patients provide airway management and ventilation, maintaining
body alignment, and provide physiologic safety.

Guidelines for Patient Positioning

 Explain the procedure. 

 Encourage client to assist as much as possible. 
 Get adequate help. 
 Use mechanical aids. 
 Raise client’s bed. 
 Frequent position changes. 
 Avoid friction and shearing. 
 Proper body mechanics
 To determine the best position for your patient, you must first consider the type of
operation, how long it will take, what kind of IV access you need, and other details of the
procedure.

Different Positions of the Patient

 Fowler’s Position
- Also known as sitting position.
- has the patient reclining on a bed at various elevations
- has varieties of this position includes:
o Low Fowler’s – where the head of the bed sits at 15 to30 degrees.
o Semi-Fowler’s – with an elevation of 30 to 45 degrees.
o High Fowler’s – which has the patient sitting nearly vertically.
- useful for head, chest, and shoulder surgeries.
 Supine
- Also called as dorsal recumbent
- the most natural of the different positions for
patient procedures.
- it has a patient lying on their back, legs might remain
extended or slightly bent. Similarly, arms may be
tucked by the patient’s sides, secured across their
torso, or strapped onto padded arm boards.
- The supine position grants access to a patient’s face, torso, and extremities, making
it useful for cardiac and abdominal procedures as well as many general exams.
 Trendelenburg
- like the supine position, except you tilt the bed so that the patient’s head is lower
than their body while their feet are higher.
- often use this position for gynecological and lower abdominal surgeries.
o Reverse Trendelenburg
– the position elevates the head and lowers the foot of the bed.
– effective for gastrointestinal operations.
 When using either of these positions, it’s important to secure the patient to
the bed to prevent sliding.
- Fowler’s position is named after George Ryerson Fowler who saw it to decrease
mortality of peritonitis.
 Orthopneic
- tripod position
- places the patient in a sitting position or on the side of
the b ed with an overbed table in front to lean on and
several pillows on the table to rest on
- useful for maximum lung expansion.
 Prone
- the patient lies on the abdomen with head turned to one side and the
hips are not flexed.
- comfortable for some patients.
- the only bed position that allows full extension of the hip and knee
joints. It also helps to prevent flexion contractures of the hips and knees.
- also promotes drainage from the mouth and useful for clients who are unconscious
or those recover from surgery of the mouth or throat.
- often used for neurosurgery, in most neck and spine surgeries.

 Lateral
- side-lying position
- the patient lies on one side of the body with the top leg in front of the bottom leg
and the hip and knee flexed.
- Flexing the top hip and knee and placing this leg in front of the body creates a wider,
triangular base of support and achieves greater stability.
- Increase in flexion of the top hip and knee provides greater stability and balance.
(This flexion reduces lordosis and promotes good back alignment).
- helps relieve pressure on the sacrum and heels especially for people who sit or are
confined to bed rest in supine or Fowler’s position.
 Sim’s Position
- Semi prone position
- When the patient assumes a posture halfway between the lateral
and the prone positions.
- The lower arm is positioned behind the client, and the upper arm
is flexed at the shoulder and the elbow. The upper leg is more
acutely flexed at both the hip and the knee, than is the lower
one.
- often used for clients receiving enemas and occasionally for clients undergoing
examinations or treatments of the perineal area.
- Pregnant women may find the Sims position comfortable for sleeping.
 Lithotomy
- is a patient position in which the patient is on their back with
hips and knees flexed and thighs apart.
- commonly used for vaginal examinations and childbirth.
- Modifications of the lithotomy position includes:

