DB Foundation I.pptx

FOUNDATION NURSING I
February 23
Wakwaya L (BSc,MPH) 1
DANDI BORU COLLEGE
HEALTH DEP’T
BY WAKWAYA L. (BSc, MPH)
08/01/2023

INTRODUCTION OF NURSING
History of nursing
A. Early Definitions of Nursing
• A nurse is a person who nourishes, fosters, and
protects—a person who is prepared to care for the
sick, injured, and aged.
 In this sense, “nurse” is used as a noun and is derived
from the Latin nutrix, which means “nursing mother.”
 The word “nurse” also has referred to a woman who
suckled a child (usually not her own)—a wet nurse.
 Dictionary definitions of nurse include such
descriptions as “suckles or nourishes,” “to take care of
a child or children,” “to bring up; rear.”
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B. Modern definition by theorists
1. Florence Nightingale (1820-1910) (1859), wrote in detail
about the concept of the aesthetic and seemed to realize the
relationship of certain qualities as health and beauty. She
suggested that: "Nursing is an art, and if it is to be made an
art, it requires as exclusive devotion, as hard a preparation,
as any painter’s or sculptor’s work, for what is having to do
with the living body - the temple of God’s spirit? It is one of
the fine Arts; I had almost said the finest of the fine Arts".
(Cited in Donahue 1996:501)
2. Mallison (1993:7) emphasizes in the difficulty to express by
writing the multidimensional whole of nursing as she
suggests that: “Nursing like dance or painting is not
primarily an art of the written word. It is partly Kinaesthetic
- transmitted in facial expressions, posture, touch, silences,
gestures, timing, intent. Attempts to pin it down with
language is like chasing butterflies:

Cont…
3. Henderson (1966:39) stated that: "the unique function of
the nurse is to assist the individual sick or well, in the
performance of those activities contributing to health or its
recovery (or to a peaceful death) that he would perform
unaided if he had the necessary strength, will or knowledge,
and to do this in such a way as to help him to gain
independence as rapidly as possible" and she went on to
describe what are these activities. (cited in Lister 1997).

Definition of nursing by American
Nursing Associations (ANA)
• Nursing is the protection, promotion and optimization
of health and abilities, prevention of illness and injury,
alleviations of suffering through the diagnosis and
treatment of human response, and advocacy in the care
of individuals, families, communities, and
populations(ANA,2003).
• Nursing is an art and science. This means that a
professional nurse learns to deliver care artfully with
compassion, caring and a respected for each client
dignity and personhood. As a science, nursing is based
upon a body of knowledge that is always changing with
new discoveries and innovations.

Historical development of nursing
process
Nursing Process
• The term “ Nursing Process ” came to the UK in the 1970’s a
nd came to be understood as:
• A form of documentation
• As a means of organizing work, that is patient allocation or
primary nursing
• As an educational tool to help achieve patient centered nursing
• As a philosophy to help nursing attain professional status by offerin
g an alternative to the medical model.
• The nursing process is “ An organized,
systematic and deliberate approach
to nursing with the aim of improving standards in nursing care ”
Rush S, Fergy S & eels D (1996)
• It uses a systematic, holistic, problem solving approach in
partnership with the patient and their family”

