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I. Purpose of the Physical Exam
- 1-Provides indication of the person’s overall health state
- 2-Can provide additional information about the clinical significance of reported symptoms
- 3-Can provide indication of how person is responding to treatment already given (reevaluate)
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A. Assessment Data
--Two Types of Data -Go Hand in Hand!
- 1-Subjective: something not measurable, family/friend/Patient tells you (coughing for 2 weeks)
- 2-Objective: (never stands alone) if measurable,what find in physical exam, or diagnostic test, lab studies, observations
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II. Nursing Assessment
- -Differs in focus from medical assessment [because we are moreglobal]—we wonder if pt understands meds and has transportation
- -Holistic approach with client and family
- a. physical
- b. psychosocial-(feeling and emotions)
- c. spiritual (esp with terminal)
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A. Types of Assessment

1- Comprehensive Examination
- --done when first meet pt (ex: do you feel safe at home, do they wanna see clergy, who lives in home
- a. A comprehensive assessment is performed with a health history and complete physical examination
- b. This type of examination is done on admission to a hospital or when first meeting a client a home or in an office or clinic setting if appropriate. [admission assessment more in depth to find baseline]
- c. This exam provides baseline data that we can use for comparison in later exams.
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2- Ongoing Partial Assessment
- a. This is conducted at regular intervals such as the
- beginning of each shift or at each home visit, and may be repeated as needed
- --(depends where you are and circumstances)
- b. This is the type of exam you will perform each week
- c. This assessment focuses on identified health problems as well as a general screening parameters to measure any positive or negative changes, and to evaluate the effectiveness of interventions
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3-Focused Assessment
- a. A focused assessment is conducted to address one specific problem. (ex: asthma)
- b. This may stand alone or be a part of a ongoing assessment or a more comprehensive assessment.
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4- Emergency Assessment
- a. A rapid assessment used to detect life threatening situations
- b. Airway,breathing, circulation come first (A,B,C’s)
- c. First survey is followed by a more complete assessment
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5- Physical Assessment
- --Preparing the environment--> privacy, clean, comfortable physically and emotionally, cultural awareness, good light
- --Gathering equipment--first before pt in position
- --Preparing the client--explain what you are doing, introduce your self, identify pt, privacy cultural
- --Maintaining cultural sensitivity
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B- Gathering Equipment
- -Stethoscope
- -BP cuff -
- Thermometer-
- Scale-Measuring Tape
- -Reflex hammer-
- Otoscope
- -Snellen Chart (eye chart)-
- Vaginal spectulum (ex:OB/GYN
- -Gloves
- -Mask
- -Gown
- -Goggles
- -Lubricant
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C-Positioning During Exams

- Supine
- Semi-fowlers
- Supine
- Dorsal recumbant
- Side lying
- Lithotomy (vagina exam)
- Knee chest (forarms down and lower leg down, like all 4’s)rectal exam
- Sims
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III. Inspection
- --The process of deliberate, purposeful observations performed in a systematic manner.
- (includes all senses; use all senses!)
- --One area at a time
- --Compare one side to the other.
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A. Palpation
- --Uses sense of touch to gather information that cannot be
- obtained through inspection alone.{ex touch for fever, bump, sweaty-diaphoretic}
- ----Light
- ----Deep-(don’t want to do this as nusrse)
--need to be able to describe! (voab words) Weber to clinical
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1- Palmar Surface of Hand
- - finger pads very sensitive, moisture, texture, masses, pulsations, edema, crepidis
- (air under skin feel like rice crispy); vibrations
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2-Dorsal Surface of Hand
- use back of hand (most sensitive to temperature); want to see if knee is hot b/c of injury and compare both
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3- Light Palpation
- - organ size, contracted (hold fingers together) DO Not Press More Than a ½ INCH!
- Ex: bowel sounds, watch face for reaction
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B. Percussion
- --Act of tapping a person’s skin in order to set up a vibration that can be interpreted by you the health professional.
- --The sound wave produced is called a percussion tone
- --Characteristics of these sounds can be described
- 1-Indirect Percussion –Use middle finger of non-dominant hand on the body, hit it with the dominant hand finger, look for consolidation or fluid
- 2-pleximeter (non-dominant hand middle finger)
- 3-plexor (dominant hand middle finger)
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- Percussion Tones
- a. Flatness Soft Thigh
- b. Dullness Medium Liver
- c. Resonance Loud Normal Lung
- (hollow air, normal lung)
- d. Hyperresonance Very Loud Emphysema
- (lost elasticity of aveoli, larger air sac) (ex left lower lobe)
- e. Tympany Loud Air in Abdomen
- (drum like)
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2- Auscultation
- -Use of stethoscope to listen to body sounds.(use all of time)
- ex: lung, heart, bowel sounds
- -Listen for:
- 1-pitch-high to low (notes)
- 2-loudness-volume
- 3-quality-characteristics (wheeze, gurgle, swish, crackles)
- 4-duration-length (short, medium, long)
- ex: high pitch end of expiration wheeze, soft (lung)
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IV. General Survey
- -First Component of any exam
- -Most important of all parts of exam
- -Can get most information from initial meeting
- -Uses inspection technique including sight, smell, and, hearing
- -Includes observation of appearance and behavior, taking vital signs, and measuring height and weight
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