A health history is a collection of data that provides a detailed profile of the patient's health status. Nurses use therapeutic communication skills and interviewing techniques during the health history to establish an effective nurse-patient relationship. Physical examination is an important tool in assessing the client’s health status. Approximate 15 % of the information used in the assessment comes from the physical examination.

1. History taking
and
physical examination

2. History Taking
• A health history is a collection of data that provides a detailed profile
of the patient's health status.
• Nurses use therapeutic communication skills and interviewing
techniques during the health history to establish an effective nurse-
patient relationship
• The nurse take history of the patient to gather data and to identify
actual and potential health problems as well as health-promotion
activities and sources of strength.

3. • Information is collected during an interview with the
patient, that is the primary source of data.
• The patient's family members and/or caregivers may
also be an important source of data.
• Nurses should know and be sensitive to cultural
differences that influence how both verbal and
nonverbal communications are interpreted.

4. Interview
• An interview is a therapeutic interaction that has a specific purpose.
• The purpose of the assessment interview is to collect information
about the client’s health history and current status in order to make
determinations about the client’s health needs.
• Effective interviewing depends on the nurse’s knowledge and ability
to skillfully elicit information from the client using appropriate
techniques of communication.
• Observation of nonverbal behavior during the interview is also
essential to effective data collection.

5. Phases of interview
• Preparatory phase
• Introduction
• Working phase
• Termination

6. Preparatory phase
1. Assure adequate lighting.
2. Maintain a comfortable room temperature.
3. Select an envrionment that is as free of noise and distractions as
possible.
4. Maintain client privacy.
5. Make sure that the interview is timed appropriately.
6. Promote client comfort.
7. Interview at 45 degree and be seatd 3-4 ft apart

7. Introduction phase
• Nurse introduce first
• Identify the purpose of the interview
• Ensure the confidentiality of the information

8. Working phase
• Nurse gather subjective data
• Use of excellence communication (active listening, eye contact, open
ended question

9. Termination
• Inform the patient about nearing end of interview
• Offer patient chance to add anything

10. Purpose of History Taking
• To obtain accurate information of the patient which helps to
determine the etiology of problems
• Large percentage (70-80%) of the information regarding problems can
be explored

11. Principle of history taking
• Be respectful
• Introduce yourself
• Use familiar words and phrases and avoid technical words
• Be patience
• Ask open ended question

12. Component of the history taking
• Patient profile
• Chief complainhistory of present illness
• Past medical history
• Family history
• Socio-economic history
• Personal habits
• System review

13. Physical Examination
•Physical examination is an important tool in
assessing the client’s health status.
•Approximate 15 % of the information used
in the assessment comes from the physical
examination.
•It is performed to collect objective data and
need to correlate it with subjective data.

14. Purpose
• To collect objective data from the client
• To detect the abnormalities with systematic technique early
• To identify the health problem and diagnose diseases
• To determine the status of present health in health check-up and
refer the client for consultation if needed

15. Principles of Physical Examination
• A systematic approach should be used while doing physical
examination. This helps avoiding any duplication or omission.
• The physical assessment is usually conducted in a head-to-toe
sequence or a system sequence but can be adapted to meet the
needs of the patient. eg,. in the case of infant, examination of heart
and lung function should be done before the examination of other
body parts, because when the infant starts crying , his/her breath and
heart rate may change.
• It is often necessary to modify the sequence, positions, and specific
assessments based on the patient's age, energy level, and cognitive
and physical state, as well as time constraints

16. Techniques of Physical Assessment
• The four primary assessment techniques are
inspection,palpation,percussion, and auscultation.
• These techniques are most often used in the sequence to
examine body parts
• Bilateral body parts are always compared; for example, the
assessment findings of one leg are compared with those of the
other leg. (Bilateral body parts are normally symmetric; that is,
they have the same size and shape as well as the same
characteristics, such as movement or pulses.)
• Assess any areas that are likely to be painful or cause the patient
extreme discomfort at the end of the examination.

