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Ppt for physical examination

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nursing procedure of physical examination

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Ppt for physical examination

  1. 1. Healthexamination Ms christine Mn prev
  2. 2. DEFINITION• Health examination• Health examination is the systematic assessment of human body which involves the use of one’s senses to determine the general physical and mental conditions of the body
  3. 3. Physical examination• Physical examination is defined as a complete assessment of a patient’s physical and mental status.• A physical assessment is the systematic collection of objective information that is directly observed or is elicited through examination techniques
  4. 4. Indication of health examination• On admission• On discharge• On follow up• Health camps• Before and after diagnostic and therapeutic procedure.
  5. 5. TECHNIQUE OF PHYSICAL ASSESSMENT
  6. 6. INSPECTION
  7. 7. GENERAL INSPECTION OF A CLIENT FOCUSES ON• Overall appearance of health or illness• Signs of distress• Facial expression and mood• Body size• Grooming and personal hygiene
  8. 8. PALPATION
  9. 9. PRINCIPLES OF PALPATION• You should have short fingernails.• You should warm your hands prior to placing them on the patient.• Encourage the patient to continue to breathe normally throughout the palpation.• If pain is experienced during the palpation. discontinue the palpation immediately.• Inform the patient where, when, and how the touch will occur, especially when the patient cannot see what you are doing.
  10. 10. LIGHT PALPATION
  11. 11. DEEP PALPATION
  12. 12. PERCUSSION
  13. 13. TYPE OF PERCUSSION• DIRECT PERCUSSION
  14. 14. INDIRECT PERCUSSION
  15. 15. AUSCULTATION
  16. 16. FOUR CHARACTERISTICS OF SOUND• 1.Pitch (ranging from high and low):frequency or number of oscillations generated per second by vibrating object• 2. Loudness (ranging from soft to loud): amplitude of sound• 3. Quality (gurgling or swishing)• 4. Duration (short, medium or long)
  17. 17. OLFACTION
  18. 18. EQUIPMENTS• STETHOSCOPE
  19. 19. OPHTHALMOSCOPE
  20. 20. OTOSCOPE
  21. 21. SNELLEN CHART
  22. 22. NASAL SPECULUM
  23. 23. VAGINAL SPECULUM
  24. 24. TUNING FORK
  25. 25. PERCUSSION HARMER
  26. 26. SPHYGMOMANOMETER
  27. 27. POSITIONING• Sitting/fowler’s
  28. 28. STANDING
  29. 29. SUPINE AND PRONE
  30. 30. DORSAL RECUMBENT
  31. 31. Sim’s
  32. 32. LITHOTOMY
  33. 33. KNEE-CHEST
  34. 34. PREPARING THE ENVIRONMENT
  35. 35. PREPARING THE PATIENT• PSYCHOLOGICAL PREPERATION
  36. 36. PHYSICAL PREPERATION
  37. 37. ARTICLES REQUIRED• Screen to provide privacy• Bowl for antiseptic lotion• Kidney tray and paper bag• Weighing machine and height scale• Patient gown
  38. 38. ARTICLES REQUIRED• Bath blanket to cover the patient• Pair of leggings• Draw sheet to cover patient’s chest• Square drum containing test tube, gauze piece, cotton swab, specimen bottle, swabsticks• Gloves• lubricant
  39. 39. ARTICLES REQUIRED• Torch• Ophthalmoscope• Snellen’s chart• Book for colour blindness• Pen• Flash card• Autoscope with speculum of different sizes• Percussion Hammer• Tuning fork
  40. 40. ARTICLES REQUIRED• Nasal speculum• Mouth gag• Laryngeal mirror• Tongue depressor• Stethoscope• Inch tape
  41. 41. ARTICLES REQUIRED• Sterile tray for vaginal examination• Proctoscope• VITALS TRAY
  42. 42. ARTICLES FOR NEUROLOGICAL• Powder, soap EXAMINATION• Snellan’s chart• Pencil or pen• Cotton wicks• Torch• Tuning fork• Salt, sugar
  43. 43. ARTICLES FOR NEUROLOGICAL EXAMINATION• Tongue depressor• 2 test tubes one with hot water and other with cold water• Safety pins• Some thing solid for grasping• Sharp object like key• Reading material to assess eyes and language of person• Knee harmer