o Low Lithotomy Position – The patient’s hips are flexed until the angle
between the posterior surface of the patient’s thighs and the O.R. bed
surface is 40 degrees to 60 degrees. The patient’s lower legs are parallel
with the O.R. bed.2
o Standard Lithotomy Position – the patient’s hips are flexed until the angle
between the posterior surface of the patient’s thighs and the O.R. bed
surface is 80 degrees to 100 degrees. The patient’s lower legs are parallel
with the O.R. bed.
o Hemi lithotomy Position – The patient’s non-operative leg is positioned in
standard lithotomy. The patient’s operative leg may be placed in traction.
o High Lithotomy Position – the patient’s hips are flexed until the angle
between the posterior surface of the patient’s thighs and the O.R. bed
surface is 110 degrees to 120 degrees. The patient’s lower legs are flexed.
o Exaggerated Lithotomy Position – the patient’s hips are flexed until the
angle between the posterior surface of the patient’s thighs and the O.R. bed
surface is 130 degrees to 150 degrees. The patient’s lower legs are almost
vertical.

 Knee Chest
- can be in lateral or prone position
 o Lateral knee-chest position – the patient lies on their side,
torso lies diagonally across the table, hips and knees are
flexed.
o Prone knee-chest position – the patient kneels on the table
and lower shoulders on to the table so chest and face rests
on the table.
- Usual position adopted for sigmoidoscopy without anesthesia.
- assumed for a gynecologic or rectal examination.
 Jackknife
- Also known as Kraske
- Wherein the patient’s abdomen lies flat on the bed (bed is
scissored so the hip is lifter, and the legs and head are low).
- frequently used for surgeries involving the anus, rectum,
coccyx, certain back surgeries, and adrenal surgery.
- At least four people are required to perform the transfer and position the patient in
the operating table.
 Kidney
- the patient assumes a modified lateral position wherein the abdomen is placed over
a lift in the operating table that bends the body.
- Patient is turned on their contralateral side with their back placed on the edge of
the table. Contralateral kidney is placed over the break in the table or over the
kidney body elevator.
- The uppermost arm is placed in a gutter rest at no more than 90º abduction or
flexion.
- allows access and visualization of the retroperitoneal area. A kidney rest is placed
under the patient at the location of the lift.

Goal of Patient Positioning

- to safeguard the patient from injury and physiological complications of immobility.

Specifically, patient positioning goals includes:
 Provide patient comfort and safety
 Maintaining patient dignity and privacy
 Allows maximum visibility and access.
II. Physical Assessment Technique (IPPA)
Four primary techniques are used in the physical examination: inspection, palpation,
percussion, and auscultation.
 Inspection
- is a visual examination of the patient; palpation is done when the person doing the
assessment places their fingers on the body to determine things like swelling,
masses, and areas of pain.
 Palpation
- can include light and deep palpation.
 - Deep palpation is cautiously done after light palpation when necessary because the
client's responses to deep palpation may include their tightening of the abdominal
muscles.
- for example, which will make the light palpation less effective for this assessment,
particularly if an area of pain or tenderness has been palpated.
 Percussion
- is the tapping the patient's bodily surfaces and hearing the resulting sounds to
determine the presence of things like air and solid masses affecting internal organs.
- The sounds that are heard with percussion are resonance, which is a hollow sound,
flatness which is typically hear over solid things like bone, hyper resonance, which is
a loud booming sound, and tympany which is a drum type sound.
 Auscultation
- is the listening to an area of the body using a stethoscope.
- For example, bowel sounds, lung sounds, and heart sounds are auscultated with a
stethoscope.
- The sounds that are heard with auscultation are classified and described according
to their duration, pitch, intensity, and quality.

