Chapter 4: Physical Examination Techniques and Equipment

Chapter 4: Physical Examination Techniques and Equipment Physical Examination Modes · Inspection: the use of visual, auditory, and olfactory senses to make purposeful observations of the patient · Percussion: a tapping motion to produce sounds to interpret about the body area thats being examined · Palpation: the use of hands and fingers on body regions · Auscultation: the use of a stethoscope to detect sounds produced by movements of air or fluid in the body or to detect the absence of expected sounds Hand Hygiene · Patient-to-patient transmission of pathogens depends on 5 steps: 1) Organisms are present on the patient's skin or immediate environment 2) Organisms are transferred from the patient to the nurse's hands on his/her environment 3) Organisms survive on the nurse's hands for at least several minutes 4) The nurse omits or performs inadequate or inappropriate hand hygiene 5) The contaminated hands of the nurse comes into direct contact with another patient or the environment, or direct contact with another patient · Hand hygiene helps prevent the transmission of pathogens and subsequent infections. It includes the use of alcohol-based hand rubs (hand sanitizers), handwashing with warm water and soap, and the use of gloves · Use ABHR's when your hands are not visibly soiled · Use soap and water when your hands are visibly soiled · Use gloves before coming into contact with bodily fluids, blood, secretions, etc. ↳ always wash hands after glove removal Anatomical Position Routine Practices · should know quadrants and regions from A&P · Nurses use routine practices with all patients to reduce the transmission of pathogens in both diagnosed and unknown infections ↳ prevent disease transmission during contact with nonintact skin, mucous membranes, blood, body fluids, and body substances ↳ treat all patients equally without stigma · underlying assumption that "all patients are colonized or infected with microorganisms whether or not there are signs or symptoms” · respiratory hygiene/cough etiquette: cough into sleeves or tissues and immediately dispose of tissues and wash hands · PPE: mask, eye protection, face shields, gowns, gloves, etc. Additional Precautions · avoidance of latex gloves due to latex allergy · negative/positive pressure rooms · N95 respirators Note: always perform hand hygiene in front of patients, it helps reassure patients that the nurses are protecting their welfare Inspection · general inspection: intentionally observing patients for specific characteristics · What to observe for: ↳ age ↳ skin colour ↳ gender ↳ hygiene ↳ LOC ↳ posture ↳ body size ↳ discomfort/anxiety · local inspection: assessing specific body systems and areas (always follows general inspection) Palpation · palpation makes use of the sensory properties of the hand. Light palpation is always used in physical examination, deep palpation is used at your discretion ↳ always ask permission to touch!! · palpation requires you to identify tactile, kinesthetic, vibratory, and temperature sensations · light palpation: appropriate for assessing skin surface characteristics, such as texture, surface lesions, lumps, inflamed areas of skin, and structures 1 cm from skin surface · deep palpation: to detect information about structures 3-4 cm below skin surface. Use firm, discontinuous pressure to avoid reducing tactile sensitivity · Commonly used movements for palpation include: ↳ circular motions ↳ dipping motions ↳ direct pressure ↳ gliding motions ↳ grasping (pincer) motions Percussion · sounds are perceived in terms of 4 characteristics: 1) pitch (frequency) 2) duration 3) quality (timbre) 4) intensity (loudness) · percussion: notes are sounds produced in the body as a result of percussing (tapping) on body surfaces ↳ 5 percussion notes: dullness, flatness, resonance, hyperesonance, and tympany · direct percussion: you tap your finger directly on the patients skin, use the lightest tap that will produce a response · indirect percussion: you tap with your middle finger of your dominant hand over the middle finger of your non-dominant hand, which you place on a body surface ↳ more common Auscultation · Auscultation: Using a stethoscope to detect sounds created by vibrations of underlying tissues transmitted to the skin surface and by closure of heart valves ↳ used when assessing BP, lung sounds, heart sounds, peripheral arteries and the abdomen · Describe sounds in terms of location, then intensity, pitch, duration, and quality · bell: low frequency sounds · diaphragm: high frequency sounds