Physical Examinations By Dr Mona Mohammed Introduction Nurses

Physical Examinations By Dr/ Mona Mohammed

Introduction: Nurses perform systematic physical assessments on a regular basis in nearly every health care setting. In acute care settings you will perform more comprehensive assessments when patients are admitted to agencies and brief physical assessments at the beginning of each shift to identify changes in a patient’s status for comparison with the previous assessment. A routine physical assessment takes 10 to 15 minutes and reveals information that supplements a patient’s database. The physical examinations are always correlated with the health history as well as with other assessments, such as laboratory or diagnostic data and/or developmental, psychosocial, family, and cultural assessment data.

Definition Of Physical Examinations: It is a collection of objective data that provides information about changes in the patient's body systems. These data are obtained through direct observation or elicited through examination techniques, such as inspection, palpation, percussion, and auscultation. In general, a physical assessment is performed after taking the health history.

Methods of Physical Examinations: The physical assessment is conducted using one of two methods: the systems method or the head-to-toe method. Sometimes, healthcare providers use parts of both methods. - The systems method: approaches the examination by assessing each body system separately. - The head-to-toe method: it begins at the top of the body and progresses downward.

Physical Examinations Techniques: A complete yet organized assessment is obtained by using a combination of head-to-toe and body-systems approach in conjunction with the use of the four basic techniques, inspection, palpation, percussion, auscultation (IPPA):

Inspection: is the visual examination of body parts or areas. Observation (see, smell); actually starts during the health history and continues throughout the exam; always comes first (before you touch or listen), but continues concurrently with PPA as well. Note general observations and then specifics of each area proceeding from the outside to the inside.

Palpation: uses the sense of touch. Touching; light (1 cm), then deep (4 cm), and rebound (deep with quick release). Assesses position, texture, size, consistency, fluid, crepitus, form, structure, vibration, or temperature.

Percussion: involves tapping the body with the fingertips to vibrate underlying tissues and organs. Tactile sensation and sound (to 5 cm deep); direct or indirect with fingertip pad or fist; more solid: higher pitch, softer intensity, shorter duration; more air: lower pitch, louder intensity, longer duration; expected percussion notes: tympanic (gastric bubble), hyperresonant (emphysematous lungs), resonant (healthy lung), dull (liver), flat (muscle).

Auscultation: is listening with a stethoscope to sounds produced by the body. Listening direct (naked ear) and indirect (acoustical stethoscope or Doppler amplification). Analyzes intensity, pitch, duration, quality, and location. The bell analyzes low-pitched sounds and the diaphragm analyzes high-pitched sounds. Through auscultation the nurse notes that there are four characteristics of sound:

- Frequency: Number of sound wave cycles generated per second by a vibrating object. The higher the frequency, the higher the pitch of a sound and vice versa. - Loudness: Amplitude of a sound wave. Auscultated sounds are described as loud or soft. - Quality: Sounds of similar frequency and loudness from different sources. Terms such as blowing or gurgling describe quality of sound. - Duration: Length of time that sound vibrations last. Duration of sound is short, medium, or long. Layers of soft tissue dampen the duration of sounds from deep internal organs.

Components of the Physical Assessment: Using inspection, palpation, percussion, and auscultation, the examiner assesses and records findings about the following attributes, body functions, and systems:

• General Appraisal: It is the first component of the physical assessment, beginning with the first moment of patient contact and continuing throughout the nurse–patient relationship. The general survey contributes to an overall impression of the patient. It includes: Physical appearance, age, overall physical development, hygiene, grooming, and posture, mobility, use of ambulatory devices, weight, height, and vital signs.

Skin, hair, and nails. Head, face, and lymphatic. Eye, ear, nose, mouth, and throat. Neck and upper extremities. Chest, breasts, and axillae. Thorax and lungs/respiratory system. Heart and cardiovascular system. Abdomen/gastrointestinal (GI) system. Genitalia/genitourinary (GU) system and anus. Lower Extremities: Musculoskeletal system (MBJB: muscles, bones, joints, and back assessment). Neurological: Reflex, neuropsychiatric. sensory, cranial, cerebral, cerebellar, neurodevelopmental,

At the conclusion of the examination, the nurse allows the client to dress privately or help the client dress if needed, help the client get in a comfortable position, and ask if he or she has any questions. Finally, the nurse informs the client and family that data will be shared with the physician.

Safety Guidelines: 1. Prioritize an assessment based on a patient’s presenting signs and symptoms or health care needs. For example, when a patient develops sudden shortness of breath, first assess the lungs and thorax. 2. Organize an examination. Compare both sides of the body for symmetry. If a patient becomes fatigued, offer rest periods. Perform painful or intrusive procedures near the end of an examination.

3. Use a head-to-toe approach following the sequence of inspection, palpation, percussion, and auscultation (except during abdominal assessment). This sequence facilitates an effective assessment. 4. Encourage a patient’s active participation. Patients usually know about their physical condition. Often a patient can let you know when certain findings are normal or when there have been changes. 5. Always identify a patient using at least two identifiers other than the room number. For example, use the patient’s name and date of birth, comparing them with the identification band or medical record.

6. Follow standard precautions for infection control. During an assessment you may have contact with body fluids and discharge. 7. Consider the possibility of latex allergy. The incidence of serious allergic reaction to latex has increased dramatically. 8. Record quick notes to facilitate accurate documentation. Inform a patient that you will be recording the data. 9. Record a summary of the assessment using appropriate medical terminology and in the sequence that findings are gathered. Use commonly accepted medical abbreviations to keep notes concise. Be thorough and descriptive, especially for abnormal findings.

Diagnostic Studies: Driven by findings on the history and physical examination; options include: Blood tests (CBC, chemistry, bedside glucose, pregnancy test, urinalysis, cardiac enzymes, coagulation studies) Imaging studies (X-rays, CT, MRI, ultrasound) Other diagnostic studies (ECG, EEG, lumbar puncture, etc. , )