Nursing Process
 Nursing process is very much like the scientific
method of problem solving and UNIQUE to the
nursing profession
 Specific to the nursing profession
 A framework for critical thinking
 It’s purpose is to:“Diagnose and treat human
responses to actual or potential health
problems”
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Nursing Process
 Organized framework to guide practice
 Problem solving method - client focused
 Systematic- sequential steps
 Goal oriented- outcome criteria
 Dynamic-always changing, flexible
 Utilizes critical thinking processes
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Advantages of Nursing Process
 Provides individualized
care
 Client is an active
participant
 Promotes continuity of
care
 Provides more effective
communication among
nurses and healthcare
professionals
 Develops a clear and
efficient plan of care
 Provides personal
satisfaction as you see
client achieve goals
 Professional growth as
you evaluate effectiveness
of your interventions
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5 Steps in the Nursing Process
 Assessment
 Nursing
Diagnosis
 Planning
 Implementing
 Evaluating
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1. Assessment
 Form a data base on information collected
about the client.
 First step of the Nursing Process
 Gather Information/Collect Data
 Primary Source - Client / Family
 Secondary Source - physical exam, nursing hist
ory, team members, lab reports, diagnostic tests.
 Subjective -from the client (symptom)
• “I have a headache”
 Objective - observable data (sign)
• Blood Pressure 130/80
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Assessment-collecting data
 Nursing Interview ( health history)
 Health Assessment -Review of Systems
 Physical Exam
 Inspection
 Palpation
 Percussion
 Auscultation
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Assessment-collecting data
 Make sure information is complete &
accurate
 Validate primary nursing process
 Interpret and analyze data
Compare to “standard norms”
 Organize and cluster data
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2. Nursing Diagnosis
 Second step of the Nursing Process
 Interpret & analyze clustered data
 Identify client’s problems and strengths
 Formulate Nursing Diagnosis (NANDA : Nor
th American Nursing Diagnosis Association)-
Statement of how the client is RESPONDING
to an actual or potential problem that requires
nursing intervention
 Interpreted data is clustered in according to bo
dy systems, risk factors, family factors, emotio
nal factors etc.
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Nsg Dx vs. MD Dx
 Within the scope of
nursing practice
 Identify responses
to health and illness
 Can change from
day to day
 With in the scope of
medical practice
 Focuses on curing
pathology
 Stays the same as
long as the disease
is present
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Formulating a Nursing Diagnosis
 Composed of 3 parts:
 Problem statement- the client’s response to
a problem
 Etiology- what’s causing/contributing to the
client’s problem
 Defining Characteristics- what’s the evide
nce of the problem
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Nursing Diagnosis
 Problem( Diagnostic Label)-based on your a
ssessment of client…(gathered information),
pick a problem from the NANDA list...
 Etiology- determine what the problem is caus
ed by or related to (R/T)...
 Defining characteristics- then state as eviden
ced by the specific facts the problem is based
on...
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Types of Nursing Diagnoses
 Health Promotion Diagnoses
 Actual diagnoses
 Risk diagnoses
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Risk Diagnoses
 Risk for injury related to disturbed sensory-
perceptual patterns.
 Risk for Aspiration related to impaired gag r
eflex.
 Risk for self –Directed violence, related to d
epression, suicidal tendencies, development
al crisis, lack of support system loss of signi
ficant others, poor coping mechanisms and
behaviors.
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Actual Diagnoses
 Impaired Verbal Communication related to aphasia
psychological impairment, or organic brain disorder.
 Actual or chronic confusion related to dementia, head
injury, stroke, or alcohol or drug abuse.
 Impaired Memory related to dementia, stroke head injur
y or alcohol or drug abuse
 Ineffective impulse control related to substance abuse
co-dependency, developmental disorder, or organic brain
disorders
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3. Planning
Third step of the Nursing Process
 This is when the nurse organizes a nursing care
plan based on the nursing diagnoses.
 Nurse and client formulate goals to help the clie
nt with their problems
 Expected outcomes are identified
 Interventions (nursing orders) are selected to aid
the client reach these goals.
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Planning – Begin by prioritizing
client problems
 Prioritize list of client’s
nursing diagnoses
using Maslow
 Rank as high,
intermediate or low
 Client specific
 Priorities can change
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Planning Developing a goal and outcome
statement
 Goal and outcome
statements are client
focused.
 Worded positively
 Measurable, specific
observable, time-limited,
and realistic
 Goal = broad statement
 Expected outcome =
objective criterion for
measurement of goal
 Utilize nursing out come
classification as standard
EXAMPLE
 Goal:
Client will achieve
therapeutic management
of disease process….
 Outcome Statement:
AEB B/P readings of
110-120 / 70-80 and client
statement of
understanding importance
of dietary sodium
restrictions by day of
discharge.
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Planning- Types of goals
 Short term goals
 Long term goals
 Cognitive goals
 Psychomotor goals
 Affective goals
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 Now that we have a nsg dx we need a plan to
help this client
 Goals allow us to determine the specific
outcome desired by the client
 Short term- goal in which a specific time frame with
date ie Able to identify 20 foods which are
low in sodium with in 2 days.
 Long term goal in which desired outcome is expecte
d in a broader time frame i.e. Client be able to devel
op a daily meal plan based on Na
restrictions by the end of the month.
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Goals are patient-centered and
SMART
Specific
Measurable
Attainable
Relevant
Time Bound
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Interventions – 3 types
 Independent ( Nurse initiated )- any actio
n the nurse can initiate without direct superv
ision
 Dependent ( Physician initiated )-nursing
actions requiring MD orders
 Collaborative- nursing actions performed j
ointly with other health care team members
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4. Implementation
 The fourth step in the Nursing Process
 This is the “Doing” step
 Carrying out nursing interventions (orders) selec
ted during the planning step
 This includes monitoring, teaching, further asses
sing, reviewing nursing care plan, incorporating
physicians orders and monitoring cost effectiven
ess of interventions
 Utilize nursing intervention classification as sta
ndard
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Implementing- “Doing”
 Monitor VS q4h
 Maintain prescribed diet
(2 Gm Na)
 Teach client amount of
sodium restriction, foods
high in sodium, use of
nutrition labels, food
preparation and sodium
substitutes
 Teach potential
complications of
hypertension to instill
importance of
maintaining Na
restrictions
 Assess for cultural
factors affecting
dietary regime
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Implementing – “Doing”
 Teach the client-
hypertension can’t be
cured but it can be
controlled.
 Remind the client to
continue medication
even though no S/S
are present.
 Teach client importance
of life style changes:
(weight reduction,
smoking cessation,
increasing activity)
 Stress the importance of
ongoing follow-up care
even though the patient
feels well.
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Wakwaya L (BSc,MPH)

