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Nursing FundamentalsHEALTH ASSESSMENT Dr. James M. Alo, RN, MAN, MAP, PhD
Preparing for the Health            Assessment Environment  •   Ensure privacy  •   Quiet, warm room  •   Special needs o...
Preparing for the Health         Assessment Equipment  • Maintenance  • Isolation precautions  • Adequate number of glove...
Preparing for the Health          Assessment Positioning  • Ensures accessibility to the body part being    assessed. Dr...
Conducting the Health and         Physical Assessment Aimed at establishing a data base  against which subsequent data ca...
Conducting the Health and         Physical Assessment Conducted in an aseptic, systematic, and  efficient manner. Requir...
General Survey Initial Observations  •   Client’s physical appearance  •   Mood and behavior  •   Speech patterns and voi...
General Survey Special Considerations  • Elderly clients  • Disabled clients  • Abused clients                drjma      ...
Measurement of Height and           Weight Height  • Height is expressed in inches (in), feet (ft),    centimeters (cm), ...
Measurement of Height and           Weight Weight  • Measurement of weight is expressed in    ounces (oz), pounds (lb), g...
Measurement of Height and           Weight Weight  • Types of scales available include chair,    stretcher, bed, and plat...
Measurement of Height and          Weight Nursing Considerations  • Accurate recordings are necessary for drug    dosage ...
Measurement of Height and          Weight Documentation  • Height and weight are recorded on the    admission assessment ...
Vital Signs The taking of vital signs refers to  measurement of the client’s body  temperature (T), pulse (P) rate,  resp...
Vital Signs Assessment of vital signs provides  specific data regarding the client’s  current condition. Variations from...
Vital Signs The sequence for recording vital sign  measurements in the nurses’ notes is T-  P-R and BP. Vital signs are ...
Thermoregulation The body’s physiological function of heat  regulation to maintain a constant internal  body temperature ...
Physiologic Function Thermoregulation  • The heat of the body is measured in units    called degrees.  • The core interna...
Thermoregulation Heat Production  •   Basal Metabolic Rate (BMR)  •   Vasodilation  •   Vasoconstriction  •   Piloerectio...
Thermoregulation Heat Loss  •   Radiation  •   Conduction  •   Convection  •   Evaporation Insensible Heat Loss         ...
Thermoregulation Behavioral Control of Body Temperature  • The person makes appropriate    environmental adjustments in r...
Respiration Respiration is the act of breathing. Terms related to respiratory function are:  •   External respiration  •...
Respiration Major physiological pulmonary functions  are:  •   Ventilation  •   Circulation  •   Diffusion  •   Transport...
Hemodynamic Regulation The circulatory system transports  nutrients to the tissues, removes waste  products, and carries ...
Hemodynamic Regulation Systemic Circulation  •   Arteries  •   Arterioles  •   Capillaries  •   Veins  •   Venules       ...
Hemodynamic Regulation Cardiac Cycle  • Systole  • Diastole Stroke Volume Cardiac Output Compensatory Mechanisms      ...
Hemodynamic Regulation Pulse  • The pulse is caused by the stroke volume    ejection and distension of the walls of the  ...
Hemodynamic Regulation Blood Pressure  • Measurement of pressure pulsations exerted    against the blood vessel walls dur...
Blood Pressure Systolic Pressure  • Maximum pressure exerted against arterial    walls during systole Diastolic Pressure...
Hemodynamic Regulation Hemodynamic regulators for blood  pressure control are:  •   Blood volume  •   Cardiac output  •  ...
Factors Influencing Vital Signs   Age   Gender   Heredity   Race   Lifestyle   Environment                  drjma   ...
Factors Influencing Vital Signs   Medications   Pain   Exercise   Anxiety and Stress   Postural Changes   Diurnal (d...
Assessing Body Temperature Temperature Scales  • Centigrade or Fahrenheit scales are used to    measure temperature.  • G...
Assessing Body Temperature Alterations in Body Temperature  •   Pyrexia  •   Hyperthermia  •   Heat Exhaustion  •   Heat ...
Assessing Pulse Sites  • The most accessible peripheral sites are the    radial and carotid sites.  • The carotid site sh...
Assessing Pulse A peripheral pulse is palpated by placing  the first two fingers on the pulse point  with moderate pressu...
