Академический Документы
Профессиональный Документы
Культура Документы
Assessment of physical findings should confirm data conclusion. Baseline information mind
for making accurate inspections: is obtained on admission. The proper examination proceeds
logically from head to be starting with general appearance, blood pressure (BP), pulse,
hands, head and neck, heart, lungs, abdomen, feet and legs
1. DEFINITION
Physical examination is defined as a complete assessment of patient's physical and mental
status.
PURPOSES
1.To understand the physical and mental well-being-' of the patient.
2.To detect disease in its early stage.
3.To determine the cause and the extent of disease.
4.To understand any changes in the condition of diseases, any improvement or regression.
5.To determine the nature of the treatment or nursing care needed for the patient.
6.To safeguard the patient and his/her family by noting the early signs especially in case of a
communicable disease.
7.To contribute to the medical research.
8.To find out whether the person is medically fit or not for a particular task.
METHODS OF EXAMINATION
Inspection
Visual lamination of_the body is called 'inspection'. It is the observation with the naked eyes
to determine the structure and functions of the body. It means looking with eyes. It reveals
any rash, scar, color, size, shape, contour or symmetry of body parts. The quality of
inspection depends on the time spent by the nurse to be thorough and systematic observation.
In a hurry, we may overlook significant findings and make an incorrect. conclusion.
The following principles should be kept in mind for making accurate inspections:
Percussion
Percussion is the examination by tapping with the fingers on the body to determine the
condition of the internal organs by the sounds that are produced. It is done by placing a finger
of the left hand firmly against a part to be examined and tapping with the finger tips of the
right hand. It means striking tapping with fingers.
It elicits sounds, which indicate whether the underlying tissues are solid or filled with air or
fluid.
The sound may be:
1.Resonance: A low-pitched and loud sound heard over the normal lung tissues.
2.Hyper resonance: Very loud, very low pitch sound longer than resonance and is of booming
quality signifies emphysema.
3.Tympany: A drum-like sound heard over the air- filled tissues such as gastric air bubble.
4.Dull: A medium-pitched sound with a medium duration without resonance heard over solid
tissues such as heart, liver.
5.Flat: A high-pitched sound with a short duration without resonance heard over complete
solid tissues such as hand, thigh.
Methods of Percussion
The percussion can be done by two methods.
These are:
Direct Percussion:
Striking the body surface directly with one or two fingers, e.g. ascitic thrill.
Indirect Percussion:
Placing the middle finger of the non-dominant hand firmly against the body surface and
striking the distal joint of non-dominant finger with the middle fingers of the dominant hand.
Auscultation
Auscultation means listening with stethoscope/placing ear against the body. It reveals sounds
produced within the body and the blood vessels such as heart beats, bowel sounds, while
auscultation frequency loud, quality and duration of the sound to be noted.
Manipulations
Manipulations is the moving of a part of the body to note its flexibility. Limitation of
movements is discovered by this method.
Testing of Reflexes
The response of the tissues to external stimuli is tested by means of percussion hammer,
safety pin, wisp of cotton, hot and cold water, etc.
General Appearance
1.Nourishment: Well-nourished or under-nourished.
2.Bodv build: Thin or obese.
3.Health: Healthy or unhealthy.
4.Activity". Active or dull (tired).
Mental Status
1.Consciousness: Conscious, unconscious, delirious, talking incoherently.
2.Look: Anxious or worried, depressed, etc.
Posture
3.Body curves: Lordosis, kyphosis and scoliosis.
4.Movement Any limp.
Height and Weight
1.Ask to stand str-ght tile measuring foe height.
2.Check the v -i king condition of foe instrument even time before use.
Skin Conditions
1.Color: Pallor, jaundice cyanosis, flushing, etc.
2.Texture: Drones, baking, wrinkling or excessive moisture.
3.Temperature: Warm, cold and clammy.
4.Lesions. Macules, papules vesicles, wounds, etc.
Head and Face
1.Shape of foe skull and fontanel.
2.Skull circumference.
3.Scalp: Cleanliness, condition of foe hair, dandruff, pediculi, infections like ringworm.
4.Face: Pale, flushed, puffiness, fatigue, pain, fear, anxiety, enlargement of parotid glands,
etc.
Eye
1.Eyebrows: Normal or absent,
2.Eyelashes: Infection, sty.
3.Eyelids: Edema, lesions, ectropion, entropion,
4.Eyeballs: Sunken or protruded.
