A physical examination is performed for several reasons: to obtain baseline health data for comparison over time, to identify nursing diagnoses and care needs, and to monitor previously identified health problems. The type of exam depends on the client's health status and setting. Exams can be comprehensive, involving a health history and head-to-toe assessment, or focused on a specific body system. Preparing the client and environment is important, including ensuring privacy, explaining the exam, and putting the client at ease.

1. PURPOSES OF PHYSICAL
EXAMINATION

2. A PHYSICAL EXAMINATION IS
PERFORMED FOR ANY OF SEVERAL
REASONS:
To obtain baseline data.

3. Data about the patient’s physical status
and functional abilities serve as a baseline
for comparison as the patient’s health
status changes.

4. To identify nursing diagnoses,
collaborative problems, and wellness
diagnoses.

5. Problem statements form the basis for the
plan of care and help to address the
patient’s nursing care needs.

6. To monitor the status of a previously
identified problem.

7.  To screen for health problems.
 Regular checkups can help to identify
health problems at early stages.

8. The type of physical examination perform
will depend on
The client’s health status,
The nature of the client , and the setting.

9. A comprehensive physical assessment,
which includes a
health history interview and
a complete head-to-toe examination of
every body system.

10. A focused physical assessment pertains to a
particular topic,
problem,
body part, or functional ability of the patient.

11. A system-specific assessment is a focused
assessment limited to one body system.
(e.g., the lungs, the peripheral circulation).

12. The following are examples of focused
and system-specific physical assessments,
respectively:
Assessing bowel sounds when a client
has abdominal pain.

13. Listening to breath sounds,
counting respirations, and obtaining pulse
oximetry readings to assess a patient’s
respiratory status.

14. ONGOING ASSESSMENT
Ongoing assessment is performed as
needed, after the initial database is
completed, and, ideally, at every interaction
with the patient.

15. For example, on a medical–surgical unit,
each nurse who provides care to a client
conducts a brief ongoing assessment to
determine changes in the client’s status and
evaluate client outcomes.

16. Develop a systematic approach and follow
the same order each time to perform a
physical exam.

17. A HEAD-TO-TOE APPROACH
A head-to-toe approach starts at the head
and neck and progresses down the body,
examining the feet last.

18. BODY SYSTEMS APPROACH
A body systems approach examines each
system in a predetermined order.
(e.g., Musculoskeletal, cardiovascular,
neurological).

19. Whatever the approach,
prepare the environment, and the client
before procedure begins.

20. Preparing for a physical examination requires
theoretical knowledge of anatomy and physiology,

21. Examination equipment and techniques,
therapeutic communication, and documentation.
Self-knowledge is also important.

22. PREPARE THE ENVIRONMENT :
Physical examination requires you to observe
and touch the client’s body, so privacy is
essential.

23. It needs a room with curtains or a door to
shield the client from view.

24. For additional privacy, drape your client
and uncover only the area you are
examining.

25. For convenience you may use bed linens
and/or a gown to drape.

26. Determine the instruments and equipment
you will need.

27. Take the time to establish rapport with the
client, to help him relax and cooperate fully
in the assessment.

28. Introduce yourself, ask the client how he
wishes to be addressed, and explain what
will be doing.

29. -Ask the client to void before the
examination;
-this promotes relaxation and also makes it
easier to palpate the abdomen.

30. -Always alert the client before touching
him.

31. The client will need to assume a variety of
positions during a comprehensive physical
examination.

32. -To begin the examination, seat the client on the
side of the bed or examination table.
-Face the client, and establish eye contact.

33. -An upright position allows the client to expand his
lungs fully and is useful for assessing vital signs, the
head and neck, the heart and lungs, the back, and the
upper extremities.

34. -As you place your client in positions that allow
to best observe the body system you are
examining, be alert to special needs that call for
you to modify the position.

35. THANKING YOU