TIME SPECIFIC CONTENT TEACHING EVALUATION

OBJECTIVES LEARNING
ACTIVITY
1min INTRODUCTION

Assessment of client
provides baseline data
for the nursing process.
Assessment enhances
identification of
physical and
psychological needs.
Advanced assessment
skills are learned and
practiced in order to
provide interventions
and to evaluate health
maintenance and
promotion practices.

½ min At the end of ANNOUNCEMENT

the class OF TOPIC
students will
be able: Today we will learn and
discuss about health
assessment.

1min To define HEALTH ASSESSMENT Student-teacher What is Health

Health Health is a state of well being. defines health Assessment?
Assessment. (WHO) assessment by using
Chalk board.
Assessment is defined as a systematic ,dynamic process by which the
nurse through the interaction with client ,significant others and health
care providers , collects and analyze data about the client.
(ANA)
 Health assessment refers to systematic appraisal of all factors
relevant to client’s health.

5 min To enumerate TYPES OF ASSESSMENT Student-teacher List the types of

the types of enumerates types of health assesment?
health  Initial Assessment health assessment by
assessment.  Focused Assessment using Chalk Board.
 Emergency Assessment
 Time Lapsed Assessment

1. Initial Assessment
It is performed within specified time after admission to a hospital.

Purpose
To establish a complete data base for problem identification,
reference and future comparison.
E.g. Nursing admission assessment.

2. Focused or Ongoing Assessment

It is an ongoing process integrated with nursing care.

Purpose
To determine the status of a specific and to identify new or
overlooked problem.
E.g. Hourly assessment of client’s fluid intake and output chart.

3. Emergency Assessment
It is a life saving assessment, the major purpose of emergency
assessment is save the patient or client’s life.

Purpose
To identify life threatening problem.
 E.g. A rapid assessment of a person’s airway, breathing and
circulation during cardiac arrest.

4. Time Lapsed Assessment

It involves assessment for several days after first initial assessment.

Purpose
To compare client’s current status to baseline data previously
obtained.
E.g. Reassessment of a client’s functional health patterns in a home.
2 min To explain the PURPOSE OF HEALTH ASSESSMENT The student teacher What are the purposes
purpose of explains the purpose of of health assessment?
health 1. To understand the physical and mental well-being of the health assessment by
assessment. clients. using chalk board.
2. To detect diseases in its early stage.
3. To determine the cause and the extent of disease.
4. To understand any changes in the condition of diseases, any
improvement or regression.
5. To determine the nature of the treatment or nursing care
needed for the client.
6. To safeguard the client and his family noting the early signs
especially in case of a communicable disease.
7. To contribute to the medical research.
8. To find out whether the person is medically fit or not for a
particular task.
9. To gather baseline data about the client`s health status.
10. To make clinical judgments about a client`s changing health
status and management.
11. To evaluate the physiological outcomes of care.

1 min To enlist the COMPONENTS OF HEALTH ASSESSMENT The student teacher List the components of
components of enlists the components health assessment.
health  Health History of health assessment by
assessment.  Physical Examination using chalk board.
 Physical examination is divided into two major parts:

 Head –to Toe examination.

 Systemic examination.

1 min To define health HEALTH HISTORY The student teacher What do you mean by
history. defines the health health history?
 It is a collection of subjective data in detail regarding client’s history by using chalk
health in a chronological order. board.

 The health history is a detailed account of the patient’s

perception of his/her current and past health , provided in
his / her own words.

15 min To describe the COMPONENTS OF HEALTH HISTORY The student teacher Name and Explain the
components of describes the components of health
health history. I. BIOGRAPHIC DATA components of health history.
history by using chalk
Name board.
Age
Sex
Ward
IP No.
Marital status
Education Occupation
Income
Religion
Language known
Address
Diagnosis
Date of admission
Date of surgery
Nature of surgery
Post O.P. day
Date of discharge
Date of care started
Date of care ended
Informant

II. INTRODUCTION
Introduction of patient and self.

III. SOCIO ECONOMIC BACKGROUND

Write whether the patient is from village /town/city. Is he/she living
on rent house or own house. No. of rooms, doors, windows. Water
facility , electric facility ,toilet facility/ income of the family/bread
winner of the family/ drainage facility/ kitchen garden and pet
animals.

