Health examination Ms christine Mn prev DEFINITION Health

Health examination Ms christine Mn prev

DEFINITION • Health examination is the systematic assessment of human body which involves the use of one’s senses to determine the general physical and mental conditions of the body

Physical examination • Physical examination is defined as a complete assessment of a patient’s physical and mental status. • A physical assessment is the systematic collection of objective information that is directly observed or is elicited through examination techniques

Indication of health examination • • • On admission On discharge On follow up Health camps Before and after diagnostic and therapeutic procedure.

TECHNIQUE OF PHYSICAL ASSESSMENT

INSPECTION

GENERAL INSPECTION OF A CLIENT FOCUSES ON • • • Overall appearance of health or illness Signs of distress Facial expression and mood Body size Grooming and personal hygiene

PALPATION

PRINCIPLES OF PALPATION • You should have short fingernails. • You should warm your hands prior to placing them on the patient. • Encourage the patient to continue to breathe normally throughout the palpation. • If pain is experienced during the palpation. discontinue the palpation immediately. • Inform the patient where, when, and how the touch will occur, especially when the patient cannot see what you are doing.

LIGHT PALPATION

DEEP PALPATION

PERCUSSION

TYPE OF PERCUSSION • DIRECT PERCUSSION

INDIRECT PERCUSSION

AUSCULTATION

FOUR CHARACTERISTICS OF SOUND • 1. Pitch (ranging from high and low): frequency or number of oscillations generated per second by vibrating object • 2. Loudness (ranging from soft to loud): amplitude of sound • 3. Quality (gurgling or swishing) • 4. Duration (short, medium or long)

OLFACTION

EQUIPMENTS • STETHOSCOPE

OPHTHALMOSCOPE

OTOSCOPE

SNELLEN CHART

NASAL SPECULUM

VAGINAL SPECULUM

TUNING FORK

PERCUSSION HARMER

SPHYGMOMANOMETER

POSITIONING • Sitting/fowler’s

STANDING

SUPINE AND PRONE

DORSAL RECUMBENT

Sim’s

LITHOTOMY

KNEE-CHEST

PREPARING THE ENVIRONMENT

PREPARING THE PATIENT • PSYCHOLOGICAL PREPERATION

PHYSICAL PREPERATION

ARTICLES REQUIRED • • • Screen to provide privacy Bowl for antiseptic lotion Kidney tray and paper bag Weighing machine and height scale Patient gown

ARTICLES REQUIRED • • Bath blanket to cover the patient Pair of leggings Draw sheet to cover patient’s chest Square drum containing test tube, gauze piece, cotton swab, specimen bottle, swabsticks • Gloves • lubricant

ARTICLES REQUIRED • • • Torch Ophthalmoscope Snellen’s chart Book for colour blindness Pen Flash card Autoscope with speculum of different sizes Percussion Hammer Tuning fork

ARTICLES REQUIRED • • • Nasal speculum Mouth gag Laryngeal mirror Tongue depressor Stethoscope Inch tape

ARTICLES REQUIRED • Sterile tray for vaginal examination • Proctoscope • VITALS TRAY

• • ARTICLES FOR NEUROLOGICAL EXAMINATION Powder, soap Snellan’s chart Pencil or pen Cotton wicks Torch Tuning fork Salt, sugar

ARTICLES FOR NEUROLOGICAL EXAMINATION • Tongue depressor • 2 test tubes one with hot water and other with cold water • Safety pins • Some thing solid for grasping • Sharp object like key • Reading material to assess eyes and language of person • Knee harmer

GENERAL SURVEY • • Identification data Gender and race Age Signs of distress Body type Posture Gait

GENERAL SURVEY • • • Body movements Hygiene and grooming Body odour Affect and mood Speech Substance abuse:

VITALS SIGNS

HEIGHT AND WEIGHT:

ASSESSING INTEGUMENT SYSTEM • Assessing skin • Skin color v Erythema

CYANOSIS

Jaundice

Pallor

Vitiligo

Inspect skin vascularity • Ecchymosis

Petechiae

C Inspect skin lesion

Palpate skin temperature, texture, moisture and turgor

EDEMA

PITTING EDEMA

PITTING EDEMA • Grades of pitting edema • • • Grade 0 : (none) Grade +1 : ( trace , 2 mm) Disappear rapidly Grade +2 ( moderate , 4 mm) 10 -15 sec Grade +3 (deep, 6 mm) ≥ 1 min Grade +4 (very deep, 8 mm) 2 -5 min

ASSESSING NAILS • Shape; convex • Angle : between nail and its base is 160 degrees • Texture: smooth, nail base should be firm and non tender • Color: pinkish nail bed with translucent white tips • Capillary refill

ABNORMALITIES OF NAIL • • Koilonychias (spoon nail) clubbing Paranychia indentations called (beau’s line)

ASSESSING HAIR AND SCALP • color, • texture and distribution. • Thickness and lubrication of hair

INSPECT THE SCALP • • Cleanliness, color, dryness, Lump, lesions, Lice (pediculus humanus capitus) Dandruff etc

HEAD AND NECK • ASSESSING THE SKULL • for size, symmetry • any nodules or masses

INSPECT THE FACE

ASSESS THE EYE • • Inspect external eye structure Position and alignment Exophthalmoses strabismus

ASSESS THE EYE • • • Eye brows Eye lid : ectropion(eversion , lid margin turn out) entropion(inversion, lid margin turns inwards) ptosis( abnormal drooping of lid over pupil

ASSESS THE EYE • Eye lashes : sty. • Eye balls • Conjunctiva and sclera{ Paleness, redness or purulent, jaundice}

ASSESS THE EYE • Cornea and iris : arcus senilis • Pupil : PEERLA.