Note: A thorough physical assessment consists of the following:

 Vital signs
 The assessment of the thorax and lungs including lung sounds
 The assessment of the cardiovascular system including heart sounds
 The assessment of the head
 The assessment of the neck
 The integumentary system assessment
 The assessment of the peripheral vascular system
 The assessment of the breast and axillae
 The assessment of the abdomen
 The assessment of the musculoskeletal system
 The assessment of the neurological system including all the reflexes
 The assessment of the male and female genitalia and inguinal lymph nodes and
 The assessment of the rectum and anus

III. Data Collection Technique and Tools (Equipment and Supplies Used for a Health
Examination  
A. Data Collection Technique and Tools)
1. Interview
 the key to efficient interviews is knowing what to ask. Efficiency in
interviewing is crucial because, of all the primary data collection methods,
in-person interviewing can be the most expensive.
 There are ways to limit the cost of interviews, such as conducting them
over the phone or through a web chat interface. But sometimes an in-
person interview can be worth the cost, as the interviewer can tailor
follow-up questions based on responses in a real-time exchange.
  Interviews also allow for open-ended questions. Compared to other
primary data collection methods, such as surveys, interviews are more
customizable and responsive.
2. Observation
 Observation involves collecting information without asking
questions.
 This method is more subjective, as it requires the researcher, or
observer, to add their judgment to the data. But in some
circumstances, the risk of bias is minimal.
 Variables that require the observer to make distinctions can
introduce potential problems.
 In general, observation can determine the dynamics of a situation,
which generally cannot be measured through other data collection
techniques.
 Observation also can be combined with additional information,
such as video.
3. Documents and Records
 Document- and records-based research uses existing data for a
study.
 Attendance records, meeting minutes, and financial records are
just a few examples of this type of research.
 Using documents and records can be efficient and inexpensive
because you’re predominantly using research that has already
been completed.
 However, since the researcher has less control over the results,
documents and records can be an incomplete data source
4. Focus Group
 A combination of interviewing, surveying, and observing, a focus
group is a data collection method that involves several individuals
who have something in common.
 It aims to add a collective element to individual data collection.
Focus groups often use open-ended questions such as, “How did
you feel about the presentation?” or “What did you like best about
the product?”
 The focus group moderator can ask the group to reflect on the
shared experience rather than forward it to the future.
 Open-ended questions ground the research in a particular state of
mind, eliminating external interference
5. Oral Histories
 Both data collection methods involve asking questions.
 more precisely defined as the recording, preservation, and
interpretation of historical information based on the opinions and
personal experiences of people involved in the events.
  Unlike interviews and surveys, oral histories are linked to a single
phenomenon.
 For example, a researcher may be interested in studying the effect
of a flood on a community.
 Oral history can shed light on exactly what transpired. It’s a holistic
approach to evaluation that uses a variety of techniques.
6. Questionnaires and Surveys
 Questionnaires and surveys can be used to ask questions that have
closed-ended answers.
 Data gathered from questionnaires and surveys can be analyzed in
many ways.
 You can assign numerical values to the data to speed up the
analysis.
 It can be helpful if you’re collecting a large amount of data from a
large population.
 Surveys can be conducted as interviews, but it makes sense to
conduct surveys using forms in most cases.
 Online forms are a modern and effective way to conduct surveys.
Unlike written surveys, which are static, the questions presented in
online forms can change according to how someone responds
B. Equipment and Supplies used for a Health Examination

 Additional Supplies are needed for a general physical examination. They include cotton
balls, cotton-tipped applicators, disposable needles, disposable syringes, gauze, dressings
and bandages, gloves, paper tissues, specimen containers, and tongue depressors.
Tool and Supplies:
1. Cotton Balls – used to stop bleeding from minor punctures after injections or
while drawing a patient’s blood.
2. Cotton-Tipped Applicators – used to collect or treat a wound and to apply
topical medication to the patient during a physical examination.
3. Disposable Needles – used to inject medicine, anesthetic, or other fluids
during a physical examination. Also used to extract blood from the patient for
laboratory testing.
4. Disposable Syringes – added to a needle to extract blood or inject fluids
during a physical examination.
5. Gauze, Dressings and Bandages – used to cover up open wounds. Non-sterile
pads can be used to cushion, clean, or absorb areas that are at less risk of
infection.
6. Gloves – worn by the medical assistant and physician to keep bodily fluids
from being absorbed into the skin.
7. Paper Tissue – helps keep exam chairs, tables, and other areas hygienic. The
paper tissue is replaced between each examination by the medical assistant.
8. Specimen Containers – used to hold blood, urine, and other bodily fluids
during an examination for later laboratory testing.
9. Tongue Depressors – used to depress the tongue of a patient to examine the
mouth and throat during a physical examination.
 Instruments