5. Evaluation- To determine effectiven
ess of nursing care plan
 Final step of the Nursing Process but also done
concurrently throughout client care.
 A comparison of client behavior and/or response
to the established outcome criteria.
 Continuous review of the nursing care plan.
 Examines if nursing interventions are working.
 Determines changes needed to help client reach
stated goals.
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Evaluation
 Outcome criteria met? Problem resolved!
 Outcome criteria not fully met? Continue pl
an of care- ongoing.
 Outcome criteria unobtainable- review each
previous step of nursing care plan and deter
mine if modification of the nursing care pla
n is needed.
 Were the nsg interventions appropriate/effec
tive?
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Evaluation
Factors that impede goal attainment:
 Incomplete database
 Unrealistic client outcomes
 Nonspecific nsg interventions
 Inadequate time for clients to achieve outco
mes.
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THE FORMAT OF THE
COMPREHENSIVE HEALTH HISTORY

Structure of the Health History Systems
approach
 A typical comprehensive adult history should include
the following contents:
1. Date – The date of assessment is always important,
and in rapidly changing conditions the time should
also be added.
2. Identifying data- Name , age, sex , race, ethnicity,
birthplace, occupation, etc.
3. Source of referral, if any, and the purpose of it.

Health History Systems
approach cont…
4. Source of history- may include the patient
himself, a relative, a friend, the patient’s medical
record or a referral letter. Documenting source of
history has the following purposes:
– It helps to assess the value and possible bias of the
information.
– Under some circumstances it is also helpful to
comment on the probable reliability of the source of
data.

approach cont…
5. Chief complaint- This is the starting point of
the main part of the history.
- It can be defined as one or more symptoms or
other concerns for which the patient is seeking
care or advice.
- It should be recorded in patient’s own words.
• “Why have you come to the health center
today?” or “Why were you admitted to the
hospital?”

approach cont…
6. History of present illness: it is the amplification of
the chief complaint.
• The history of the present illness usually identifies
major disease mechanisms and may even establish the
diagnosis when symptoms are precise.
• In the history of present illness, the health provider
organizes the data obtained form the primary or
secondary source.
• History of present illness should include:

approach cont…
• A narrative including :
– The onset of the problem.
– The setting in which it developed.
– Its manifestations.
– Any treatments and results
– Location, quality, severity
– Timing (onset, duration and frequency)

approach cont…
• The setting in which they occur- this is the
description of where and what the person was doing
when the symptom occurred.
• Aggravating or relieving factors- identify what
worsens (aggravates)or relives (alleviates) the
symptom. For example, does the chest pain change
with exercise, emotional upset, or rest etc.
• Associated manifestations- Assess associated
factors or symptoms.

approach cont…
7. History of past illness- this explores prior
illnesses, injuries, child hood illness,
operations, hospitalizations and medical
interventions.
8. Current medications:
– Home remedies.
– None prescription drugs (vitamins/mineral
supplements).
– Medicines borrowed from family.

approach cont…
– Allergies- type of substance(s) that induce
the allergy, manifestations of the allergy.
– Recreational drugs- type, dose, duration.
– Diet – Usual favorite diet, restrictions, if
any, and problems with it.
– Others-(screening tests, immunizations,
sleep patterns, environmental hazards)

approach cont…
9. Family history – The family health history is a
past medical history of relatives.
- The clinician needs to assess the person’s family
history with respect to the present illness and future
health risks. The following are areas to be included
in the family health history.
o Present health status of parents and siblings:
Ask the patient about the age and health status of the mother,
father, and each of the siblings, or the age at death and cause.

