RECEPTION AND NEEDS OF MRS LC MUKONDA

PATIENTS BSC, RNM

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 INTRODUCTION
In this lesson you will look at the admission procedure of
the patient. You can admit a patient in three ways; namely
non-emergency, emergency and planned admission. You
are also going to assess the health status. You will also
cover the basic needs of the patient like bathing, oral care,
hair care and nail care.
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These basic needs you can encourage the patient to
do them if he is able to or you can do them for them
if the patient is not able to. Furthermore we will go
through mobility and immobility.

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OBJECTIVES

By the end of this unit you should be able to:

1. Describe admission procedures
2. Describe assessment of client’s health status
3. Describe the basic needs of a client
4. Explain the assessments and management of
selected signs and symptoms

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 ADMISSION PROCEDURES
The people you admit to hospital feel anxious and
unsure of a lot of things. You being the first health worker
to meet the patient, you should put the patient at ease.
Greet the patient, introduce yourself.
It is important for you to appear pleasant and friendly as
this will reassure the patient.
It is also the beginning of your relationship with the
patient (nurse/patient relationship).
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 Admission is when the patient comes to the hospital and the
doctor decides that he/she should stay in the hospital.
 Admission is an act of accepting the patient for in-patient
service in a hospital.
Reception
• Observe gait and facial expression of the patient-in
observing the patient you can be able to detect any
abnormalities
• Greet patient/client and welcome him/her – a smile
makes patient relax and feel at home.

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 Make patient comfortable – put him/her in bed.
From here you need to establish the relationship between
you and the patient.
Interpersonal relationship
• Introduce yourself to build rapport.
• Orient patient to the environment for example where
toilets are and how to use them. Introduce patient to
fellow patients and staff.
Now check
• -Temperature
• -Pulse
• -Respiration
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-Blood Pressure
General condition of patient
• Collect urine and carry out urinalysis.
• Record your findings on charts.
• Take care of patient’s belongings.
• After relatives have gone, ask patient again on
illness – may not have revealed some of the
problems in the presence of relatives.
• All times provide privacy to patient.
• Explain whatever you do to patient to allay anxiety.
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 TYPES OF ADMISSION
Planned admission is where they have been informed
as the ward nurse about a client who has been booked
for admission. The client may have been seen in the Out
Patient Department (OPD) and booked to be admitted in
a specific ward.
This type of admission is ideal for patients coming for
special investigations or procedures for example
endoscopy. The patient may also be booked for elective
surgery
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Unplanned or non-emergency admission –
we are referring to patients who come to hospital hoping to
be treated as out patients and end up being admitted.
As ward staff you can be informed about the patient a few
minutes or hours before the patient is brought to the ward.
They will tell you the patient’s name, age, diagnosis and
the condition of the patient.

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Emergency admission is the third type of admission
where the patient is brought to the ward with a life
threatening condition which needs prompt nursing
action and medical intervention. The patient may either
be ambulant or non-ambulant. EG. Fainting, Sudden
severe pain anywhere in the body, Sudden or
persistent vomiting, Suicidal or homicidal feeling,
Chest pain or upper abdominal pain, Difficulty in
breathing, Poisoning, Asthmatic attack.
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Upon receiving the message that there is an emergency
coming, you should prepare the resuscitative equipment
and emergency drugs for example, oxygen cylinders,
suction machine, airway, ambubag, mouth gag or spatula.
• Bed should be made in the acute room or acute bay
or intensive care unit (ICU).
• Should be near nurses’ bay for easy observation

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 ASSESSING HEALTH STATUS
Comprehensive assessment of a patient health status is
valuable in the following ways:
It maximizes the amount and quality of information that
you can obtain from a client.
It provides you with a decision making basis with
regard to the planning of nursing care
It individualizes the nursing care because you will
render the nursing care according to the problems you
noticed after history taking.
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It provides baseline data with regard to the patient’s
condition that can be used later to evaluate the patient’s
progress.

History taking
Now start the assessment with history taking which is
the first step you need to take as you are assessing
the client.

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 TYPES OF HISTORY
a. Complete comprehensive history: This is usually
obtained during an initial visit. It is detailed and it is
meant for providing continuous care for the patient (for
all new patients)
b. Interval health history: This is taken at subsequent
visits. It may be a way of topping up information to
update current needs
c. Problem focused or chief complaint focused: This
involves collecting data about specific problem,
system or region MRS MUKONDA 15
 Types of data/sources
1. Subjective data- what the patient tells you
(primary source) (recorded in the history)
2. Objective data- what is detected during the
physical examination (secondary source)
(represents all physical examination findings)

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History taking involves the following:

Personal history: For example, name, age, marital status,

habits and hobbies among others.
Family history: find out if there has been an occurrence of
any illness and history for example, asthma, hypertension
and TB.
Case history: find out the patients complaints for example
onset of illness that is, when it started, precipitating factors,
past illness, medical and surgical and nature of illness.
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 General observation: posture and gait,
nutritional status, nature of speech, mental
reaction, emotional state, texture of skin
and texture and distribution of hair.
After taking history you can go ahead and do the
physical examination.

