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Describe ways to prepare the physical environment and make it conducive to a physical examination.
- Comfortable, warm temperature
- Private area free of interruption
- Quiet area with adequate lighting
- Firm examination table or bed
- Beside table/tray to hold equipment
Explain ways to prepare the client for a physical examination.
- Establish nurse-client relationship
- Explain the procedure the physical assessment will follow
- Respect client's desire and request
- Begin examination with less intrusive procedure
Demonstrate the correct method used for inspection during the physical examination.
- Room at comfortable temperature
- Good lighting
- Look and observe before touching
- Completely expose part being examined
- Note characteristics
- Compare appearance
Explain the purpose and differences between light, deep, and bimanual palpation.
- The depth of the structure being palpated and the thickness of the tissue overlying that structure determine whether you
- should use light, moderate, or deep palpation. Bimanual palpation is the use of both hands to hold and feel a body structure.
- Light- There should be very little or no depression (less than 1 cm). Feel the surface structure using a circular motion.
- Use this technique to feel for pulses, tenderness, surface skin texture, temperature, and moisture.
- Deep- Place your dominant hand on the skin surface and your non dominant hand on top of your dominant hand to apply pressure. This should result in a surface depression between 2.5 and 5 cm (1 and 2 inches). This allows you to feel very deep organs or structures that are covered by thick muscle.
- Bimanual palpation- Use two hands, placing one on each side of the body part (e.g., uterus, breasts, spleen) being palpated. Use one hand to apply pressure and the other hand to feel the structure. Note the size, shape, consistency, and mobility of the structures you palpate.
Demonstrate correct direct, indirect, and blunt percussion techniques used during the physical examination.
- Direct percussion is the direct tapping of a body part with one or two fingertips to elicit possible tenderness
- (e.g., tenderness over the sinuses).
- Indirect or mediate percussion is the most commonly used method of percussion. The tapping done with this type of percussion produces a sound or tone that varies with the density of underlying structures. As density increases,
- the sound of the tone becomes quieter.
- Blunt percussion is used to detect tenderness over organs (e.g., kidneys) by placing one hand flat on the body surface and using the fist of the other hand to strike the back of the hand flat on the body surface.
Explain the correct use of the stethoscope and the purpose of the bell and the diaphragm.
- Eliminate distracting noise, Expose the body part being auscultated (IPDQ)
- Diaphragm: high-pitched sounds;
- bell: low-pitched sounds
- Place earpieces into outer ear canal, Angle binaurals down towards nose
- Warm diaphragm and bell before use
- Explain what you are listening to and answer any questions
- Avoid listening through clothes