Meaning
Lot of health related information may be obtained by looking thoroughly at all parts of the client’s body. A systematic way of doing that is called ‘physical examination’.
Preparation
Before starting physical examination, the client, environment, equipment and the nurse must be prepared.
a)The Client Preparation
i) Explain to the client what you are planning to do and why?
ii) Make sure that his/her clothing do not interfere with physical examination.
iii) Make sure that he empties his bladder and bowel (if necessary) before examination.
iv) Help the client to relax as much as possible.
Lot of health related information may be obtained by looking thoroughly at all parts of the client’s body. A systematic way of doing that is called ‘physical examination’.
Preparation
Before starting physical examination, the client, environment, equipment and the nurse must be prepared.
a)The Client Preparation
i) Explain to the client what you are planning to do and why?
ii) Make sure that his/her clothing do not interfere with physical examination.
iii) Make sure that he empties his bladder and bowel (if necessary) before examination.
iv) Help the client to relax as much as possible.
v) Put him/her in a position in which the patient feels comfortable.
b)Environmental Preparation
i)Make sure that the place used for physical examination is clean quiet, warm and well lighted. Direct sun light is better than artificial light.c)
ii) One of the close relatives or friends must be with the client to give him/her support.Because the first time physical examination may be a frightening experience to the client.
iii) Provide adequate privacy by putting screen around the client. Also do not expose the body parts unless it is necessary for physical examination use drapings.
Preparation of Equipment or Articles
For a systematic physical examination you need to collect the following articles:
A medium size steel/enamel tray, containing the following articles:
1) BP apparatus
2) Stethoscope
3) TPR tray
4) Inch tape — to measure height, abdominal girth
5) Weighing machine
6) Otoscope
7) Tongue depressor
8) Nasal speculum
9) Ophthalmoscope
10) Knee hammer —to check nervous system reflexes
11) Test tubes with hot and cold water -for testing the ability to differentiate temperature variation
12) A feathur or a cotton ball —to check the touch sensation
13) Small amount of sugar and salt -to check his ability to differentiate taste.
14 ) Torch —to see inside any body cavity
15)Sample specimen containers for blood, urine, sputum, etc.
d) Preparation of the Nurse
i) Wash your hands in presence of the client even if your hands are clean. This simple act will increase his confidence in you as a conscientious professional.
ii) Wear gloves and mask only if it is necessary, e.g., if there is any infection, open ulcer or wounds on his body.
iii) You must learn to perform basic skills of physical examination. These are:
b)Environmental Preparation
i)Make sure that the place used for physical examination is clean quiet, warm and well lighted. Direct sun light is better than artificial light.c)
ii) One of the close relatives or friends must be with the client to give him/her support.Because the first time physical examination may be a frightening experience to the client.
iii) Provide adequate privacy by putting screen around the client. Also do not expose the body parts unless it is necessary for physical examination use drapings.
Preparation of Equipment or Articles
For a systematic physical examination you need to collect the following articles:
A medium size steel/enamel tray, containing the following articles:
1) BP apparatus
2) Stethoscope
3) TPR tray
4) Inch tape — to measure height, abdominal girth
5) Weighing machine
6) Otoscope
7) Tongue depressor
8) Nasal speculum
9) Ophthalmoscope
10) Knee hammer —to check nervous system reflexes
11) Test tubes with hot and cold water -for testing the ability to differentiate temperature variation
12) A feathur or a cotton ball —to check the touch sensation
13) Small amount of sugar and salt -to check his ability to differentiate taste.
14 ) Torch —to see inside any body cavity
15)Sample specimen containers for blood, urine, sputum, etc.
d) Preparation of the Nurse
i) Wash your hands in presence of the client even if your hands are clean. This simple act will increase his confidence in you as a conscientious professional.
ii) Wear gloves and mask only if it is necessary, e.g., if there is any infection, open ulcer or wounds on his body.
iii) You must learn to perform basic skills of physical examination. These are:
- Measurement
- Inspection
- Palpation
- Percussion
- Auscultation
- Detection of odors.
These skills require training in the use of your eyes, ears, hands and nose.Now let us discuss each of these skills briefly.
Measurement: It is an activity to calculate the magnitude of the body’s structure and function and record the findings in numbers and symbols.The data obtained by measurement are Blood Pressure, Temperature, Pulse rate,Respiratory rate, Height, Weight, Circumference of body parts (e.g., abdomen, leg). length and diameter of bony structures (e.g., pelvic outlet in prenatal examination).