Assessing Pulse    drjma         27-37
Assessing Pulse A pulse deficit occurs when the apical  pulse rate is greater than the radial pulse  rate. Pulse Charact...
Assessing Pulse Nursing Considerations  • An irregular pulse rate, if not previously    documented, should be reported   ...
Assessing Respirations Sites  • Observation of chest wall expansion and    bilateral symmetrical movement of the    thora...
Assessing Respirations Rate is counted by number of breaths  taken per minute. Observation of thoracic and abdominal  mo...
Assessing Respirations A stethoscope is used to auscultate  breath sounds throughout the respiratory  system.            ...
Assessing Respirations   Dyspnea,   Bradypnea, tachypnea, apnea   Hypoventilation   Hyperventilation                dr...
Assessing Respiratory Function Cyanosis  • Bluish appearance in the nail beds, lips, and    skin  • Reduced oxygen levels...
Assessing Respiratory Function Clients with respiratory alterations require  additional nursing assessment.  • Pulse oxim...
Assessing Respiratory Function    drjma                   27-46
Assessing Blood Pressure The direct method of measuring blood  pressure requires an invasive procedure. The indirect met...
Assessing Blood Pressure The most common site for indirect  measurement is the client’s arm over the  brachial artery. A...
Assessing Blood Pressure Korotkoff sounds are five distinct phases  of sound heard with a stethoscope during  auscultatio...
Assessing Blood Pressure Hypotension refers to a systolic blood  pressure less than 90 mm Hg or 20 to 30  mm Hg below the...
Assessing Blood Pressure Orthostatic Hypotension (postural  hypotension)  • Sudden drop in systolic pressure when client ...
Assessing Blood Pressure False Readings  • Clients who have recently eaten, ambulated,    or experienced an emotional ups...
The Physical Examination Techniques  •   Inspection  •   Palpation  •   Percussion  •   Auscultation                     ...
Integumentary System Skin Hair and Scalp Nails              drjma             27-54
Skin Assessment Skin assessment provides a noninvasive  window to observe the body’s  physiological functions.           ...
Skin Assessment   Color   Lesions   Moisture   Temperature   Texture   Mobility and Turgor   Edema                 ...
Integumentary System Hair  • The amount and texture of hair vary with    age, sex, race and body part.  • Vellus  • Termi...
Integumentary System Nails  •   Clubbing  •   Koilonychia (spoon nail)  •   Beau’s line  •   Paronchia                  d...
Physical Examination Head  • Skull and face assessment involves    inspection and palpation.  • The client’s face has its...
Physical Assessment Eyes  • Conjunctive and sclera are assessed for    color, redness, swelling, exudate, foreign    bodi...
Physical Assessment Ears  •   Auditory screening  •   Inspection and palpation of external ear  •   Placement, symmetry  ...
Physical Examination Mouth and Pharynx  •   Breath  •   Lips  •   Tongue  •   Buccal mucosa  •   Gums and teeth  •   Hard...
Physical Examination Neck  •   Neck muscles  •   Lymph nodes of head and neck  •   Thyroid gland  •   Trachea            ...
Physical Examination Thorax and Lungs  • Landmarks for inspection, auscultation, and    percussion  • Anterior and poster...
Thorax and Lungs Auscultation of Normal Breath Sounds  • Vesicular sounds  • Bronchovesicular sounds  • Bronchial sounds ...
Thorax and Lungs. Auscultation of Adventitious Breath  Sounds  •   Crackles  •   Rhonchi  •   Wheezes  •   Pleural fricti...
Heart and Vascular System Heart  • Landmarks for inspection, palpation,    auscultation  • Heart sounds  • Palpation for ...
Heart and Vascular System Vascular System  • Blood perfusion of peripheral vessels    - Peripheral pulses compared bilate...
Physical Examination Lymphatic System  • Lymphatic drainage  • Lymph nodes               drjma            27-69
Breasts and Axillae Palpation of four quadrants of breasts Palpation of supraclavicular,  infraclavicular, and axillary ...