IV. FAMILY HEALTH HISTORY

1.Family Tree
2. Family Composition

S. Name Relatio Age Education Occup Health

No. n of & ation Status
patient Sex

3. Family Medical History

Particular attention to be given to disorders like cancer, DM , HTN. ,

Obesity, Arthritis, TB , Alcoholism and any Mental Disorders.

V. PERSONAL HISTORY

Personal Habits
The amount, frequency and duration of substance use (tobacco
chewing, smoking, alcohol, coffee, cola, tea).
Diet
Number of meals and snacks per day
Vegetarian / Non vegetarian
Nutritional assessment 24 hours recall and recommended diet plan
Likes and dislikes of food.

Sleep /Rest
Usual Daily sleep
Number of hours per day and night, wake time , difficulty sleeping
and remedies used for difficulties.

Activities of daily living

Any difficulties experiencing in the basic activities of eating,
brushing, bath, grooming, dressing, elimination and locomotion.

Elimination
Bowel habits- Number of times per day
Bladder habits- Number of times per day and night

Hobbies/Interests
Reading books/ watching TV/Playing /Listening to
music/others(specify).

Menstrual History
Puberty attained on
Duration of cycle
Amount of flow
Regular/Irregular
Any abnormalities
Any plan

Marital History
Consangious/ Nonconsangious/ separated/ Divorced/ Widowed
Duration of marriage
Sexual history
Contraceptives
Obstetrical History

VI. HISTORY OF PRESENT ILLNESS

Present Medical History
When the symptoms started
Onset of symptoms were sudden or gradual
How often the problem occurs
Exact location of the distress
Character of the complaint
Symptoms associated with the chief complaints
Aggravating factors

Present Surgical History

Date and type of procedure performed , name of surgeon, client’s
reaction and its outcome.

Present Obstetrical History

1st trimester:
2nd trimester:
3rd trimester:

VII. HISTORY OF PAST ILLNESS

Past Medical History
Previous hospitalization (medical/surgical)
Any communicable disease
On treatment for any disease
Immunization if any
Allergies: H/O drug allergy

Past Surgical History

Nature of surgery
Date of surgery
Name of surgeon
Client’s reaction to each procedure and its outcome
 Past Obstetrical History

1 min To define The student teacher What do you understand

physical PHYSICAL EXAMIANTION defines the physical by physical
examination. examination by using examination?
 Physical examination is defined as a complete assessment of chalk board.
a patient’s physical and mental status.

 It is a systematic collection of objective information that is

directly observed or elicited through examination technique.

5 min To show the The student teacher Demonstrate the

techniques of TECHNIQUES OF PHYSICAL EXAMINATION:- shows the techniques techniques of physical
physical physical examination by examination.
examination. The four basic techniques used in physical examination are: demonstration.

Inspection:-
It is a systemic visual examination of the client or it is the process of
performing deliberate purposeful observation in a systemic manner. It
involves observation of the color, shape, size, symmetry, position and
movements. It also use the sense of smell(olfaction) to detect odor
and sense of hearing to detect sounds.

Auscultation:-
The process of listening to sounds that are generated within the body.
Auscultation is usually done with the help of a stethoscope.
a) Direct auscultation uses the ear alone, such as when
listening to the grating of a moving joint.
b) Indirect auscultation involves the use of a stethoscope to
amplify the sounds from within the body, like a
heartbeat.
 Quality (gurgling or swishing);
 Duration (short, medium or long).

