INTERVIEWING THE PARENT INTERVIEWING THE ADOLESCENT

• Greet the child & the parent's name • Communicate with the adolescent with
• Refer to the child by name respect
• 1-6 years old • Explain every step & give the rationale.
- Focus more on the parents • Silent period are best avoided. Give a
- Provide toys to occupy the chico little time to collect his/her thought but
as the nurse & the parent talk silence is threatening.
- Avoid questions that put parenting • They are sensitive to non verbal
ability in question. complication.
- Talk with the child at eye level but • Reassure them of confidentiality of any
avoid constant eye contact. information share to you.
- Non verbal communication is very- • Praise every action regarding healthy
important to children. lifestyle choices.
- Choose simple words.
INTERVIEWING PEOPLE WITH
INTERVIEWING THE INFANT SPECIAL NEEDS
• Non verbal communication is the • Hearing impaired people
primary method. • Face directly so he/she can read lip
• Crying is the infant primary expression movement & see facial expression
of discomfort. • Speak slowly
• Talk with the presence of parents. • written communication is efficien
• Acutely ill people
INTERVIEWING THE PRE- • Prompt action is required combine
SCHOOLER（2-7 YEARS OLD） interviewing with physical examination.
• Use short, simple sentence with • Ask brief & concise questions
concrete explanation. • Attend to the comfort first of a patient.
• Preschooler can have animistic • Establish priority.
thinking about unfamiliar, objects.
• They also have fear of ________ of • Pacemaker - is a medical device that
their body parts helps regulate the heartbeat when the
heart's natural electrical system isn't
INTERVIEWING THE SCHOOL AGE working properly. It sends small
(7-12YEARS OLD) electrical impulses to the heart to ensure
• They can tolerate & understand other's it beats at a normal rate and rhythm.
viewpoints more objective & realistic. • Chamber - Refers to one of the four
• They wants to knew functional aspects compartments of the heart that pump
how things work & why things are done. blood:
 Right Atrium: Receives - Leave the examining room door
oxygen-poor blood from the open
body. - Position yourself between the
Right Ventricle: Pumps patient & the door.
oxygen-poor blood to the lungs. - Be calm & talk in soft voice.
Left Atrium: Receives • Anxiety
oxygen-rich blood from the - Allow the client to verbalize
lungs. feelings, fears & concerns.
Left Ventricle: Pumps
oxygen-rich blood to the rest of PREPARING THE PHYSICAL
the body. SETTING (STANDARD
PRECAUTIONS)
INTERVIEWING PEOPLE WITH A. HAND HYGIENE
SPECIAL NEEDS - Hand-washing with non-
• People under influence of strict drugs antimicrobial soap and water hand-
or alcohol washing with antiseptic soap using
- ask simply & direct question. an antiseptic hand rub (waterless
- no non threatening questions. product that is usually alcohol-
• Personal questions: based) performing surgical hand
• No need to answer every question ask antisepsis
by the patient.
• Be sensitive to the possibility of a
motive behind the personal questions.
• Sexually aggressive people
• Maintain professional relationship.
• Crying
• Let the person cry & express his/ her
feelings freely.offer a tissue & wait till
regain control soon