  44. 44. GENERAL SURVEY• Identification data• Gender and race• Age• Signs of distress• Body type• Posture• Gait
  45. 45. GENERAL SURVEY• Body movements• Hygiene and grooming• Body odour• Affect and mood• Speech• Substance abuse:
  46. 46. VITALS SIGNS
  47. 47. HEIGHT AND WEIGHT:
  48. 48. ASSESSING INTEGUMENT SYSTEM• Assessing skin• Skin color Erythema
  49. 49. CYANOSIS
  50. 50. Jaundice
  51. 51. Pallor
  52. 52. Vitiligo
  53. 53. Inspect skin vascularity• Ecchymosis
  54. 54. Petechiae
  55. 55. C Inspect skin lesion
  56. 56. Palpate skin temperature, texture, moisture and turgor
  57. 57. EDEMA
  58. 58. PITTING EDEMA
  59. 59. PITTING EDEMA• Grades of pitting edema• Grade 0 : (none)• Grade +1 :( trace , 2 mm)• Disappear rapidly• Grade +2 ( moderate , 4 mm)• 10-15 sec• Grade +3 (deep, 6 mm)• ≥ 1min• Grade +4 (very deep, 8 mm)• 2-5min
  60. 60. ASSESSING NAILS• Shape; convex• Angle : between nail and its base is 160 degrees• Texture: smooth, nail base should be firm and non tender• Color: pinkish nail bed with translucent white tips• Capillary refill
  61. 61. ABNORMALITIES OF NAIL• Koilonychias (spoon nail)• clubbing• Paranychia• indentations called (beau’s line)
  62. 62. ASSESSING HAIR AND SCALP• color,• texture and distribution.• Thickness and lubrication of hair
  63. 63. INSPECT THE SCALP• Cleanliness, color, dryness,• Lump, lesions,• Lice (pediculus humanus capitus)• Dandruff etc
  64. 64. HEAD AND NECK• ASSESSING THE SKULL• for size, symmetry• any nodules or masses
  65. 65. INSPECT THE FACE
  66. 66. ASSESS THE EYE• Inspect external eye structure• Position and alignment• Exophthalmoses• strabismus
  67. 67. ASSESS THE EYE• Eye brows• Eye lid :• ectropion(eversion ,lid margin turn out)• entropion(inversion, lid margin turns inwards)• ptosis( abnormal drooping of lid over pupil
  68. 68. ASSESS THE EYE• Eye lashes : sty.• Eye balls• Conjunctiva and sclera{ Paleness, redness or purulent,jaundice}
  69. 69. ASSESS THE EYE• Cornea and iris :arcus senilis• Pupil : PEERLA.
  70. 70. ACCOMMODATION
  71. 71. PUPILLARY REFLEX TO LIGHT
  72. 72. VISUAL ACUITY
  73. 73. INSPECT INTERNAL EYE STRUCTURES
  74. 74. EXTRA OCULAR MOVEMENTS
  75. 75. PERIPHERAL VISION
  76. 76. EARS• AURICLES• EAR CANAL AND TYMPANIC MEMBRANE
  77. 77. HEARING• WEBER’S TEST:• RINNE, S TEST:
  78. 78. NOSE AND SINUSES
  79. 79. INSPECT THE MOUTH PHARYNX AND NECK• LIPS: lesions ,pallor (anemia), cyanosis(respiratory cardiovascular problems), cherry colored• BUCCAL MUCOSA , GUMS AND TEETH: teeth look for alignment , dental caries.buccal mucosa is a good site to visualize jaundice and pallor.leukoplakia (thick white patches ) is a precancerous lesion.• TONGUE• FLOOR OF MOUTH• PHARYNX:
  80. 80. ABNORMAL FINDINGS• pallor, cyanosis or redness• lesions, swollen lips red tonsils, swollen red bleeding gums,• white coating of tongue fissured tongue from dehydration.• bright red tongue seen in deficiency of iron b12 or niacin,• black tongue
  81. 81. ASSESS THE NECK
  82. 82. PALPATE TRACHEA AND LYMPH NODES
  83. 83. PALPATE THE THYROID GLAND
  84. 84. ASSESS THE THORAX AND LUNGS• INSPECT THE THORAX• Abnormal findings :increase in chest size and contour , abnormal breathing pattern with the use of accessory muscles, unequal chest expansion, and abnormal breath sounds, barrel chest, pigeon chest
  85. 85. PALPATE THE THORAX
  86. 86. PERCUSS THE THORAX
  87. 87. AUSCULATE BREATH SOUND• Bronchial sounds heard over the trachea are high – pitched, harsh sounds with expiration longer than inspiration .• Bronchovesicular sounds: heard over the main stem bronchus and is moderate (blowing) sound with inspiration equal to expiration.• Vesicular sounds are soft , low pitched and heard best in base of lungs during inspiration longer than expiration.