17. Preparation for physical examination
• Prior to beginning a physical examination, think about how to
make the patient comfortable and relaxed.
• Be sure to use appropriate verbal and nonverbal
communication techniques.
• Language
• Urination before examination
• Think about the sequence of the examination-what order will be
used to assess the areas required by the examination.
• Chest: inspection, palpation, percussion, and auscultation
• Abdomen: inspection, auscultation, percussion, palpation
• Adjust the lighting and the environment

18. Inspection
• Inspection is the process of performing deliberate, purposeful
observations in a systematic manner.
• Closely observe visually but also use hearing and smell to gather
data throughout the assessment.
• Assess details of the patient's appearance, behavior, and movement.
• Inspection begins with the initial patient contact and continues
through the entire assessment.
• Adequate natural or artificial lighting is essential for distinguishing
the color, texture, and moisture of body surfaces.
• Inspect each area of the body for size, color, shape, position,
movement, and symmetry, noting normal findings and any deviations
from normal.
• Inspection, followed by palpation, may sequentially be used during
the assessment of each body part.

19. Palpation
• Palpation uses the sense of touch.
• The hands and fingers are sensitive tools that can assess skin
temperature, turgor, texture, and moisture, as well as vibrations within the
body (such as the heart) and shape or structures within the body (e.g.,the
bones).
• Specific parts of the hand are more effective at assessing different
qualities
• The dorsum (back) surfaces of the hand and fingers are used for gross
measure of temperature.
• The palmar (front) surfaces of the fingers and fingerpads are used to
assess firmness, contour, shape, tenderness, and consistency.
• The fingerpads are best at fine discrimination. Use fingerpads to locate,
lymph nodes, and other small lumps, and to assess skin texture and
edema.

20. Palpation continue…
• Vibration in heart is palpated best with the ulnar,or outside,
surface of the hand.
• The nurse's hands should be warm and the fingernails short.
• Inform the patient about the areas to be palpated and ask for
permission to use touch.
• When conducting palpation, any area of tenderness is palpated
last.
• Light (gentle), moderate,or deep palpation may be used,
controlling the depth by the amount of pressure applied.
• Light palpation is used to feel abnormalities that are on the surface,
usually pressing down 1-2 centimeters. Deep palpation is used to feel
internal organs and masses, usually pressing down 4-5 centimeters

21. Percussion
• Percussion is the act of striking one object against another to
produce sound. The fingertips are used to tap the body over
body tissues to produce vibrations and sound waves.
• Abnormal sounds suggest alteration of tissues, such as an
emphysematous lung, or the presence of a mass, such as an
abdominal tumor.
• A quiet environment allows sounds to be heard.
• Percussion determines the density of various parts of the body from
the sound produced by them, when they are tapped with fingers.
• Percussion helps to find out abnormal solid masses, fluid and gas in
the body and to map out the size and borders of the certain organ like
the heart.

22. Methods of percussion are:
• ① Put the middle fingers of his/her hand of the left hand against the
body part to be percussed
• ② Tap the end joint of this finger with the middle finger of the right
hand
• ③ Give two or three taps at each area to be percussed
• ④ Compare the sound produced at different areas

24. Resonance is a low-pitched sound that is hollow
in terms of sound quality with a moderate
duration.
Hyperresonance is also low-pitched but is more
of a booming sound in terms of sound quality and
has a longer duration than resonance.
Tympany is high-pitched and sounds like a drum
in terms of quality with longer duration than
resonance and hyperresonance.
Dullness is a quiet thud in terms of quality with a
high pitch and short duration.
Flatness is even more quiet than dullness with an
even shorter duration and a high pitch.

25. Auscultation
• Auscultation is the act of listening with a stethoscope to sounds
produced within the body.
• Auscultation is performed by placing the stethoscope diaphragm or
bell against the body part being assessed.
• When auscultating, expose the part listened to, use the proper part
of the stethoscope (diaphragm or bell) for specific sounds and listen
in a quiet environment.
Four characteristics of sound are assessed by auscultation:
(1) pitch (ranging from high to low),
(2) loudness (ranging from soft to loud),
(3) quality (e.g., gurgling or swishing),
(4) duration (short, medium, or long).

26. • Thank you