ACCOMMODATION

PUPILLARY REFLEX TO LIGHT

VISUAL ACUITY

INSPECT INTERNAL EYE STRUCTURES

EXTRA OCULAR MOVEMENTS

PERIPHERAL VISION

EARS • AURICLES • EAR CANAL AND TYMPANIC MEMBRANE

• WEBER’S TEST: • RINNE, S TEST: HEARING

NOSE AND SINUSES

INSPECT THE MOUTH PHARYNX AND NECK • LIPS: lesions , pallor (anemia), cyanosis(respiratory cardiovascular problems), cherry colored • BUCCAL MUCOSA , GUMS AND TEETH: teeth look for alignment , dental caries. buccal mucosa is a good site to visualize jaundice and pallor. leukoplakia (thick white patches ) is a precancerous lesion. • TONGUE • FLOOR OF MOUTH • PHARYNX:

ABNORMAL FINDINGS • pallor, cyanosis or redness • lesions, swollen lips red tonsils, swollen red bleeding gums, • white coating of tongue fissured tongue from dehydration. • bright red tongue seen in deficiency of iron b 12 or niacin, • black tongue

ASSESS THE NECK

PALPATE TRACHEA AND LYMPH NODES

PALPATE THYROID GLAND

ASSESS THE THORAX AND LUNGS • INSPECT THE THORAX • Abnormal findings : increase in chest size and contour , abnormal breathing pattern with the use of accessory muscles, unequal chest expansion, and abnormal breath sounds, barrel chest, pigeon chest

PALPATE THORAX

PERCUSS THE THORAX

AUSCULATE BREATH SOUND • Bronchial sounds heard over the trachea are high – pitched, harsh sounds with expiration longer than inspiration. • Bronchovesicular sounds: heard over the main stem bronchus and is moderate (blowing) sound with inspiration equal to expiration. • Vesicular sounds are soft , low pitched and heard best in base of lungs during inspiration longer than expiration.

ABNORMAL BREATH SOUNDS • • WHEEZE RHONCHI CRAKLES FRICTION RUB

CARDIO VASCULAR SYSTEM • INSPECT NECK AND PRECORDIUM • PALPATE THE PRECORDIUM • AUSCULATATE HEART SOUND

AUSCULATATION

ASSESSING THE BREAST AND AXILLA • INSPECT BREAST AND AXILLA • PALPATION OF BREAST AND AXILLA

ASSESSING THE ABDOMEN

QUATRANTS OF ABDOMEN

INSPECT THE ABDOMEM

AUSCULTATE BOWEL SOUNDS

PERCUSS THE ABDOMEN

PALPATE THE ABDOMEN

ASSESS MUSCULO SKELTAL SYSTEM • INSPECT AND PALPATE MUSCLE

MUSCULO SKELTAL SYSTEM • • • PALPATE THE BONES INSPECT AND PALPATE THE JOINTS INSPECT SPINAL CURVES kyphosis Lordosis Scoliosis

ASSESSING MALE AND FEMALE GENITALIA • INSPECT AND PALPATE FEMALE GENITALIA

INSPECT AND PALPATE RECTUM AND ANUS

NEUROLOGICAL SYSTEM

MENTAL AND EMOTIONAL STATUS:

BEHAVIOR AND APPEARANCE

LANGUAGE

INTELLECTUAL FUNCTION • • • Memory Knowledge Abstract thinking Association Judgment

CRANIAL NERVE FUNCTION • • • Olfactory nerve(1): Optic nerve(2) Occulomotor(3) Trochlear(4) Trigeminal(5) Abducens(6)

CRANIAL NERVE FUNCTION • • • Facial(7) Auditory(8). Glossopharyngeal(9) Vagus(10) Spinal accessory(11 Hypoglossal(12)

MOTOR FUNCTION • Balance and gait • Romberg’s test • Motor function and coordination

SENSORY FUNCTION

REFLEX FUNCTION • • • Biceps reflex Triceps reflex Knee and patellar reflex Ankle/ Achilles tendon reflex Babinski reflex Abdominal reflex

PERIPHERAL VASCULAR SYSTEM ASSESSMENT • • • ALLEN’S TEST BUERGER’S TEST CAPILLARY REFILL HOMAN’S SIGN PALPATE PERIPHERAL PULSES

DOCUMENTATION OF DATA

AFTER CARE OF THE PATIENT

AFTER CARE OF ARTICLES