Ch. 30 Health Assessment Flashcards
What is the purpose of the physical examination
- Gather baseline data about a patient’s health status
- Supplement, confirm, or refute subjective data obtained
- Make clinical decisions about a patient’s changing health status and management
- Evaluate the outcomes of care
Baseline assessment findings
These are the pattern of findings identified from the patient is first assessed. They reflect a patient’s functional abilities and serve as the basis for comparison with subsequent assessment findings
How would you prepare for an examination for infection control
Use standard precautions throughout an examination
- When open sore is present, wear gloves to reduce contact
- If there is excessive drainage, use additional PPE such as isolation gown or eye shield
- Hand hygiene before and after
- Find out if patient has latex allergy
What types of allergic responses appear with latex allergies
- immunological reaction - type 1 response for which the body develops IgE that can lead to an anphylactic response
- Type IV (delayed type) hypersensitivity which is T cell mediated and appears 6 to 48 hours after exposure
What do we do to the environment to prepare for an exam?
- Requires privacy
- Need to be well equipped for any procedure
- adequate lighting
- Eliminate extra noise
- prevent interruptions
- Warm enough to maintain comfort
- Special exam tables make positioning easier
What equipment do we have to prepare for an exam
How do we physically prepare the patient for an exam
- Allow the patient to use the restroom first
- Make certain patient privacy is maintained with proper dress and draping
- Drafts eliminated, temperature is controlled and blankets provided
- Organize the exam so that all techniques requiring a sitting position are completed first followed by supine and so forth
Name all the different patient positions
- Sitting
- Supine - laying flat on bed - provides easy access to pulse sites
- Dorsal recumbent - laying flat with knees bent and arms up position is for abdominal assessment
- Lithotomy - flat with knees/legs up in air bent - provides maximal exposure of female genitalia
- Prone - Laying on stomach - assessing extension of hip joint, skin and but
- Lateral recumbent - laying on the side flexing the hip and knee - helps detect murmurs
- knee chest - laying on stomach and bending over on knees provides exposure to rectal area
What do we say to the patient to prepare them for an exam? Psychological preparation of a patient
Thorough explanation of the purpose and steps of each assessment lets a patient know what to expect
Convey an open, professional approach while remaining relaxed
During the exam watch patient’s emotional responses by observing whether their facial expressions show fear or concern
How do you prepare different age groups for an exam
When examining children:
- Gather all or part of the history on infants and children from the parents. Older children can be interviewed and provide details of their history
- Gain a child’s trust before doing any type of exam. Talk and play with the child first. Start the exam from the periphery and move to the center
- Offer parents support during the exam to avoid them thinking they are being judged
- Call children by their first name and address the parents as Mr or Mrs
- Treat adolescents as adults
What are some principles to follow when examining an older adult
- Do no stereotype about aging parent’s level of cognitiion
- Recognize that some older adults have sensory or physical limitations that affect how quickly they can be interviewed and examined. It might be necessary to plan more than 1 session
- Perform the exam with adequate space
- Use patience, allow for pauses, and observe for details. Let patients tell their stories and explore any symptoms or problems they reveal
- Be alert to signs of increasing fatigue
How do we organize the exam
Assess each body system during a physical exam
Follow a systematic routine
Use the head to toe approach
- compare both sides of the body for symmetry
- Assess the systems of the body most at risk for being abnormal for example complete a cardiovascular assessment first when caring for a patient with chest pain
- Offer rest periods
- Perform painful procedures at the END of the axam
What are the techniques of physical assessment
- inspection
- auscultation
- percussion
- palpation
Inspection
Occurs when interacting with a patient, watching for nonverbal expressions of emotional and mental status and assessing physical movements and structural components
Recognize the nature and source of body odors. Olfaction helps to determine abnormalities
Palpation
Using the sense of touch to gather information
You palpate the skin for temperature, moisture, texture, turgot, tenderness and thickness and the abdomen for tenderness, distention or masses
Palpate tender areas last
Two types of palpation: light and deep
Light = place hand on the body part and press inward about 1 cm (1/2 inch)
Deep = to examine the condition of organs such as those in the abdomen. Press inward about 4 cm (2 inches)