  88. 88. ABNORMAL BREATH SOUNDS• WHEEZE• RHONCHI• CRAKLES• FRICTION RUB
  89. 89. CARDIO VASCULAR SYSTEM• INSPECT NECK AND PRECORDIUM• PALPATE THE PRECORDIUM• AUSCULATATE HEART SOUND
  90. 90. AUSCULATATION
  91. 91. ASSESSING THE BREAST AND AXILLA• INSPECT BREAST AND AXILLA• PALPATION OF BREAST AND AXILLA
  92. 92. ASSESSING THE ABDOMEN
  93. 93. QUATRANTS OF ABDOMEN
  94. 94. INSPECT THE ABDOMEM
  95. 95. AUSCULTATE BOWEL SOUNDS
  96. 96. PERCUSS THE ABDOMEN
  97. 97. PALPATE THE ABDOMEN
  98. 98. ASSESS MUSCULO SKELTAL SYSTEM• INSPECT AND PALPATE MUSCLE
  99. 99. MUSCULO SKELTAL SYSTEM• PALPATE THE BONES• INSPECT AND PALPATE THE JOINTS• INSPECT SPINAL CURVES• kyphosis• Lordosis• Scoliosis
  100. 100. ASSESSING MALE AND FEMALE GENITALIA• INSPECT AND PALPATE FEMALE GENITALIA
  101. 101. INSPECT AND PALPATE RECTUM AND ANUS
  102. 102. NEUROLOGICAL SYSTEM
  103. 103. MENTAL AND EMOTIONAL STATUS:
  104. 104. BEHAVIOR AND APPEARANCE
  105. 105. LANGUAGE
  106. 106. INTELLECTUAL FUNCTION• Memory• Knowledge• Abstract thinking• Association• Judgment
  107. 107. CRANIAL NERVE FUNCTION• Olfactory nerve(1):• Optic nerve(2)• Occulomotor(3)• Trochlear(4)• Trigeminal(5)• Abducens(6)
  108. 108. CRANIAL NERVE FUNCTION• Facial(7)• Auditory(8).• Glossopharyngeal(9)• Vagus(10)• Spinal accessory(11• Hypoglossal(12)
  109. 109. MOTOR FUNCTION• Balance and gait• Romberg’s test• Motor function and coordination
  110. 110. SENSORY FUNCTION
  111. 111. REFLEX FUNCTION• Biceps reflex• Triceps reflex• Knee and patellar reflex• Ankle/ Achilles tendon reflex• Babinski reflex• Abdominal reflex
  112. 112. PERIPHERAL VASCULAR SYSTEM ASSESSMENT• ALLEN’S TEST• BUERGER’S TEST• CAPILLARY REFILL• HOMAN’S SIGN• PALPATE PERIPHERAL PULSES
  113. 113. DOCUMENTATION OF DATA
  114. 114. AFTER CARE OF THE PATIENT
  115. 115. AFTER CARE OF ARTICLES

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