5.Conjunctiva: Pale, red, purulent.
6.Sclera: Jaundiced,
7.Cornea and iris: Irregularities and abrasions.
8.Pupils: Dilated, constricted reaction to light.
9. Lens: Opaque or transparent.
10.Fundus: Congestion, hemorrhagic spots.
11. Eye muscles: Strabismus (squint).
12. Vision: Normal, myopia, hypermetropia.
Ears
1.External ear-discharges, cerumen obstructing the ear passage
2.Tympanic membrane: Perforations, lesions, bulging
3.Hearing: Hearing acuity.
Nose
1.External nares: Crusts or discharges
2.Nostrils: Inflammation of the mucus membrane, septal deviations.
Mouth and Pharynx
1.Lips: Redness, swelling, crusts, cyanosis, angular stomatitis.
2.Odor of the mouth: Foul smelling.
3.Teeth: Discoloration and dental caries.
4.Mucus membrane and gums: Ulceration and bleeding, swelling, pus formation.
5.Tongue: Pale, dry, lesions, sords, furrows, tongue tie, etc.
6.Throat and pharynx: Enlarged tonsils, redness and pus.
Neck
1.Lymph nodes: Enlarged, palpable.
2.Thyroid gland: Enlarged.
3.Range of motion: Flexion, extension and rotation.
Chest
1.Thorax: Shape, symmetry of expansion, posture.
2.Breath sounds: Sigh, swish, rustle, wheezing, rales, crepitations, pleural rub, etc.
3.Heart: Size and location, cardiac murmurs.
4.Breasts: Enlarged lymph nodes.
Abdomen
1.Observation: Skin rashes, scars, hernia, ascites distension, pregnancy, etc.
2.Auscultation: Bowel sounds, fetal heart sounds.
3.Palpation: Liver margin, palpable spleen, tenderness at the urea of appendix, inguinal
hernias.
4.Percussion: Presence of gas, fluid or masses.
Extremities
Movement of joints, tremors, clumbing of fingers, ankle edema, varicose veins, reflexes, etc.
Back
Spina bifida curves.
Genital and Rectum
1.Inguinal lymph glands: Enlarged, palpable.
2.Patency of urinary meatus and rectum (in infants).
3.Descent of the testes.
4.Vaginal discharges.
5.Presence of sexually transmitted diseases.
6.Hemorrhoids.
7.Enlargement of the prostate gland.
8.Pelvic masses.
Neurological Tests
1.Coordination tests.
2.Reflexes.
3.Equilibrium tests.
4.Tests for sensations.
5.Role of the nurse in the physical examination.
Mental Preparation
1.The patient may be quite new to the hospital situation and patient may be anxious about his
illness.
2.Patient may have false ideas about the medical examination.
3.It is the duty of the nurse to allay his patient's, anxieties and fears by proper explanations.
4.Explain the sequence of the procedure to gain his/ her confidence and cooperation.
5.As far as possible a nurse should remain with a female patient during the physical
examination.
ASSISTANCE IN THE EXAMINATION
Take height and weight
1.To measure the length of the baby who cannot stand, place the baby on a hard surface, with
the soles of the feet supported in an upright position.
2.The knees are extended and the measurement is taken from the soles of the feet to the
vertex of the head.
3.The head should be in such a position that the eyes are facing the ceiling.
4.After a child can stand, the height can be measured, if the child with the heels back and
head against a wall.
5.A small flat board held from the top of the head to the wall, will give an accurate measure
of the height that is the distance from the floor to the board.
6.The weight of a person who can stand is generally measured by a standing scale.
7.The patient stands on the platform and the weight is noted on the dial.
8.Usually the weight is taken without shoes.
9.To take the weight of the baby, a baby weighing scale is used, in which there is a container,
where the baby can be laid.
10.It is important to weigh a baby unclothed. If weighed with cloth then weigh the clothes
separately and subtract this weight.
Measure the Skull Circumference
The skull is measured at its greatest diameter from
above the eyes to the occipital protuberance.
Examination of the Eyes
1.The examination is done in a lying or sitting position
2.The examiner frequently uses a head mirror that reflects light to the patient's face.
3.The first examination is one of inspection to determine the movements of the eyes, reaction
to light, accommodation to near and far objects.
4.For detailed examination of the internal parts of the eye, an ophthalmoscope is used.