INTERVIEWING PEOPLE WITH

SPECIAL NEEDS
• Threat of violence
- Be aware of " Red flag" Ex: Fist
clenching, pacing back-of forth, a
vacant stare. Statement that do not
make sense.
B. GLOVES to be encountered. Remove a soiled
- Wear gloves (clean, non sterile gown as promptly as possible, and
gloves are adequate) when touching wash
blood, body fluids, secretions, Hands to avoid transfer of
excretions, and contaminated items. Microorganisms to other patients or
Put on clean gloves just before environments
touching mucous membranes and E. Patient care Equipment
non intact skin. Change gloves F. Environmental control
between tasks and procedures on G. Linen
the same patient after contact with H. Occupational Health and blood-
material that may contain a high borne Pathogens
concentration of microorganisms. I. Patient placement
Remove gloved promptly after use,
before touching non-contaminated HOW TO PUT ON PERSONAL
items, and environmental surfaces, PROTECTIVE EQUIPMENT (PPE)
and before going to another patient.
Wash hands immediately to avoid DIFFERENT POSITION OF THE
transfer of microorganisms to other PATIENT
patients on environment Mask, eye LITHOTOMY POSITION
protection, face shield wear a mask - The client lies on his or her back
and eye protection or a face shield with the hips at the edge of the
to protect mucous membranes of examination table and the feet
the eyes, nose, and mouth during supported by stirrups. The lithotomy
procedures and patient care position is used to examine the
activities that are likely to generate female genitalia, reproductive tracts,
splashes or sprays of blood, body and the rectum.
fluids, secretions, kid excretions. - The client may require assistance
getting into this position. It is an
C. GOWN exposed position, and clients may
- Wear a gown (a clean, non-sterile feel embarrassed.
gown is adequate) to protect skin - In addition, elderly clients may not
and to prevent soiling of clothing be able to assume this position for
during procedures and patient care very long or at all. Therefore, it is
activities that are likely to generate best to keep the client well draped
splashes or sprays of blood, body during the examination and to
fluids, secretions, or excretions. perform the examination as quickly
Select a gown that is appropriate for as possible.
the activity and amount of fluid likely
 -In trendelenburg position, the
patient is supine on the table with
their head declined below their feet
at an angle of roughly 16*

THE PRONE POSITION

- Is a patient position used during
surgical procedures that provide
surgical access to the dorsal
aspects of the patient's body. !, in
the prone position, the patient is
positioned face down with their DORSAL RECUMBENT POSITION
head in a neutral position without - A position in which the patient lies
excessive flexion, extension, or on the back with the lower
rotation extremities moderately flexed and
rotated outward.
- It is employed in the application of
obstetrical forceps, repair of lesions
following parturition, vaginal
examination, and bimanual
palpation.
THE SUPINE POSITION
- Means lying horizontally with the
face and torso facing up,

SIMS POSITION
- Is a standard position in which the
patient lies on their left side, with
THE TRENDELENBURG POSITION right hip and knees bent.
- Is a position for a patient on the The lower arm is behind the back,
operating table, most commonly the thighs flexed. The left knee is
used during lower abdominal slightly tilted. The right arm is
surgeries and central venous positioned comfortably in front of the
catheter placement. body, the right arm is rested behind
the body.
 changes in venous return and
cardiac output.
- However, the magnitude of these
changes and their consequences on
intraoperative haemodynamics and
anaesthetic requirements remain to
THE LATERAL POSITION be determined.
- Is used for surgical access to the
thorax, kidney, retroperitoneal
space, and hip.
- Depending on the side of the body
on which the patient is being
operated, the patient will fie on their
left or right side. PHYSICAL EXAMINATION
- Before being placed in the lateral TECHNIQUES
position, the patient is induced in • Four basic techniques must be
the supine position. mastered before you can perform a
thorough and complete assessment of
the client. These techniques are: (Mostly
lumalabas sa board exam)
• Inspection
• Palpation
• Percussion and
FOWLER'S POSITION • Auscultation
- Is a standard position where the
patient is seated in a semi-upright ICTERIC JAUNDICE - Refers to a
position at an angle between 30 and condition where the skin, sclera (whites
90 degrees, with legs either bent or of the eyes), and mucous membranes
straight. turn yellow due to the buildup of bilirubin
in the blood. This yellow discoloration is
caused by issues in bilirubin metabolism
or excretion.