To be useful, measurement must be accurate and specific to the need.Inspection or Observation: It is a detail visual examination of the client’s general physical appearance and specific body parts, noting its size, colour, position, symmetry and degree of movement.Inspection can be done while talking to the client and while performing other skills of physical examination.
Palpation or Touch: A client’s body can be examined by touch or palpation. By this method you can feel any hardness, size, texture, swelling and movability of an internal organ or part. The pads of the fingers, the most sensitive area of the fingers, are used for palpation.
Percussion or Tapping: This is method of examination of the body by tapping it with fingers. The technique most commonly used is to place one hand on the body surface with the middle finger, called the pleximeter over the area to be percussed. The middle finger of the other hand is used to strike rapidly and sharply just proximal to the distal interphalangeal joint. The sound is produced from the vibration of the body structures adjacent to the pleximeter
You will be able to find out the following points by percussion:
a) The amount of air, liquid or solid materials.
b) The positions and boundaries of organs such as the heart and liver.
c) The excursion of the diaphragm.
Ausculitation: Is listening for sounds produced within the body. The sounds most frequently listened for are those of the abdominal and thoracic viscera and movement of blood in the cardiovascular system. Direct auscultation, using the ear only is rarely done. Indirect auscultation is generally done with a stethoscope.The Detection of Abnormal Odors: It is a very important diagnostic skill. Odor of blood, rotten fruit odor and foul odor in breath, alcoholic odor, odor of some poisonous chemicals, ammonia odor of urine, odor of decomposed tissue etc are very helpful in detecting the cause of the ailments.
Approaches/Ways of Doing Physical Examination
Experts have suggested many approaches/ways of doing physical examination systematically.These are:
1) Body System Approach
In this approach, examination is done for each of the body systems, namely, nervous system,respiratory system, cardiovascular system etc.The Review of system in Nursing History is based on this system.
2) Head-to-foot Examination
Wolff and Erickson have developed a special device/picture to help us make a head-to-foot assessment. To use this device, we begin with the client’s head (noting mental and emotional status, vision, hearing and mouth) and proceed down the body to his extremities (noting movement and sensation).
Measurement: It is an activity to calculate the magnitude of the body’s structure and function and record the findings in numbers and symbols.The data obtained by measurement are Blood Pressure, Temperature, Pulse rate,Respiratory rate, Height, Weight, Circumference of body parts (e.g., abdomen, leg). length and diameter of bony structures (e.g., pelvic outlet in prenatal examination).
To be useful, measurement must be accurate and specific to the need.Inspection or Observation: It is a detail visual examination of the client’s general physical appearance and specific body parts, noting its size, colour, position, symmetry and degree of movement.Inspection can be done while talking to the client and while performing other skills of physical examination.
Palpation or Touch: A client’s body can be examined by touch or palpation. By this method you can feel any hardness, size, texture, swelling and movability of an internal organ or part. The pads of the fingers, the most sensitive area of the fingers, are used for palpation.
Percussion or Tapping: This is method of examination of the body by tapping it with fingers. The technique most commonly used is to place one hand on the body surface with the middle finger, called the pleximeter over the area to be percussed. The middle finger of the other hand is used to strike rapidly and sharply just proximal to the distal interphalangeal joint. The sound is produced from the vibration of the body structures adjacent to the pleximeter
You will be able to find out the following points by percussion:
a) The amount of air, liquid or solid materials.
b) The positions and boundaries of organs such as the heart and liver.
c) The excursion of the diaphragm.
Ausculitation: Is listening for sounds produced within the body. The sounds most frequently listened for are those of the abdominal and thoracic viscera and movement of blood in the cardiovascular system. Direct auscultation, using the ear only is rarely done. Indirect auscultation is generally done with a stethoscope.The Detection of Abnormal Odors: It is a very important diagnostic skill. Odor of blood, rotten fruit odor and foul odor in breath, alcoholic odor, odor of some poisonous chemicals, ammonia odor of urine, odor of decomposed tissue etc are very helpful in detecting the cause of the ailments.
Approaches/Ways of Doing Physical Examination
Experts have suggested many approaches/ways of doing physical examination systematically.These are:
1) Body System Approach
In this approach, examination is done for each of the body systems, namely, nervous system,respiratory system, cardiovascular system etc.The Review of system in Nursing History is based on this system.
2) Head-to-foot Examination
Wolff and Erickson have developed a special device/picture to help us make a head-to-foot assessment. To use this device, we begin with the client’s head (noting mental and emotional status, vision, hearing and mouth) and proceed down the body to his extremities (noting movement and sensation).
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