Breasts and Axillae Drainage patterns of  the left breast.                 drjma          27-71
Abdomen Inspection  •   Contour  •   Symmetry  •   Umbilicus  •   Surface motion  •   Scars                 drjma   27-72
Abdomen Auscultation  • All four quadrants in a systematic fashion  • Beginning with the RLQ     -   Tympany     -   Dull...
Abdominal Quadrants    drjma             27-74
Abdomen Light palpation in all four quadrants  beginning with the RLQ  •   Resistance  •   Tenderness  •   Rebound tender...
Female Genitalia and Anus Cultural Considerations Inspection and Palpation  •   Mons pubis and vulva  •   Labia majora, ...
Male Genitalia, Anus, and         Rectum Testes and male gonads Seminal vesicles and bulbourethral  glands Epididymis, ...
Musculoskeletal System   Inspection   Palpation   Range of Motion (ROM)   Bilateral Comparison               drjma    ...
Musculoskeletal System Muscle  •   Hypertrophy  •   Atrophy  •   Hypertonicity  •   Hypotonicity                  drjma  ...
Musculoskeletal System Joints  • Arthritis  • Osteoarthritis  • Crepitus                 drjma              27-80
Neurologic System Mental Status  • Physical appearance and behavior  • Communication  • Level of consciousness           ...
Mental Status Cognitive Abilities and Mentation  •   Attention  •   Memory  •   Judgment, insight  •   Spatial perception...
Neurological Assessment Sensory Assessment  •   Exteroceptive sensations  •   Proprioceptive sensations  •   Cortical sen...
Neurological Assessment   Cranial Nerves Assessment   Motor Assessment   Cerebellar Assessment   Reflex Assessment    ...
drjma   27-85
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Transcript of "Nsg fundamentals.health assessment,drjma"

  1. 1. Nursing FundamentalsHEALTH ASSESSMENT Dr. James M. Alo, RN, MAN, MAP, PhD
  2. 2. Preparing for the Health Assessment Environment • Ensure privacy • Quiet, warm room • Special needs of the client • Surface for placement of equipment drjma 27-2
  3. 3. Preparing for the Health Assessment Equipment • Maintenance • Isolation precautions • Adequate number of gloves drjma 27-3
  4. 4. Preparing for the Health Assessment Positioning • Ensures accessibility to the body part being assessed. Draping • Prevents chilling. • Prevents unnecessary exposure. drjma 27-4
  5. 5. Conducting the Health and Physical Assessment Aimed at establishing a data base against which subsequent data can be compared. • Comprehensive Assessment (head to toe) • Assessment of a body part (focused) • Assessment of a body system (focused) drjma 27-5
  6. 6. Conducting the Health and Physical Assessment Conducted in an aseptic, systematic, and efficient manner. Requires the fewest position changes for the client. drjma 27-6
  7. 7. General Survey Initial Observations • Client’s physical appearance • Mood and behavior • Speech patterns and voice intonations • Signs and symptoms of distress • Vital signs • Height and weight drjma 27-7
  8. 8. General Survey Special Considerations • Elderly clients • Disabled clients • Abused clients drjma 27-8
  9. 9. Measurement of Height and Weight Height • Height is expressed in inches (in), feet (ft), centimeters (cm), or meters (m). • A scale for measuring height is usually attached to a standing weight scale. • Infant’s length is measured from vertex (top) of head to soles of feet while infant is lying with knees extended. drjma 27-9
  10. 10. Measurement of Height and Weight Weight • Measurement of weight is expressed in ounces (oz), pounds (lb), grams (g), or kilograms (kg). • Daily weights should be obtained at the same time of the day, on the same scale, with the client wearing the same type of clothing. drjma 27-10
  11. 11. Measurement of Height and Weight Weight • Types of scales available include chair, stretcher, bed, and platform scales. • Infants are weighed on platform or cradle scales. drjma 27-11
  12. 12. Measurement of Height and Weight Nursing Considerations • Accurate recordings are necessary for drug dosage calculations and evaluation of effectiveness of drug, fluid, and nutritional therapy. drjma 27-12