Inspection
Use the following guidelines as you
practice the technique of inspection:
THE KNEE-CHEST (KC) POSITIÓN
- Make sure the room is a
- Is often used for spine surgery. It
comfortable temperature. A too-cold
is considered to promote significant
 or too-hot room can alter the normal - Shape (well defined/ irregular),
behavior of the client and the and degree of tenderness.
appearance of the client's skin. - Three different parts of the hand-
- Use good lighting, preferably 1. The finger pads,
sunlight. Fluorescent lights can alter 2. Ulnar/palmar surface
the true color of the ski it. In 3. Dorsal surface-are used
addition, abnormalities may be during palpation.
overlooked with dim lighting.
- Look and observe before touching. PERCUSSION
Touch can alter appearance and THREE TYPES OF PERCUSSION -are
distract you from a complete. direct, blunt, and Indirect.
Focused observation. 1. DIRECT PERCUSSION
- Completely expose the body part - Is the direct tapping of a body part
you are inspecting while draping te with one or two fingertips to elicit
rest of the client as appropriate. possible tenderness (e 8,
- Note the following characteristics tenderness over the sinuses).
while inspecting the client: Color, 2. BLUNT PERCUSSION
patterns, size, location, consistency, - Is used to detect tenderness over
symmetry, movement, behavior, organs (eg. Kidneys) by placing one
odor, or sounds. hand flat on the body surface and
- Compare the appearance of using the fist of the other hand to
symmetric body parts (e-go, eyes, strike the back
ears, arms, hands) or both sides of 3. INDIRECT OR MEDIATE
any individual body part. PERCUSSION
-Is the most commonly used method
PALPATION of percussion. The tapping done
Consists of using parts ef the hand to with this type of percussion
touch and feel for the following produces a sounds or tone that
Characteristics: varies with the density of underlying
- Texture (rough/ smooth), - structures
temperature (vara/cold),
- moisture (dry/wet), sobility
(fixed/novable/still/vibrating), -
consistency (soft/ hard/fluid filled), AUSCULTATION
- Strength of pulses The following guidelines should be
(strong/weak/thread/bounling), followed as you practice the technique
- Size (small /sedfun/large), of auscultation:
 - Eliminate distracting or competing • During examination of the abdomen, it
noises from the environment (e z. is important to flex the patient's knees to
Radio, television, machinery). relax the abdominal muscles. This
- Expose the body part you are facilitates the examination of abdominal
going to auscultate. Do not organs.
auscultate through the client's • The sequence of examining the
clothing or gown. Rubbing against quadrants of the abdomen is as follows:
the clothing obscures the body Right lower
sounds. quadrant, right
- Use the diaphragm of the Upper quadrant, left upper quadrant, left
stethoscope to listen for high- lower quadrant.
pitched sounds, such as normal • Avoid abdominal palpation among
heart sounds, breath sounds, and patients with tumor of the liver and
bowel sounds, and press the tumor of the kidneys.
diaphragm firmly on the body part • Do auscultation of the abdomen for 5
being auscultated. minutes before concluding absence of
- Use the bell of the stethoscope to bowel sounds.
listen for low pitched sounds such
as abnormal heart sounds and ABDOMEN - IAPP is a systematic
bruits (abnormal loud, blowing, or method for examining the abdomen in a
murmuring sounds heard during clinical setting. It stands for Inspection,
auscultation). Hold the bell lightly on Auscultation, Percussion, and Palpation.
the body part being auscultated. VITAL SIGN
• Vital signs reflect essential body
PHYSICAL EXAMINATION functions, including your heartbeat,
GUIDELINES breathing rate, temperature, and blood
• Write out the examination sequence pressure.
and refer to it as needed, or use a • Your health care provider may watch,
printed form of the procedure, initially. measure, or monitor your vital signs to
Explain to the patient that making brief check your level of physical /functioning.
notations will ensure accuracy of • Normal vital signs change with age,
findings. sex, weight, exercise capability, and a
• Perform the procedure using head to health.
toe sequence. • Vital signs include temperature
• The sequence of techniques for recorded in Celsius or Fahrenheit, pulse,
examination of the abdomen as follows: respiratory rate, blood pressure, and
Inspection, auscultation, percussion, oxygen saturation using a pulse
palpation. oximeter.
TYPE OF BODY TEMPERATURE
• Core temperature
• Temperature of the deep tissues of
the body
• Measured by taking oral & Rectal
temperature.
FACTORS AFFECTING BODY HEAT
• Is the temperature of the internal
PRODUCTION
organs, such as the liver, located deep
• Basal metabolic rate
within the body.
• Muscle activity
• The human body maintains its core
• Thyroxine output
temperature within a very narrow range
• Epinephrine, norepenephine
of 36.5-38.5 °c |97.7: 101.3 °f/-
• Increased temperature of body cells
(fever)
TYPE OF VITAL SIGNS
TEMPERATURE
PROCESS INVOLVED IN HEAT LOSS
• Alterations in body temperature
• Radiation
PYREXIA
• Conduction
- body temperature above normal
• Convection
range hyperpyrexia
• Evaporation
- very high fever (41"C'(105.8°c) of
TYPE OF FEVER
above.
INTERMITTENT FEVER
HYPOTHERMIA (LOWER THAN
- Temperature fluctuates between
36.5°C OR 96.0°F)
period of fever & period of normal /
- May be seen in prolonged exposure
Subnormal temperatures.
to the cold, hypoglycemia,
REMITTENT FEVER
hypothyroidism, or starvation.
- Temperature fluctuates with a wide
HYPERTHERMIA (HIGHER THAN
range over the 24 hours period but
38.0°C OR 2)0°*
remain above normal.
- May be seen in viral or bacterial
RELAPSING FEVER
infections, malignancies, trauma, and
- Temperature is elevated for few days
various blood, endocrine, and immune
alterna ted with 1 or 2 days of normal
disorders. In the older adult,
temperature
temperature may range from 95.0°f to
Constant fever
97.5°f.
- Body temperature is constantly high
41-42°c/cause irreversible brain all
damage)
MONROEL KELLY HYPOTHESIS - - 9 mins for adults
Describes the relationship between the - 5 mins infants / children
contents of the skull and intracranial
pressure (ICP). It is based on the idea TYPE OF VITAL SIGNS PULSE
that the skull is a rigid, non-expanding • measure of the heart rate.
structure, and its internal volume is • regulated by autonomic nervous
fixed. system.