Palpation:-It is use of the hands and fingers to gather information

through touch.
i. It is the assessment technique which uses sense of touch.
ii. It is the feeling of body or a part with hands to note the size
and position of the organs.
iii. The hands and fingers are sensitive tools and can assess
temperature, turgor, texture, moisture, vibrations, size,
position, consistency, masses and fluid.
iv. The dorsum (back) surfaces of the hand and fingers are used
to measure temperature.
v. The palmar (front) surfaces of the fingers and finger pads are
used to assess texture, shape, fluid, size, consistency and
pulsation.
vi. Vibration is palpated best with the palm of the hand.
vii. The nurse hand should be warm and fingernails short and the
touch should be gentle and respectful.
viii. Areas of tenderness are palpated last.
ix. Light, moderate or deep palpation may be used.
x. The purpose of deep palpation is to locate organs, determine
their size and to detect abnormal masses.
xi. The nurse depresses the area being examined approximately
2-4 cm (1-2 inches).
area to be percussed and the finger creating vibrations that
allows discrimination among five different tones.

MANIPULATION

It is the moving of a part of the body to note its flexibility. Limitation

of movement is discovered by this method.

TESTING OF THE REFLEXES

The response of the tissues to external stimuli is tested by means of a

percussion hammer, safety pin, wisp of cotton, or hot and cold water.
5 min To teach how to PREPARATION FOR EXAMINATION The student teacher How can you prepare a
prepare the teaches how to prepare patient for physical
patient for In order to perform physical examination of a client; proper the patient for physical examination.
physical preparation is required to prevent error and incomplete findings. The examination by using
examination. following are areas to be prepared for the client`s physical chalk board.
examination;

1. Reviewing general information

It is good to collect some general information about the client using

secondary data sources which includes chart or other health care
providers.

Client`s name, age, current medical history, treatment etc. can be

collected from secondary sources. Primary data is gathered from the
client.

2. Preparation of the environment

i) The environment must be comfortable for both nurse and

the client.
ii) A warm, quiet, well-lit room is ideal.
iii) Standard precaution should be used throughout physical
examination, if a client has excessive drainage from a
wound, the examiner may need to wear gloves and gown.
iv) Adequate lightening is needed for proper illumination of
body parts.
v) Examination area should be sound proofed so that the
client feels comfortable discussing their condition.
vi) Examine the client on bed or stretcher, position them
safely.
vii) In case of children nurse must be sensitive and anticipate
the child`s reaction to the examination as a strange and
unfamiliar experience.
viii) Children who are chronically ill or disabled, foster
children and foreign born adopted children may require
 additional examination visits.

ix) In case of elderly client the nurse must recognize that

with advancing age the body does not respond vigorously
to injury or disease, allow pause and observe for details.
x) Check the functioning of the examination table with
proper and alignment.
xi) All the needed equipment in full functional capacity must
be available.
xii) The equipment needed for the examination should be
neat and clean, readily available and arranged in order for
easy use.
xiii) Equipments should be kept warm appropriately and must
ensure that it functions properly
xiv) Provide privacy, confidentiality must be ensured.

2 min To show the Articles required for physical examination:- The student teacher Which instrument is
articles used for 1. Sphygmomanometer; shows the articles used used to examine eye?
physical 2. Stethoscope; for physical examination
examination. 3. Fetoscope; by demonstration.
4. T.P.R. tray;
5. Tongue depressor;
6. Pharyngeal retractor;
7. Laryngoscope;
8. Tape measure;
9. Flash light;
10. Weighing machine;
11. Ophthalmoscope;
12. Otoscope;
13. Tuning fork;
14. Nasal speculum;
15. Percussion hammer, safety pin, cotton wool, cold and hot
water in test tube;
16. Vaginal speculum;
17. Proctoscope;
 18. Gloves;
19. Sterile specimen bottles;
20. Slides, cotton applicators.
21. Cytobrush;
22. Disposable pads;
23. Drapes;
24. Eye chart(snellen chart);
25. Forms(Physical; Laboratory);
26. Patient dress;
27. Water soluble lubricant;
28. Paper towel;
29. Ruler;
30. Scale with height measurement rod;
31. Specimen containers;
32. Tissues;
33. Wrist watch with second hand or digital display.

