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Ha Report

POWERPOINT

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Jhoanna Fernandez
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10 views36 pages

Ha Report

POWERPOINT

Uploaded by

Jhoanna Fernandez
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PREPARATION &

TECHNIQUES IN
PHYSICAL
EXAMINATION
Presented By ALDA & TAN
PHYSICAL EXAMINATION
A complete nursing assessment
includes both the collection of
subjective data, and the collection of
objective data.
Objective data include information
about the client that the nurse directly
observes during interaction with the
client and information elicited through
physical assessment (examination)
techniques
PHYSICAL EXAMINATION
To become proficient with physical
assessment skills, the nurse must have
basic knowledge in three areas:
Types and operation of equipment
needed for the particular examination
(e.g., penlight, sphygmomanometer,
otoscope, tuning fork, stethoscope)
Preparation of the setting, oneself,
and the client for the physical
assessment
Performance of the four assessment
techniques: inspection, palpation,
percussion, and auscultation
WHAT TO PREPARE
PHYSICAL SETTING
Comfortable, warm room Quiet area free of distractions:
01 temperature: Provide a warm
blanket if the room temperature 03 Turn off the radio, television, or
other noisy equipment.
cannot be adjusted.

Private area free of interruptions Adequate lighting: It is best to


02 from others: Close the door or
pull the curtains if possible. 04 use sunlight (when avail- able).
However, good overhead lighting
is sufficient. A portable lamp is
helpful for illuminating the skin
and for viewing shadows or
contours.
PHYSICAL SETTING
Firm examination table or bed at
05 a height that prevents stooping: A
roll-up stool may be useful when
it is necessary for the examiner to
sit for parts of the assessment.
A bedside table/tray to hold the
06 equipment
examination.
needed for the
EQUIPMENTS NEEDED
EQUIPMENTS NEEDED
EQUIPMENTS NEEDED
EQUIPMENTS NEEDED
EQUIPMENTS NEEDED
EQUIPMENTS NEEDED
EQUIPMENTS NEEDED
PREPARING ONESELF
Proper Hand Hygiene
Proper Complete Personal Protective Equipment
Respiratory Hygiene / Cough Etiquette
Patient Placement
Patient Care Equipment and Instrument Devices
Care of the Environment
Textiles and Laundry
Safe Injection Practices
Infection Control Practices for Special Lumbar
Puncture Procedures
Worker Safety
APPROACHING THE CLIENT
Establish nurse-client relationship during the
interview before Physical Examination
It is important to help alleviate any tension/anxiety
of the patient
At the end of interview, explain the Physical
Examination
RESPECT the CLIENT
POSITIONING
THE CLIENT
SITTING POSITION
Sit upright at the edge
-Position good for: head, neck,
lungs, chest, back, breasts,
axillae, heart, vital signs, upper
extremities
-Permits full expansion of
lungs
SUPINE POSITION
Lie down with legs
together
-Allow abdominal muscles to
relax -> access to peripheral
pulse sites
-Head, neck, chest, breasts,
axillae, abdomen, heart, lungs,
all extremities
DORSAL RECUMBENT
POSITION
Lies down with knees bent,
legs separated
-Areas assessed: head, neck,
chest, axillae, lungs, heart,
extremities, breast, and
peripheral pulses
-No abdomen bc muscles are
contracted
SIM’S POSITION
Lies on left/right with
lower arm placed behind
body and upper arm flexed
at the shoulder and elbow
Upper leg fixed at sharper
angle and pulled forward
- Useful for assessing the
rectal and vaginal areas
STANDING POSITION
Stand straight and still
-Normal, comfortable, resting
posture
-Assess posture, balance, and
gait
-Examines the male genitalia
PRONE POSITION
Lies on abdomen
- Assess hip joint
- Can also assess the back
KNEE-CHEST
POSITION
90 degree angle
- Assesses the rectum
LITHOTOMY
POSITION
Use stirrups for feet
- Assesses the female genitalia,
reproductive tracts, and the
rectum
ORTHOPNEIC
POSITION
Also called the Tripod
Position
- Used by patients with
respiratory problems
- Helps expand the chest and
lungs to allow more oxygen
ROSE POSITION
Both head and neck are
extended, done by keeping
a sand bag under the
supine patient’s shoulder
blade
- This is used in examinations
such Tonsillectomy and
Adenoidectomy
THE 4 BASIC
TECHNIQUES
INSPECTION
Using the senses
Room is comfortable, good lighting,
look before touch, expose body part
inspecting, note while inspecting,
compare symmetric parts
PALPATION
Using hand to touch/feel
Texture, temp, moisture, mobility,
consistency, strength of pulse, size,
shape, degree of tenderness
Light palpation, moderate palpation,
deep palpation, bimanual palpation
PALPATION
PALPATION
PERCUSSION
Tapping body parts
Eliciting pain, determining location,
size, and shape, determining density,
detecting abnormal masses, eliciting
reflexes
PERCUSSION
PERCUSSION
AUSCULTATION
This requires stethoscope to listen to
the heart, blood, bowel, air
The sounds detected are intensity,
pitch, duration, quality
Eliminate distractions, expose body
part, use diaphragm for high pitch,
use bell for low pitch
THANK YOU

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