approach cont…
o Medical problems: Ask the person about family
history of disorders that may be influenced by
heredity or contact. Also ask about family allergies,
deformities, or serious illnesses.
o You may include the following: diabetes, heart
disease, renal disease, cancer, tuberculosis, stroke,
gout, arthritis, mental illness, alcoholism, seizures,
obesity, hypertension, and others.

approach cont…
• Similar illness or symptom in the
family: is any one is the family
experiencing an illness or symptoms
similar to the person’s present
illness?

approach cont…
10.The Psychosocial history- this part of the history
helps to identify some contributory factors in the
patient’s illness and to evaluate the patient’s sources of
support, reactions to illness, coping mechanisms,
strengths and concerns. The psychosocial history often
includes:
 Home situation and significant other.
 Daily life- from day to night.
 Important experience: up brining, schooling, military
service, job history.

approach cont…
 Financial situation, marriage and
retirement.
 Religious beliefs relevant to perception
of health, illness and treatment.

approach cont…
11. Review of systems (functional inquiry)
• It is a detailed account of signs and symptoms
referable to each system of the body.
• The major purpose of functional inquiry (systems
review) is to un earth symptoms of which the
patient has not complained spontaneously and
which he/she may feel are not relevant to the
presenting complaint.

approach cont…
• Functional inquiry has the following advantages:
 It gives a clear understanding of the history of the present
illness.
 It is a double check of the history of the present illness.
 It helps to group symptoms that need to be considered
with the present complaint in order to arrive at a plausible
diagnosis.
 Note: The absence of symptoms is as important as their presence.

approach cont…
• The systems review should be recorded as follows
 General – Usual wt.,recent wt, changes,
weakness, fatigue, fever
 Skin – Rashes, lumps sores, itching, dryness,
color change, changes in hair or nails
 Head- headache, head injury .

approach cont…
• Eyes- vision, glasses, contact lenses,
pain, changes in color, tearing, double
vision, blurring of vision, spots,
flashing of lights, glaucoma, and
cataracts.

approach cont…
 Ears- Hearing, tinitus, vertigo, earaches, infection,
discharge. If hearing is decreased, use of hearing aids.
 Nose and sinuses- frequent colds, nasal stiffiness,
discharge or itching, bleeding, sinus trouble.
 Mouth and throat – conditions of teeth and gums,
bleeding gums, sore tongue, dry mouth, frequent sore
throat, hoarseness.

approach cont…
 Neck – Lumps, swollen glands, goiter, pain or stiffness
in the neck.
 Breasts- Lumps, pain or discomfort, nipple discharge,
self –examination.
 Respiratory- cough, sputum (color, quantity, odor),
hemoptysis, wheezing, asthma, bronchitis, emphysema,
pneumonia, tuberculosis, pleurisy, chest pain, shortness
of breath, cyanosis.

approach cont…
 Cardiovascular- edema, rheumatic fever,
leg cramps, varicose veins. dyspnea (degree
of exercise tolerance), palpitation,
orthopnea (number of pillows required),
paroxysmal nocturnal- dyspnea, chest pain,
syncope, stridor, hypertension.

approach cont…
Gastrointestinal tract- Appetite,
nausea, vomiting, dysphagia, heart
burn, food idiosyncrasy, abdominal
pain, bowel habits, jaundice,
bloody, tarry or clay colored stool,
hemorrhoids, hepatitis.

Cont…
Genito-urinary tract- flank pain ( steady,
colicky, etc.) frequency, dysuria, urgency,
hesitancy, haematuria, pyuria, incontinence,
STIs, menstrual history (menarche, interval
between periods, duration and amount of
flow, inter-menustrual bleeding or discharge
post coital bleeding),dysparunia, menopause,
postmenopausal symptoms.

Cont…
 Musculoskeletal – Muscle or joint pain,
stiffness, arthritis, backache.
 Neurologic – Fainting, black outs, seizures,
weakness, paralysis, numbness or loss of
sensation, tingling, involuntary movement
(tremors, tics, fasciculation), poor memory, lack
of orientation.
 Endocrine- heat or cold intolerance, excessive
sweating, diabetes (diagnosed), excessive thirst
or hunger, polyuria.