3. Preparation of the client:-

The should prepare the client physically and mentally in order to
perform physical examination.

i) Keep the client clean;

ii) Shave the part if necessary;
iii) Keep the client in comfortable position which is
convenient for the doctor or examiner to examine the
client;
iv) Empty the bladder prior to the examination;
v) Empty the bowel by an enema if required;
vi) Loosen the garments and change into the hospital dress if
it is custom;
vii) Drape the client with extra sheets and expose only the
needed areas. Avoid unnecessary exposure.
viii) Relieve the anxiety of the client by explaining the routine
of the hospital and about the procedure;
ix) Explain the sequence of the procedure to gain his
confidence and co-operation;
 x) As far as possible nurse should remain with the female
client during the physical examination

15 min To demonstrate PROCESS OF PHYSICAL EXAMINATION The student teacher Show the steps of
the steps of demonstrates the steps physical examination.
physical 1. General Appearance:- of physical examination.
examination. a) Nourishment:
well-nourished/undernourished
b) Body build: Thin/obese
c) Health: Healthy/Unhealthy
d) Activity: Active or dull (tired)

2. Mental Status:-
a) Conciousness:
Concious/unconscious/delirious/talking/incoherently
b) Look:
Anxious/worried/depressed etc;

3. Posture:-
a) Body Curves:
Lordosis/Kyphosis/Scoliosis
b) Movement: any limp

4. Height and weight

5. Skin condition
a) Color: Pallor/Jaundice/cyanosis, flushing etc
b) Texture: Dryness/flaking/wrinkling or excessive moisture
c) Lesions: Macules/papules/vesicles/wounds etc

6. Head and face

a) Shape of the skull and fontanels (noted in the newborns)
b) Skull circumference
c) Scalp: Cleanliness, condition of the hair, dandruff, pediculi,
 infections like ringworm
d) Face: Pale, flushed, puffiness, fatigue, pain, fear, anxiety,
enlargement of parotid glands etc.

7. Eyes
a) Eyebrows: Normal or absent
b) Eye lashes: Infection, sty
c) Eyelids: Oedema, lesions, ectropion(eversion),
entropion(inversion)
d) Eyeballs: Sunken or protruded
e) Conjunctiva: Pale, red, purulent
f) Sclera: Jaundiced
g) Cornea and Iris: Irregularities and abrasions
h) Pupils: Dialated, constricted, reactions to light
i) Lens: Opaque or transparent
j) Fundus: Congestion, hemorrhagic spots;
k) Eye muscles: Strabismus(squint)
l) Vision: Normal, myopia,(short sight), hyperopia(long sight)

8. Ears
a. External ear: Discharges, cerumen, obstructing the ear
passage
b. Tympanic membrane: Perforations, lesions, bulging
c. Hearimg: Hearing acuity

9. Nose
a) External nares: Crusts or discharges
b) Nostrils: Inflammation of the mucus membrane, septal
deviations

10. Mouth and pharynx

a) Lips: redness, swelling, crusts, cyanosis, angular stomatitis
b) Odor of the mouth: Foul smelling
c) Teeth: Discoloration and dental caries
d) Mucus membrane & gums: Ulceration and bleeding,
swelling, pus formation
 e) Tongue: Pale dry, lesions, surds, furrows, tongue tie etc
Throat and pharynx: Enlarged tonsils, redness and pus

11. Neck
a) Lymph nodes: Enlarged, palpable
b) Thyroid glands: Enlarged
c) Range of motion: flexion, extension and rotation

12. Chest
a) Thorax: Shape, symmetry of expansion, posture
b) Breath sounds: swish, rustle, wheezing, crepitations, sigh
c) Heart: size and location, cardiac murmur
Breasts: Enlarged lymph no
13. Abdomen
a) Observation: Skin rashes, scar, hernia, ascites, distension,
pregnancy etc;
b) Auscultation: Bowel sounds,foetal heart sounds
c) Palpation: Liver margin, palpable spleen, tenderness at the
area of appendix, inguinal hernia
d) Percussion: Presence of gas, fluid or masses