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PHYSICAL EXAMINATION

There are basically five methods you can

use namely:
• Inspection
• Palpation
• Percussion
• Auscultation
• Olfaction
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 INSPECTION
As an examiner you utilize the sense of sight.
• This is the first technique or process you make at the first
moment you come into contact with patient.
• The general appearance of patient, you can be able to
observe it even as the patient walks in the ward.
• Movement-You observe the movement of the patient as
he/she walks into the ward. Is the patient limping or
cannot walk because of the illness?
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• Skin-Observe whether patient is cyanotic; the bluish
colour on the lips and the face due to insufficient oxygen,
jaundiced which is yellow discolouration of the skin and
mucus membrane or has he got oedema that is, swelling
on the limbs or has lost weight.
• You can also observe if patient is dyspnoeic that is, is the
patient having difficulties in breathing.
• You can also be able to observe the mood or behaviour
of patient by this technique.
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• The quality of inspection depends on your
intelligence to carry out the examination
skilfully and thoroughly.
• A good lighting and exposure are necessary
for you during this examination so that you
can see properly and be able to detect any
abnormalities.
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 PALPATION
This is the process of examining the patient by
application of hands and fingers to the external
surface of the body to detect any abnormalities in the
various organs. This is the type of examination where
you utilize the sense of touch when examining the
abdominal organs.
• It involves the use of hands and the sense of touch to
detect tenderness, temperature, calcification in the body
structures.
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• You can use this technique to examine all accessible
parts of the body.
• Tell the client or the patient to be relaxed either in sitting
or lying down position.
• When palpating, your hands should be warm and the
finger nails should be short to avoid causing discomfort
to the client.
• You can do light palpation of abdomen to detect areas
of tenderness.
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• After light palpation, you can do deep
palpation to examine the condition of the
organs such as those in the abdomen. You
can depress an area of 2.5cm in order to
examine these organs.
• As student nurse you should not do this
procedure alone unless in the presence of a
qualified nurse or doctor.
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 PERCUSSION
This is the tapping of the body lightly but sharply to
determine the position, size and presence of fluids in the
underlying structure. This is done by striking a particular
area of the body either by finger tips or using percussion
hammer. If you hear a dull sound it often signifies presence
of fluid whereas the hollow sound signifies absence of fluid.
You can establish the presence of fluid by resonance and pitch
of sound emitted.
To percuss is to tap parts of the body to aid in diagnosis
through the sound being produced on tapping
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 The following are the areas you can do percussion:
Abdomen, Bladder, Chest, Kidney, Liver, Ovaries, Spleen,
Uterus.
Percussion can help you to verify abnormalities
assessed through palpation and inspection.
When you strike the body structure with the finger,
vibration in sound is produced.
Abnormal sound is a sign of presence of mass or fluid
within an organ or body cavity.
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 TYPES OF PERCUSSION
There are two types of percussion. These are:
• Direct Percussion – This is where fingers strike on
the skin directly.
• Indirect Percussion –This is when the two hands
are used. One hand (non- dominant) placed against
the body surface, with palms and fingers remaining
on the skin.
-A quick sharp stroke is used with the four arm
kept stationary.
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There are five types of sound produced:
a). Timpani– Drum like sound produced by
percussing the air filled stomach.
b). Resonance – Sound elicited over air filled lines
or dull sound heard when you percuss solid areas
like the bones.
c). Hyper-resonance – is audible while percussing
over inflated lung tissue of the patient with
emphysema (condition in which there is abnormal
increase in the size of the air spaces or alveoli) it is
common among smokers.
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d). Dullness – This sound is heard
when percussing the liver.
e). Flatness – This sound is heard
when percussing the thigh.

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AUSCULTATION
This is the process of listening to sounds
produced in some body cavities especially the
chest and abdomen in order to detect some
abnormal conditions. The examiner makes
use of the sense of hearing with the aid of the
stethoscope.

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 In this process a stethoscope is used and must be
well fitted to produce a good sound. Before doing
this procedure, you should be aware of the normal
sound, such as the normal heart sounds, movement
of air through the lungs and bile sounds. For
effective results you need:
• Good sense of hearing (good auditory acuity)
• Good working stethoscope
• Knowledge on how to use a stethoscope.
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 OLFACTION
is a type of physical examination where you can use
the sense of smell.
• It enables you to observe and report any unpleasant
or pleasant odour on the patient.
• Unpleasant odour will tell you that patient has not
bathed or patient’s mouth is dirty and this is detected
by the halitosis. It can also tell you that patient is
incontinent of urine.
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 EQUIPMENT USED IN PHYSICAL
EXAMINATION
The following are the equipment used during physical
examination;
Stethoscope – It is used to detect the heart and
respiratory sounds.
Sphygmomanometer – It is used for checking
(measuring) for blood pressure and used in conjunction
with stethoscope.
Patella Hammer (Reflex Hammer) – It is used to detect
the reflexes. MRS MUKONDA 34
Spatula– It is used to examine the tongue, throat.
A spot light or touch is needed to provide good light
source.
Thermometer – It is used to check the temperature.
Pins – It is used to test the sensation.
Weighing scale– you can use it to check weight of patient.
Diagnostic set – you can use it for ear, nose and throat
examination
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Cotton wool swabs– you can use it to detect the light
touch and corneal reflexes.
Height measure (tape measure), you can use it to
measure the circumference for example of the head,
abdomen and height.
Spot light– you can use it to provide good light source.