  13. 13. Measurement of Height and Weight Documentation • Height and weight are recorded on the admission assessment form. • Daily weights are usually recorded on the vital signs record. • Measurements taken at different times or on different scales should be recorded. drjma 27-13
  14. 14. Vital Signs The taking of vital signs refers to measurement of the client’s body temperature (T), pulse (P) rate, respiratory (R) rate, and blood pressure (BP). Vital signs are the first step in the physical examination. drjma 27-14
  15. 15. Vital Signs Assessment of vital signs provides specific data regarding the client’s current condition. Variations from baseline values may indicate potential problems with the client’s health status. drjma 27-15
  16. 16. Vital Signs The sequence for recording vital sign measurements in the nurses’ notes is T- P-R and BP. Vital signs are plotted on graphic forms that facilitate data comparison at a glance. drjma 27-16
  17. 17. Thermoregulation The body’s physiological function of heat regulation to maintain a constant internal body temperature drjma 27-17
  18. 18. Physiologic Function Thermoregulation • The heat of the body is measured in units called degrees. • The core internal temperature of 98.6 degrees Fahrenheit (F) does not vary more than 1.4 degrees F. • Core internal temperature is higher than the skin and external temperature. drjma 27-18
  19. 19. Thermoregulation Heat Production • Basal Metabolic Rate (BMR) • Vasodilation • Vasoconstriction • Piloerection drjma 27-19
  20. 20. Thermoregulation Heat Loss • Radiation • Conduction • Convection • Evaporation Insensible Heat Loss drjma 27-20
  21. 21. Thermoregulation Behavioral Control of Body Temperature • The person makes appropriate environmental adjustments in response to the body’s signaling conditions of either being overheated or too cold. drjma 27-21
  22. 22. Respiration Respiration is the act of breathing. Terms related to respiratory function are: • External respiration • Internal respiration • Inspiration • Expiration • Vital capacity drjma 27-22
  23. 23. Respiration Major physiological pulmonary functions are: • Ventilation • Circulation • Diffusion • Transport • Regulation drjma 27-23
  24. 24. Hemodynamic Regulation The circulatory system transports nutrients to the tissues, removes waste products, and carries hormones from one part of the body to another. drjma 27-24
  25. 25. Hemodynamic Regulation Systemic Circulation • Arteries • Arterioles • Capillaries • Veins • Venules drjma 27-25
  26. 26. Hemodynamic Regulation Cardiac Cycle • Systole • Diastole Stroke Volume Cardiac Output Compensatory Mechanisms drjma 27-26
  27. 27. Hemodynamic Regulation Pulse • The pulse is caused by the stroke volume ejection and distension of the walls of the aorta. • The bounding of blood flow in an artery is palpable at various points in the body (pulse points). drjma 27-27
  28. 28. Hemodynamic Regulation Blood Pressure • Measurement of pressure pulsations exerted against the blood vessel walls during systole and diastole drjma 27-28
  29. 29. Blood Pressure Systolic Pressure • Maximum pressure exerted against arterial walls during systole Diastolic Pressure • Pressure remaining in the arterial system during diastole drjma 27-29
  30. 30. Hemodynamic Regulation Hemodynamic regulators for blood pressure control are: • Blood volume • Cardiac output • Peripheral vascular resistance • Viscosity drjma 27-30
  31. 31. Factors Influencing Vital Signs Age Gender Heredity Race Lifestyle Environment drjma 27-31
  32. 32. Factors Influencing Vital Signs Medications Pain Exercise Anxiety and Stress Postural Changes Diurnal (daily) Variations drjma 27-32
  33. 33. Assessing Body Temperature Temperature Scales • Centigrade or Fahrenheit scales are used to measure temperature. • Glass or electronic thermometers are used. Temperature Sites • Oral • Rectal • Axillary drjma 27-33
  34. 34. Assessing Body Temperature Alterations in Body Temperature • Pyrexia • Hyperthermia • Heat Exhaustion • Heat Stroke • Hypothermia • Frostbite drjma 27-34
  35. 35. Assessing Pulse Sites • The most accessible peripheral sites are the radial and carotid sites. • The carotid site should always be used to assess the pulse in a cardiac emergency. drjma 27-35
