Health Assessment (Lecture)

STUDENT ACTIVITY SHEET

BS NURSING / FIRST YEAR
Session # 3

LESSON TITLE: Physical Examination

LEARNING OUTCOMES:
Upon completion of this lesson, the nursing student can:
Materials:
1. Describe how to individualize the physical examination
approach based on the patient’s needs and the Book, pen and notebook, index card/class list
environment
2. Select an environment features necessary to ensure
patient safety and comfort during a physical examination
3. Discuss the environmental features necessary to ensure
patient safety and comfort during a physical examination References: Bates’ Nursing Guide to Physical
4. Identify safety precautions when conducting the physical Examination and History Taking (Second Edition)
examination. by Beth Hogan-Quigley, Mary Louise Palm, and
5. Indicate the correct order and how to use the four cardinal Lynn Bickley.
technique

MAIN LESSON (60 minutes)

The students will study and read Chapter 3 of their book about this lesson:

Physical Examination

• Is a process to obtain objective data from the patient

• Each body system connects to another
• The purpose of the physical examination is to determine changes in a patient’s health status and how to respond
to a problem as well as promote healthy lifestyles and wellbeing.

THE COMPREHENSIVE ADULT PHYSICAL EXAMINATION

Beginning the Examination: Setting the Stage

Preparing for the Physical Examination:

• Reflect on your approach to the patient.
• Adjust the lighting and the environment.
• Make the patient comfortable.
• Check your equipment.
• Choose the sequence of examination.

Reflect Your Approach to the Patient:

 Identify yourself as a nursing student.
 Try to appear calm, organized, and competent
 Most patients view the physical examination with some anxiety.
 avoid interpreting your findings - If you find anything that is unusual or disturbing, always talk with your clinical
instructor.

Adjust the Lighting and Environment:

• “set the stage” so that both you and the patient are comfortable
• Good lighting and a quiet environment make important contributions to what you see and hear but may be hard to
arrange
• Tangential lighting optimal for inspecting structures such as the jugular venous pulse, the thyroid gland, and the
apical impulse of the heart

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Make the Patient Comfortable
• Showing concern for privacy and patient modesty must be ingrained in your professional behavior.
Close nearby doors and draw the curtains in the hospital or examining room before the examination begins
• Wash your hands
• draping the patient - goal is to visualize one area of the body at a time keep the patient informed, especially when
you anticipate embarrassment or discomfort checking vital signs, tell the patient the results the examination is
completed, tell the patient your general impressions and what to expect next

Observe Standard and Universal Precautions

STANDARD AND MRSA precautions:

• Based on the principle that all blood, body fluids, secretions, excretions except sweat, non intact skin, and
mucous membranes may contain transmissible infectious agents.
• Hand hygiene, use of protective equipment, safe injection practices, safe handling of contaminated equipment

Universal Precautions
• Set of guidelines designed to prevent transmission of human immunodeficiency virus (HIV), hepatitis B virus
(HBV), and other blood-borne pathogens when providing first aid or health care.
• following fluids are considered potentially infectious:
• all blood and other body fluids containing visible blood, semen, and vaginal secretions; and cerebrospinal,
synovial, pleural, peritoneal, pericardial, and amniotic fluids

Protective barriers include:

• gloves, gowns, aprons, masks, and protective eyewear
• All health care workers should observe the important precautions for safe injections and prevention of injury from
needle sticks, scalpels, and other sharp instruments and devices

Make the Patient Comfortable

PATIENT PRIVACY AND COMFORT:

• Close nearby doors, draw the curtains in the hospital or examining room, wash your hands thoroughly
• During the examination be aware of the patient’s feeling’s and any discomfort.

Draping the Patient:

• GOAL: to visualize one are of the body at a time.
• When patient is sitting, auscultate the lungs with the gown unties in back
• Breast examination, uncover the right breast and keep the left chest draped
• Abdominal examination, only the abdomen should be exposed

Cardinal Techniques of Examination:

• INSPECTION
• PALPATION
• PERCUSSION
• AUSCULTATION

*abdominal examination, the pattern will be inspection, auscultation, percussion, and palpation

Inspection
• Close observation of the details of the patient’s appearance, behavior, and movement such as:
• facial expression, mood, body build and conditioning, skin conditions such as petechiae or ecchymoses, eye
movements, pharyngeal color, symmetry of thorax, height of jugular venous pulsations, abdominal contour, lower
extremity edema, and gait.

Palpation
• Tactile pressure from the palmar fingers or fingerpads to assess areas of skin elevation, depression, warmth, or
tenderness; lymph nodes; pulses; contours and sizes of organs and masses; and crepitus in the joints.
Metacarpal/phalangyeal joint or ulnar surface of the hand is used to detect vibration.
•

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Percussion
 Use of the striking or plexor finger, usually the third, to deliver a rapid tap or blow against the distal pleximeter
finger, usually the distal third finger of the left hand laid against the surface of the chest or abdomen, to evoke a
sound wave such as resonance or dullness from the underlying tissue or organs. This sound wave also generates
a tactile vibration against the pleximeter finger.

Auscultation
• Use of the diaphragm and bell of the stethoscope to detect the characteristics of heart, lung, and bowel sounds,
including location, timing, duration, pitch, and intensity. For the heart this involves sounds from closing of the four
valves and flow into the ventricles as well as murmurs.
• Auscultation also permits detection of bruits, ie, turbulence over arterial vessels.

CHECK FOR UNDERSTANDING (10 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 20 minutes for this activity:

Instructions: Label and give the function of each instrument used during a physical examination.

1. 2.

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3. 4.

5. 6.

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 7. 8.

9. 10.

LESSON WRAP-UP (10 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Strategy: Turn and talk

(Students turn to talk partner/s to – find out, summarize, clarify, share ideas, point of view or opinions)

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