COLLECTING OBJECTIVE DATA: PHYSICAL EXAM TECHNIQUES Flashcards
how will you prepare the physical setting, yourself, and the client can affect the quality of the data you elicit, which will support your clinical judgments.
PREPARING FOR THE EXAMINATION
the physical examination may take place in a variety of settings such as a hospital room, outpatient clinic, physician’s office, school health office, employee health office, are a client’s home.
PREPARING THE PHYSICAL SETTING
careful preparation of yourself as an examiner is essential to be able to gather objective data to elicit sound and clinical judgments. As a beginning examiner, it is helpful to assess your own feelings and anxieties before examining the client
PREPARING ONESELF
READ:
In 2007, the Centers for Disease Control and Prevention (CDC) and the Hospital Infection Control Practices Advisory Committee (HICPAC) updated Standard Precautions to be followed by all healthcare workers caring for clients
- it is used for all client care
- they are based on a risk assessment and make use of common sense practices and personal protective equipment use that protect health care providers from infection and prevent the spread of infection from client to client.
STANDARD PRECAUTIONS
- it is establishing the nurse-client relationship during the client-interview before the physical examination takes place
- it helps alleviate any tension or anxiety that the client is experiencing
approaching and preparing the client
POSITIONING THE CLIENT:
- the client should sit upright on the side of the examination table
SITTING POSITION
POSITIONING THE CLIENT:
- ask the client to lie down with the legs together on the examination table. A small pillow may be placed under the head to promote comfort.
SUPINE POSITION
POSITIONING THE CLIENT:
- the client lies down on the examination table or bed with the knees bent, the leg separated, and the feet flat on the table or the bed.
- this position may be more comfortable than the supine position for clients with pain in the back or the abdomen.
DORSAL RECUMBENT POSITION
POSITIONING THE CLIENT:
- this position is useful for assessing the and vaginal areas
SIMS POSITION
POSITIONING THE CLIENT:
- it is used primarily to assess the hip joint.
- the back can also be assessed with the client in this position.
- clients with cardiac and respiratory problems cannot tolerate this position
PRONE POSITION
POSITIONING THE CLIENT:
- this position allows the examiner to assess posture, balance, and gait
- used for examining the male genitalia
STANDING POSITION
POSITIONING THE CLIENT:
- this position may be embarrassing and uncomfortable for the client; therefore, the client should get in the position for as limited a time as possible.
- elderly clients and clients with respiratory and cardiac problems may be unable to tolerate this position
KNEE-CHEST POSITION
POSITIONING THE CLIENT:
- it is used to examine the female genitalia, reproductive tracts, and the rectum.
- it is an exposed position, and clients may feel embarrassed.
- elderly clients may not be able to assume this position for very long or at all
LITHOTOMY POSITION
what are the eight types of positioning the client?
- SITTING
- SUPINE
- DORSAL RECUMBENT
- SIMS
- STANDING
- PRONE
- KNEE-CHEST
- LITHOTOMY
what are the four basic techniques that must be mastered before you perform a thorough and complete assessment of the client?
- inspection
- palpation
- percussion
- auscultation
it involves using the senses of vision, smell, and hearing to observe and detect any normal or abnormal findings
INSPECTION
it consists of using parts of the hand to touch and fill for the following characteristics:
- texture (rough/smooth)
- temp. (warm/cold)
- moisture (dry/wet)
- mobility (fixed/movable/still/vibrating)
- consistency (soft/hard/fluid filled)
- strength of pulses (strong/weak/thready/bounding)
- size (small/medium/large)
- shape (well defined/irregular)
- degree of tenderness
PALPATION
PARTS OF HAND TO USE WHEN PALPATING:
- find discriminations: pulses, texture, size, consistency, shape, crepitus
FINGERPADS
PARTS OF HAND TO USE WHEN PALPATING:
- vibrations, thrills, fremitus, temperature
ULNAR OR PALMAR SURFACE
DORSAL (BACK) SURFACE
4 TYPES OF PALPATION:
- Light palpation
- moderate palpation
- deep palpation
- bimanual palpation
this technique is used to feel for pulses, tenderness, surface skin texture, temperature, and moisture
light palpation
this palpation involves depressing the skin surface from 1 to 2 cm (0.5-0.75 in.) with your dominant hand, and use a circular motion to fill for easily palpable body organs and masses.
moderate palpation
this palpation allows you to feel very deep organs or structures that are covered by thick muscle
deep palpation
use two hands, placing one on each side of the body part being palpated. use one hand to apply pressure and the other hand to fill the structure. note the size, shape, and mobility of the structures you palpate
bimanual palpation