TYPES OF ASSESSMENT
• Initial assessment: is performed shortly after
patient admission to a health agency or hospital
• Focused assessment: the nurse gathers data about
a specific problem that has already been
identified.
• Emergency assessment: the nurse performs this
type of assessment on a physiological or
psychological crisis to identify the life –
threatening problems.
• Time – lapsed assessment: this assessment done
to compare a patient current status to the base line
data obtained earlier

The Functional Pattern
Approach
When you assess your patient / client
using the functional health pattern
approach, either you may take
subjective data first and then do
physical examination, or you may take
both subjective and objective data at
the same time for every pattern

Cont….
1.Date
2.Time- in rapidly changing conditions.
3.Identifications- name, age, sex,
address, religion, ethnicity.
4.Source of referral
5.Source of information

Cont…
6.Date of admission( if admitted)
7.Medical diagnosis( if established)
8.Condition on admission (if applicable)
9.Vital signs( optional )
10.Assessment of the eleven functional
health patterns

The Eleven Functional Health
Pattern
1. Health Perception and Management
Safety practices.
■ Adherence to mental and physical health
promotion activities.
■ Adherence to agreed-upon medical or nursing
prescriptions.
■ Follow-up care.

2. Exercise and Activity
• Feeding.
■ Bathing-hygiene.
■ Dressing-grooming.
■ Toileting.
Also included are:
■ Home management.
■ Shopping.
■ Type, quantity, and quality of exercise.
■ Leisure activities.
■ Complex functions of four supporting systems: cardiac,
pulmonary, musculoskeletal, and neurological

3. Nutrition and Metabolism
Typical daily nutrient intake.
■ Types of snacks.
■ Eating times.
■ Quantity of food and fluids consumed.
■ Particular food preferences.
■ Use of nutrient, vitamin, and mineral
supplements.
■ Condition of the skin.

4. Elimination
■ Bowel, bladder, and skin excretion.
■ Regularity of urination and bowel evacuation.
■ Color, quality, and quantity of urine and feces.
■ Aids used to facilitate function, such as
routines, devices, and methods to control
excretion.
■ Changes or disturbances in bowel or bladder
elimination.

5. Sleep and Rest
■ Quality of sleep time.
■ Quantity of sleep.
■Rest and relaxation or quiet periods during the day.
■ Sleep disturbances.
■ Use of aids to sleep, such as medications or night
time routines.

6. Self Perception and Concept
• Self-identity: This is the body boundary that
defines the person, distinguishing the self from
non self. Name is important in identity.
■ Self-esteem or self-worth: These are the
thoughts and feelings that comprise self-
evaluation, or the self-portrait of oneself.
■ Self-competency: This is the self-evaluation of
capabilities: cognitive, social, and physical.
■ Body image: This is the mental picture of one’s
body related to appearance and function.

Cont…
In addition, this pattern is focused on feeling and
mood states, such as:
■ Happiness
■ Anxiety
■ Hope
■ Power
■ Anger
■ Fear
■ Depression
■ Control

7. Roles and Relationships
■ Role satisfaction or dissatisfaction.
■ Role performance.
■ Role conflict, strain, or loss.
Also, the following factors that can place a strain on
relationships are included in assessment:
■ Impaired communication, such as through aphasia.
■ Not speaking dominant language.
■ Translocation, including immigration, moving from
home to nursing home, and moving from intensive to
standard care.
■ Caregiving burden.
■ Alcoholism or use of drugs.

8. Coping and Stress
Tolerance
 Stressors and stress tolerance.
■ Coping patterns and their
effectiveness.

9. Sexuality and
Reproductive Pattern
■ Sexuality.
■ Sexual relations.
■ Reproduction.
■ Family planning.
■ Menstruation and menopause

10. Values and Belief
Pattern
■ Important values.
■ Plans for the future.
■ Spiritual or religious affiliation.
■ Spiritual support and religious needs

11. Cognition and
Perception
■ Adequacy of vision, hearing, taste,
touch, kinesthesia, and smell.
■ Compensations or prostheses
currently used, such as glasses and
hearing aids.
■ Pain and how it is managed.
■ Cognitive functional abilities, such as
orientation, memory, reasoning,
judgment, and decision making.

In the history of past illness:
– If the child is under two years and has
neurological or developmental; problems,
include his birth history(antenatal, natal,
and neonatal history)
– If the child is under two years and you
are dealing with problems of nutritional
status, include history on feeding (
including breast feeding, bottle feeding,
weaning, childhood eating habits)

PHYSICAL EXAMINATION
• It is always advisable to follow the points
below while examining the patient:
 Examination should take place with good
lighting and in a quite environment
 It is advisable to examine a supine patient
from the patient’s right side
 By words or gesture, be as clear as possible
in your instructions

Cont…
If possible try to demonstrate the patient
what to do rather than giving verbal
instructions alone.
Keep the patient informed as you proceed
with your examination
While examining the patient, it is help full
to move “from Head to Toe.”