  36. 36. Assessing Pulse A peripheral pulse is palpated by placing the first two fingers on the pulse point with moderate pressure. A Doppler ultrasound stethoscope is used on superficial pulse points. A stethoscope is used to auscultate the heart’s rate and rhythm. drjma 27-36
  37. 37. Assessing Pulse drjma 27-37
  38. 38. Assessing Pulse A pulse deficit occurs when the apical pulse rate is greater than the radial pulse rate. Pulse Characteristics • Pulse quality • Pulse rate (bradycardia, tachycardia) • Pulse rhythm (dysrhythmias) • Pulse volume drjma 27-38
  39. 39. Assessing Pulse Nursing Considerations • An irregular pulse rate, if not previously documented, should be reported immediately. • Clients on certain cardiac medications may need to monitor their pulse rate. • Routine exercise lowers resting and activity pulses. drjma 27-39
  40. 40. Assessing Respirations Sites • Observation of chest wall expansion and bilateral symmetrical movement of the thorax • Placement of back of hand next to client’s nose and mouth to feel expired air drjma 27-40
  41. 41. Assessing Respirations Rate is counted by number of breaths taken per minute. Observation of thoracic and abdominal movements includes: • Depth, rhythm, and symmetry • Costal (thoracic) breathing • Diaphragmatic breathing drjma 27-41
  42. 42. Assessing Respirations A stethoscope is used to auscultate breath sounds throughout the respiratory system. drjma 27-42
  43. 43. Assessing Respirations Dyspnea, Bradypnea, tachypnea, apnea Hypoventilation Hyperventilation drjma 27-43
  44. 44. Assessing Respiratory Function Cyanosis • Bluish appearance in the nail beds, lips, and skin • Reduced oxygen levels in the arterial blood drjma 27-44
  45. 45. Assessing Respiratory Function Clients with respiratory alterations require additional nursing assessment. • Pulse oximetry • Apnea monitor drjma 27-45
  46. 46. Assessing Respiratory Function drjma 27-46
  47. 47. Assessing Blood Pressure The direct method of measuring blood pressure requires an invasive procedure. The indirect method requires use of the sphygmomanometer and stethoscope for auscultation and palpation as needed. drjma 27-47
  48. 48. Assessing Blood Pressure The most common site for indirect measurement is the client’s arm over the brachial artery. Accurate measurement requires the correct width of the blood pressure cuff as determined by the circumference of the client’s extremity. drjma 27-48
  49. 49. Assessing Blood Pressure Korotkoff sounds are five distinct phases of sound heard with a stethoscope during auscultation. The forearm or leg sites can be palpated to obtain a systolic reading when the brachial artery is inaccessible. drjma 27-49
  50. 50. Assessing Blood Pressure Hypotension refers to a systolic blood pressure less than 90 mm Hg or 20 to 30 mm Hg below the client’s normal systolic pressure. Hypertension refers to a persistent systolic pressure greater than 135 to 140 mm Hg and a diastolic pressure greater than 90 mm Hg. drjma 27-50
  51. 51. Assessing Blood Pressure Orthostatic Hypotension (postural hypotension) • Sudden drop in systolic pressure when client moves from a lying to a sitting to a standing position drjma 27-51
  52. 52. Assessing Blood Pressure False Readings • Clients who have recently eaten, ambulated, or experienced an emotional upset • Improper cuff width • Improper technique in deflating cuff • Improper positioning of extremity • Failure to recognize an auscultatory gap drjma 27-52
  53. 53. The Physical Examination Techniques • Inspection • Palpation • Percussion • Auscultation drjma 27-53
  54. 54. Integumentary System Skin Hair and Scalp Nails drjma 27-54
  55. 55. Skin Assessment Skin assessment provides a noninvasive window to observe the body’s physiological functions. drjma 27-55
  56. 56. Skin Assessment Color Lesions Moisture Temperature Texture Mobility and Turgor Edema drjma 27-56
  57. 57. Integumentary System Hair • The amount and texture of hair vary with age, sex, race and body part. • Vellus • Terminal hair The scalp should be smooth, clean, intact, and free of lumps or tender areas. drjma 27-57
  58. 58. Integumentary System Nails • Clubbing • Koilonychia (spoon nail) • Beau’s line • Paronchia drjma 27-58