14. Extremities
Movement of joints, tremors, clubbing of fingers, ankle
oedema, varicose veins, reflexes etc

15. Back
Spina bifida, curves

16. Genitalia and rectum

a) Inguinal lymph glands: enlarged, palpable
b) Patency of urinary meatus and rectum(in infants)
c) Descent of the testes (in infants)
d) Vaginal discharges
e) Presence of sexually transmitted diseases
f) Hemorrhoids
g) Enlargement of the prostate gland
 h) Pelvic masses

17. Neurological test

a) Coordination tests: reflexes

Equilibrium tests: test for sensations
5 min To describe the ROLE OF A NURSE IN PHYSICAL EXAMINATION The student teacher Explain the role of a
role of a nurse describes the role of a nurse in physical
in physical 1. A separate examination room is needed. Keep the doors nurse in physical examination.
examination. closed. The relatives are not allowed. Drape the client examination by using
according to the parts that are exposed. chalk board.
2. As far as possible, natural light should be available in the
examination room because if a client is jaundiced, it may not
be detected in the artificial light, There should be adequate
lighting.
3. The client should be placed comfortably throughout the
examination.
4. There should be provision for the maintenance of a suitable
position e.g; a Lithotomy position may be maintained when
examining the genitalia.To maintain the position, a special
examination table with strip rods is needed.
5. All the articles needed for the physical examination are kept
ready for the examination at hand.
6. The nurse may record the finding during or after the physical
examination.
7. If the findings have revealed serious abnormalities, such as a
mass or highly irregular heart rate, the client`s physician
should be consulted before any findings are revealed.
8. It is the physician responsibility to make definitive medical
diagnosis The nurse can explain the type of abnormality
found and the need for the physician to conduct an additional
examination.
9. The nurse may delegate cleaning the examination area to
assistive personnel.
10. Infection control practices are used in removing materials or
 instruments soiled with potentially infectious wastes.
11. The nurse checks to make sure that the recording of the
assessment is complete.
12. The client may need a number of ancillary examinations such
as x-ray, lab tests after physical examination to provide
additional screening to rule out the abnormalities.
The nurse should explain the purpose of these tests and sensation the
client can expect
1/2 min SUMMARY
Today we have
discussed about health
assessment, purpose,
its components,
techniques,
instruments , process
of physical
examination and role
of a nurse in physical
examination.

½ min CONCLUSION
Thus health
assessment is essential
for planning,
implementing ,
evaluation and taking
decisions related to
health.

½ min BIBLIOGRAPHY

Sr. Nancy, Textbook of Principles and practice of Nursing , 6th ed.

Indore : N.R. publishing house, 2006, pp. 166- 184.

Black M.J. , Medical Surgical Nursing , 7th ed.

India : Elsevier publisher private limited, 2005 , pp. 68-75.

Brunner & Suddarth’s, Textbook of Medical-Surgical Nursing ,10th

ed. Lippincott Williams & Wilkins publishers. ,2003, pp. 60-72

http://www.healthline.com/health/physical-examination
 IDENTIFICATION DATA

Name of the student teacher – Ms. Esther Manohar

Class - MSc. I yr.

Subject - Advance Nursing Practice

Topic - Health Assessment

Group of student - M.Sc. First year students

Size of group - 18

Duration of teaching - 1 Hour

Venue of teaching -Nursing Foundation Laboratory

Supervisor - Ms. Fareha Khan

Method of teaching - Demonstration

Audio visual aids - practical

Date & time of teaching -

Previous knowledge of the group – group has previous knowledge about health assessment.
GENERAL OBJECTIVE:

To help the students acquiring knowledge and understanding about physical examination and to develop desirable skills in performing procedure.

SPECIFIC OBJECTIVE:

At the end of procedure, the students will be able to:

 Explain related terminologies

 Define the physical examination.
 Enumerate the purposes and indication of physical examination.
 Explain the special consideration related to the procedure.
 Demonstration procedure of physical examination.
 RUFAIDA COLLEGE OF NURSING
JAMIA HAMDARD

DEMONSTRATION ON HEALTH ASSESSMENT

SUBMITTED TO: SUBMITTED BY:
Ms. Fareha Khan Ms. Esther Manohar
Assistant Professor M.Sc. Nursing 1st year
RCON RCON
.