The components of
Comprehensive examination
are:
 General Appearance: Is the patient
acutely sick, Chronically sick looking or
not sick looking at all? Is patient in
cardio respiratory distress or not?

Cont…
 Vital Signs:
 Pulse( Rate, volume, character,
Radio femoral delay)
Blood Pressure(Specify arm and the
position it was taken)
Respiratory Rate
Temperature(Specify the location it
was taken)

Cont…
 H.E.E.N.T
 Lymphoglandular system
 Respiratory system
 Cardiovascular system
 Gastrointestinal system
 Genito urinary system
 Integumentary System
 Musculoskeletal system
 Nervous system

PHYSICAL ASSESSMENT
SKILLS
Four basic methods are used to
systematically guide the uses of senses
of sight, touch and hearing in physical
assessment.
 They are inspection, palpation,
percussion and auscultation.

1. Inspection
 Inspection is the visual scrutiny of the client
that begins at the first moment of contact, to
observe the normal condition or any
deviations from normal of various body parts.
 All observations must be conducted with
adequate lighting.
 Expose body parts being observed while
keeping the rest properly draped

Cont…
Always look before touching.
Provide a warm room for examination.
Observe for color, size, location,
texture, symmetry, odors, and sounds.

2. Palpation
 This is the use touch to determine the characteristics of
normal and abnormal areas of the body.
 Palpation is used to assess the roughness,
smoothness, hardness, softness, moistness,
dryness, motility, and a nodule or mass can be
determined by touch.
 The tactile sense also reveals the temperature of a given
part. The dorsum of the hand is more sensitive to
temperature because the skin is much thinner there.

Cont…
 Palpation can also inform you of vibrations (thrills,
fremitus).The palmar aspects of the fingers best
detect the presence of vibration.
 Finger trips are used for fine discriminations and
pulsation.
 Light palpation precedes deep palpation.
 Tender areas are palpated last through light
palpation, in order not to aggravate pain and
interfere with further gathering of pertinent data.

Cont…
 Light palpation used to feel for surface by
depressing skin ½” to ¾” with finger pads.
 Deep palpation used to feel internal organs
by depressing skin 1 ½” to 2” with firm,
deep pressure.
 Bimanual palpation used to assess organs
deep in the abdomen by using two hands,
one on each side of body part or organs
being felt.

Light Palpation

Bimanual palpation
liver and spleen

Deep press palpation
tenderness point

3.Percussion
To tap a portion of the body to elicit tenderness or
sounds that varies with the density of underlying
structures.
There are two basic types of percussion: direct and
indirect.
In the direct technique, the body is lightly tapped
directly with the fingers or hand. This technique is
used usually to elicit tenderness or pain.

Cont….
 The indirect method is done bimanually. This
technique is used to elicit one of the following sounds
over the chest or abdomen, flatness(muscle,
bone),dullness(liver,spleen),resonant(normal
lung),hyperresonant(lung with emphysema)and
tympanic(puffed-out cheek, air in bowel).These are
arranged from the most dense to the least dense
underlying body structure.

Cont…
• The technique used in this type of percussion,
press middle finger of the hand firmly on body
part. Keep other fingers off body part, strike the
on the body part with middle finger of the
dominant hand. Flex wrist quickly (not fore arm).

Indirect percussion

Direct Percussion

4. Auscultation
 Usually involves listening for various breath, heart, and
bowel sounds using a stethoscope.
 An adequate stethoscope is about 30 to 35 cm long and
about 0.3cm internal lumen diameter, with diaphragm
and bell.
 The diaphragm best transmits high-pitched sounds
(i.e. normal heart sounds, breath sounds, bowel sounds,
friction rubs and crepitus, by pressing it firmly on body
part.
 The bell usually used to detect low-pitched sounds (i.e.
bruits of stenotic arteries, heart murmurs, and
venous hums.

Cont…

Remember
o Always inspect, palpate, and then auscultate,
except in the abdominal examination.
o Auscultate bowel sounds and percuss the
abdomen prior to palpation to avoid
alterations in bowel sounds.
o Use each technique to compare symmetrical
sides of the body and organs.

I thank you!

DB Foundation I.pptx

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