1. Audio scope 
- tool used to screen patients for hearing loss.
- It is placed in the patient’s ear and makes a serious of tones which the patient can
respond to.
2. Examination Light 
- the medical assistant must make sure that all lights in the physical examination
room are functioning properly and directed appropriately for the physician to exam
the patient’s body.
3. Laryngeal Mirror 
- tool used to exam the larynx and other areas of the throat.
- It reflects the inside of the mouth and throat for the physical examination.
- It may be used to visualize the throat for the application of anesthesia or to remove
tissue from the mouth.
4. Nasal Speculum 
- tool inserted into the nostril to assist the physician with the visual inspection of the
lining of the nose, nasal membranes, and septum.
5. Otoscope 
- allows the physician to view the ear canal and tympanic membrane. 
- has a magnifying lens, light and cone-shaped insert to examine the inner ear.
6. Ophthalmoscope 
- tool used to examine the interior structures of the eye.
- has a light, magnifying lens and opening for the physician to view the eye.
7. Penlight 
- provides additional light for the physician to examine a specific area of the patient’s
body.
- typically used to examine the eyes, nose, and throat.
8. Percussion Hammer 
- tool used to test neurologic reflexes.
- The head of the instrument is used to test reflexes by striking the tendons of the
ankle, knee, wrist, and elbow.
9. Sphygmomanometer 
- physical examination tool used to measure a patient’s blood pressure.
- is composed of an inflatable rubber cuff, a bulb that inflates and releases pressure
from the cuff, and use of a stethoscope to listen to arterial blood flow in the patient.
10. Stethoscope 
- tool used for listening to body sounds including the sounds of the heart, lungs, and
intestines.
- also used while taking blood pressure.
11. Thermometer 
- tool used to measure a patient’s body temperature.
- It can be inserted in the mouth under the tongue, under the armpit or into the
rectum.
12. Tuning Fork 
 - tool used to test a patient’s hearing.
- The physician strikes the prongs causing them to vibrate and produce a humming
sound.
- Then the prongs are placed next to the patient’s skull, near the ear, with the patient
describing what they heard.
- The physician may order additional tests depending on the results of this hearing
test.
IV. Vital Signs
- are measurements of the body's most basic functions.
- useful in detecting or monitoring medical problems.
- can be measured in a medical setting, at home, at the site of a medical emergency,
or elsewhere.
- The four main vital signs routinely monitored by medical professionals and health
care providers include the following:

o
Body temperature
- normal body temperature of a person varies depending on gender, recent activity,
food and fluid consumption, time of day, and, in women, the stage of the menstrual
cycle.
- Normal body temperature can range from 97.8 degrees F (or Fahrenheit, equivalent
to 36.5 degrees C, or Celsius) to 99 degrees F (37.2 degrees C) for a healthy adult.
- How to take a body temperature?
 Orally - Temperature can be taken by mouth using either the classic glass
thermometer, or the more modern digital thermometers that use an
electronic probe to measure body temperature.
 Rectally – Temperatures taken rectally (using a glass or digital thermometer)
tend to be 0.5 to 0.7 degrees F higher than when taken by mouth.
 Axillary – Temperatures can be taken under the arm using a glass or digital
thermometer. Temperatures taken by this route tend to be 0.3 to 0.4
degrees F lower than those temperatures taken by mouth.
 By ear – A special thermometer can quickly measure the temperature of the
ear drum, which reflects the body's core temperature (the temperature of
the internal organs).
 By skin – A special thermometer can quickly measure the temperature of the
skin on the forehead.
- Hyperthermia
 Body temperature may be abnormal due to fever (high temperature)
 A fever is indicated when body temperature rises about one degree or more
over the normal temperature of 98.6 degrees Fahrenheit (AAFP)
- Hypothermia
 is defined as a drop in body temperature below 95 degrees Fahrenheit.(low
temperature)
o Pulse rate
- measurement of the heart rate, or the number of times the heart beats per minute.
- As the heart pushes blood through the arteries, the arteries expand and contract
with the flow of the blood.
- Taking a pulse not only measures the heart rate, but also can indicate the following:
  Heart rhythm

