Cultivating Your Senses Physical examination requires use of technical skills through senses (sight, smell, touch, or hearing) to obtain data. Requisite skills performed one at a time typically in this order Inspection Palpation Percussion Auscultation
Inspection Inspection is concentrated watching. Close, careful scrutiny, first of individual as a whole and then of each body system. you may feel embarrassed Begins when you first meet person with a general survey As you proceed through examination, start assessment of each body system with inspection. Inspection always comes first. Inspection requires good lighting. adequate exposure. occasional use of instruments, including otoscope, ophthalmoscope, penlight, or nasal and vaginal specula, to enlarge your view.
Palpation Palpation applies sense of touch to assess the following: Texture, temperature and moisture Organ location and size Swelling, vibration, pulsation or crepitation Rigidity or spasticity Presence of lumps or masses Presence of tenderness or pain Should be performed slow and systematic Start with light and proceed to deep. Bimanual palpation is used for certain body parts or organs.
Palpation Techniques Different parts of hands are best suited for assessing different factors: Fingertips: best for fine tactile discrimination of skin texture, swelling, pulsation, determining presence of lumps Fingers and thumb: detection of position, shape, and consistency of an organ or mass Dorsa of hands and fingers: best for determining temperature because skin here is thinner than on palms Base of fingers or ulnar surface of hand: best for vibration
Percussion Methods (2 of 2) The striking hand Use the middle finger of your dominant hand (the plexor). Hold forearm to skin surface making muscles steady but not rigid. Flex striking finger so tip makes contact.
Standard Equipment Standard equipment needed for a screening physical examination Be prepared to have all necessary equipment in place before starting examination. Perform hand hygiene. Protective equipment including but not limited to gloves Measurement of vital signs requires platform scale (with height attachment), stethoscope, sphygmomanometer, and thermometer. Pulse oximetry reading can be included.
Standard Precautions for Use with All Patients Components based on preventing spread of transmission from body sources Hand hygiene • Key factor in decreasing spread of infection • Before and after patient care • Protocols for visibly or not visibly soiled Use of protective equipment • Gloves, gown, mask, eye protection, or face shield Respiratory hygiene/cough etiquette • Education, posted signs, and source control measures
Question 1 The nurse is preparing to do a physical assessment on a patient who is end-stage HIV positive. What should the nurse do for self-protection?
1. Wash hands and don gloves, gown, and protective face
shield. 2. Don gloves and wash hands after examination; no other protective equipment is necessary. 3. Wash hands and don two pairs of gloves and gown. 4. Wash hands, don gloves, and wash hands after examination; no other protective equipment is necessary.
Answer to Question 1 The correct answer is 4. The nurse should always wash hands prior to the examination. This patient should be treated with “standard precautions.” Gloves are necessary with all patients, regardless of HIV status Option 1 is incorrect because a gown and face shield are not necessary for use with patients who have HIV. Option 2 is incorrect because hands should be washed prior to physical examination. Option 3 is incorrect because double-gloving is not necessary.
The Clinical Setting: General Approach Consider your emotional state and that of the person being examined. The patient is usually anxious due to the anticipation of being examined by a stranger and the unknown outcome of the examination. If anxiety can be reduced, the person will feel more comfortable and data gathered will more closely describe the person’s natural state.
The Clinical Setting: Hands On Measurement and vital signs Have patient change into examination gown. Maintain privacy and respect. Perform hand hygiene. Provide explanations. Begin with person’s hands as point of initial contact. Concentrate on one step at a time—avoid distractions. Examination sequence—offer health teaching Provide explanations. Summarize findings for person.
Developmental Competence Order of the developmental stage is more meaningful than the chronologic age. Position, preparation, and sequence will vary across the life cycle. Infants and toddlers Preschool, school-age child. and adolescent Aging adult Increase comfort with a positive memory of health care providers.
Examination of the Person Who Is Sick The ill person You may need to alter position during examination. Adapt assessment to patient’s comfort level. May be necessary just to examine body areas appropriate to problem, collecting a mini database. You may return to finish a complete assessment after initial distress has been resolved.