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Case History charts– for doctor to observe
findings.
Tuning Forks– you can use this for hearing the
vibration.
Ophthalmoscope- you can use it to examine the
optic disc.
Visual Acuity charts (alphabetic charts) – you can
use charts for sight detection
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 MEASUREMENT

Measurement of Patients Height

The measurement of the patient’s height is routinely
done on first visit and for medical examination.

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 Measuring the Weight
Weight is also routinely done during
admission into hospital. You may delay
Weighing if patient’s condition is poor,
unless weight should be known for drug
dosage calculations.

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 Procedure (preparation of the patient)
• Wash hands
• Explain the procedure to the patient
• Ensure that patient has voided
• Check that the clothing will not interfere with
the examination

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 Examination of Head and Neck
You can inspect for cleanliness/dirty, dandruff,
sores, hair distributions, do the contours of the
skull, measurement of the head circumference at
times. You can examine the scalp and hair, and
then the head is palpated for nodules.
On the neck you check for the thyroid gland
palpate it for any enlargement, lymph nodes,
larynx and trachea
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 Examination of Eyes
Inspect the Eye lids and eye brows, pupil
reaction to light are checked for. You can
also examine the interior of the eye ball
using the ophthalmoscope. Examine sight
and field vision using the reading test
charts (Snellen’s Chart).
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 Examination of the Nose
You can inspect and palpate the nose
using a flash light head mirror and nasal
speculum to inspect the interior or part of
the nasal cavity. The sense of smell is
tested by using commonly recognized
substances for example, Onions.
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 Examination of the Lips, Mouth and Throat
These are inspected for abnormalities with
the use of light and the tongue depressor.
You check the tongue, teeth, tonsils, gums,
larynx, pharynx, hard palate and soft palate

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 Examination of the Ears
You can examine the external auditory
canal using the otoscope. You can also use
the tuning fork for examining the activity of
hearing. An audiometer can also be used
to test the sense and accuracy of hearing.

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 Examination of the Chest
Breasts: Check for the symmetry of breasts,
size, and position. Palpate the whole breast
checking for nodes, lamps and tumours. When
there are tumours blood comes out when the
breast is squeezed.
Rest of the chest: Examine the contours, size,
and shape of the chest.

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 The other methods used on the chest are:
• Palpation and percussion
• Chest x-ray can be taken for observations of
chest organs for example lungs, bronchioles.

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 Examination of the Cardiovascular System
In here you use inspection, palpation,
percussion and auscultation. A chest X-ray
is taken in order to reveal the size of the
heart, apex beat, pulse rate and blood
pressure

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 Examination of the Abdomen
Check the shape, (whether distended or not) Check
the skin of the abdomen. Palpate the abdomen
where you detect any masses of any enlarged
abdominal organs. Percussion can be done to
determine air contained masses. Auscultation can be
used to listen to bowel sounds. All quadrants of the
abdomen should be examined as well as the pelvic
area.
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 Examination of the Back
Use palpation to determine contours and
shapes of the spine. An inspection is done
to check the colour of the skin or condition
of the skin. X-rays of the spine can also be
taken.

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 Examination of the Genitalia, Perineum,
Anus and Rectum
These are normally done by inspection and
palpation. On inspection you can see the pubic
hair distribution and its healthiness. For vaginal
and rectal examination, palpate for abnormalities
for example You can do palpation of tumours.
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 In females you can also check for
abnormal vagina discharge, warts, bruises,
and pubic lice infestation. In males, a rectal
examination is performed in order to
palpate for enlarged prostate glands; you
can also do scrotal examination in order to
elicit swellings on the testis and pubic hair
examination to inspect for lice infestation. MRS MUKONDA 52
 Neurological Examination
These refer to the central nervous system
examination. You can test patient’s reflexes as
well as senses. You can test the reflexes using a
patella hammer. You also test the sense of touch,
pain and sensations where you can use hot or
cold water to test heat receptors. Use sugar or salt
to test the tasting receptors. You can use a pin or
needle to test response to stimuli.
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 Examination of the Muscular-Skeletal
System
You can use inspection and palpation
method. By inspection, check for the status
of the limbs, muscles and the length of the
bones. Make use of X-rays to identify any
pathological changes. Check the muscle
tone as well.
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 After the procedure leave the patient
comfortable by attending to his needs.
Clear off the equipment and send any
specimens which should be well labelled to
the laboratory. Inform the ward incharge of
the procedure and document the findings.

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THE END

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