  59. 59. Physical Examination Head • Skull and face assessment involves inspection and palpation. • The client’s face has its own unique characteristics related to race, state of health, emotions, environment. drjma 27-59
  60. 60. Physical Assessment Eyes • Conjunctive and sclera are assessed for color, redness, swelling, exudate, foreign bodies • Visual acuity • Fundoscopy drjma 27-60
  61. 61. Physical Assessment Ears • Auditory screening • Inspection and palpation of external ear • Placement, symmetry • Otoscopic assessment Nose and Sinuses • Inspection and palpation • Use of a penlight drjma 27-61
  62. 62. Physical Examination Mouth and Pharynx • Breath • Lips • Tongue • Buccal mucosa • Gums and teeth • Hard and soft palate • Pharynx drjma 27-62
  63. 63. Physical Examination Neck • Neck muscles • Lymph nodes of head and neck • Thyroid gland • Trachea drjma 27-63
  64. 64. Physical Examination Thorax and Lungs • Landmarks for inspection, auscultation, and percussion • Anterior and posterior examination • Shape and symmetry • Thoracic expansion • Tactile fremitus drjma 27-64
  65. 65. Thorax and Lungs Auscultation of Normal Breath Sounds • Vesicular sounds • Bronchovesicular sounds • Bronchial sounds drjma 27-65
  66. 66. Thorax and Lungs. Auscultation of Adventitious Breath Sounds • Crackles • Rhonchi • Wheezes • Pleural friction rub • Stridor drjma 27-66
  67. 67. Heart and Vascular System Heart • Landmarks for inspection, palpation, auscultation • Heart sounds • Palpation for thrills and heaves • Abnormal auscultatory findings - Murmurs - Bruits drjma 27-67
  68. 68. Heart and Vascular System Vascular System • Blood perfusion of peripheral vessels - Peripheral pulses compared bilaterally - Skin temperature, color drjma 27-68
  69. 69. Physical Examination Lymphatic System • Lymphatic drainage • Lymph nodes drjma 27-69
  70. 70. Breasts and Axillae Palpation of four quadrants of breasts Palpation of supraclavicular, infraclavicular, and axillary nodes Education and encouragement of questions about breast self-examination (BSE) Breast cancer can also occur in males. drjma 27-70
  71. 71. Breasts and Axillae Drainage patterns of the left breast. drjma 27-71
  72. 72. Abdomen Inspection • Contour • Symmetry • Umbilicus • Surface motion • Scars drjma 27-72
  73. 73. Abdomen Auscultation • All four quadrants in a systematic fashion • Beginning with the RLQ - Tympany - Dullness - Bruits - Hyperactive or hypoactive bowel sounds drjma 27-73
  74. 74. Abdominal Quadrants drjma 27-74
  75. 75. Abdomen Light palpation in all four quadrants beginning with the RLQ • Resistance • Tenderness • Rebound tenderness • Organ enlargement drjma 27-75
  76. 76. Female Genitalia and Anus Cultural Considerations Inspection and Palpation • Mons pubis and vulva • Labia majora, labia minora • Clitoris • Urethral meatus and vaginal introitus • Perineum and anus drjma 27-76
  77. 77. Male Genitalia, Anus, and Rectum Testes and male gonads Seminal vesicles and bulbourethral glands Epididymis, vas deferens, ejaculatory ducts Scrotum, penis, spermatic cord Anorectral exam including the prostate Monthly testicular self-examination (TSE) drjma 27-77
  78. 78. Musculoskeletal System Inspection Palpation Range of Motion (ROM) Bilateral Comparison drjma 27-78
  79. 79. Musculoskeletal System Muscle • Hypertrophy • Atrophy • Hypertonicity • Hypotonicity drjma 27-79
  80. 80. Musculoskeletal System Joints • Arthritis • Osteoarthritis • Crepitus drjma 27-80
  81. 81. Neurologic System Mental Status • Physical appearance and behavior • Communication • Level of consciousness drjma 27-81
  82. 82. Mental Status Cognitive Abilities and Mentation • Attention • Memory • Judgment, insight • Spatial perception • Calculation • Abstraction • Thought process and content drjma 27-82
  83. 83. Neurological Assessment Sensory Assessment • Exteroceptive sensations • Proprioceptive sensations • Cortical sensations • Dermatome map drjma 27-83
  84. 84. Neurological Assessment Cranial Nerves Assessment Motor Assessment Cerebellar Assessment Reflex Assessment drjma 27-84
  85. 85. drjma 27-85
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