METHODS OF TAKING FACTORS AFFECTING PULSE RATE

TEMPERATURE • Age
ORAL TEMPERATURE • Sex/ Gender
- 2-3 mins • Exercise
- Allow 15 mins to elapse between a • Fever
clients intake of hot or cold forward • Medications
smoking • Hemorrhage
- Shake the thermometer dose 35.5 / • Stress
"C96f)
- Thermometer under - the tongue LEFT VENTRICLE - also called left
Towards the sides. ventricular hypertrophy (LVH), occurs
- Wash the thermometer before use when the muscular wall of the heart's left
from the bulb to the stem. ventricle thickens. This can be due to
- After use from stem to the bulb.o increased workload or other conditions
that strain the heart.
PULSE SITE (Memorize 1 by 1 In front)
1. Temporal
2. Carotid
3. Apical-5th ics
4. Brachial
5. Radial
RECTAL TEMPERATURE
6 femoral
- Most accurate measurement of
7. Posterior tibial
temperature
8. Popliteal
- Lateral position
9. Dorsalis pedis
- 0.5-1.5 inches insertion of
RHYTHM
thermometer
ARRHYTHMIA
- Lubricate the thermometer.
- Variation in normal rhythm
DYSRHYTHMIA
AXILLARY TEMPERATURE
-Abnormal disturbed rhythm
- Safest & non invasive
Results from impulse formation - Movement of gases in & out of the
disturbance of conduction disturbance lungs.
Inhalation- inspiration exhalation-
VOLUME expiration diffusion- exchange of gases
•(Amplitude) from an area of / higher pressure to an
• Strength of pulse area of lower pressure( alveoli- capillary
• Normal pulse- felt with moderate membrane
pressure Perfusion- availability & movement of
• Scale blood for transport of gases nutrients
• 0- absent metabolic
• 1+- weak thready Waste products.
• 2+ - normal
• 3+ full bounding TYPE OF BREATHING
• Costal (thoracic) involves movement of
ARTERIAL WALL ELASTICITY the chest.
- Artery feels straight, smooth & soft. • Diaphragmatic(abdominal)
- Presence / absence of bilateral • VMedulla orlongata- primary center
equality • Pons
• Pneumotoxic center- rhythm/
RESPIRATION • Apneustic center-responsible for deep
- Act of breathing prolonged inspiration.
VENTILATION