 Strength of the pulse

- Normal pulse for healthy adults - ranges from 60 to 100 beats per minute. The pulse
rate may fluctuate and increase with exercise, illness, injury, and emotions.

- Females ages 12 and older, in general, tend to have faster heart rates than do
males.

- Athletes, such as runners, who do a lot of cardiovascular conditioning, may have

heart rates near 40 beats per minute and experience no problems.

- Where to find the pulse?

 The pulse can be found on the side of the neck, on the inside of the elbow,
or at the wrist. For most people, it is easiest to take the pulse at the wrist. If
you use the lower neck, be sure not to press too hard, and never press on
the pulses on both sides of the lower neck at the same time to prevent
blocking blood flow to the brain.

- How to check your pulse?

 Using the first and second fingertips, press firmly but gently on the arteries
until you feel a pulse.

 Begin counting the pulse when the clock's second hand is on the 12.

 Count your pulse for 60 seconds (or for 15 seconds and then multiply by four
to calculate beats per minute).

 When counting, do not watch the clock continuously, but concentrate on the
beats of the pulse.

 If unsure about your results, ask another person to count for you.

o Respiration rate
 rate of breathing
 the number of breaths a person takes per minute.
 The rate is usually measured when a person is at rest and simply involves
counting the number of breaths for one minute by counting how many times
the chest rises.
 Respiration rates may increase with fever, illness, and other medical
conditions. When checking respiration, it is important to also note whether a
person has any difficulty breathing.
 Normal respiration rates for an adult person at rest range from 12 to 16
breaths per minute.
 o Blood pressure
 (Blood pressure is not considered a vital sign but is often measured along
with the vital signs.)

 the force of the blood pushing against the artery walls during contraction
and relaxation of the heart.

 Each time the heart beats, it pumps blood into the arteries, resulting in the
highest blood pressure as the heart contracts. When the heart relaxes, the
blood pressure falls.

 Two numbers are recorded when measuring blood pressure.

 Systolic Pressure - The higher number, refers to the

pressure inside the artery when the heart contracts and
pumps blood through the body.
 Diastolic Pressure - The lower number, refers to the
pressure inside the artery when the heart is at rest and is
filling with blood.
 Both the systolic and diastolic pressures are
recorded as "mm Hg" (millimeters of mercury).
 This recording represents how high the mercury
column in an old-fashioned manual blood pressure
device (called a mercury manometer or
sphygmomanometer) is raised by the pressure of
the blood. Today, your doctor's office is more likely
to use a simple dial for this measurement
- Blood pressure is categorized as:

 Normal – blood pressure is systolic of less than 120 and

diastolic of less than 80 (120/80)
 Elevated – blood pressure is systolic of 120 to 129 and diastolic
less than 80
 Stage 1 – high blood pressure is systolic is 130 to
139 or diastolic between 80 to 89
 Stage 2 – high blood pressure is when systolic is 140 or
higher or the diastolic is 90 or higher
V. References
 Patient Positioning (Sims, Orthopneic, Dorsal Recumbent) Guide [2020]
(nurseslabs.com)
 The Different Positions for Patient Procedures (medicalpositioning.com)
 Techniques of Physical Assessment: NCLEX-RN || RegisteredNursing.org
 Data Collection Methods (jotform.com)