Ppt for physical examination
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Transcript of Ppt for physical examination
Health examination
Ms christineMn prev
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
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
Indication of health examination• On admission• On discharge• On follow up• Health camps• Before and after diagnostic and therapeutic
procedure.
TECHNIQUE OF PHYSICAL ASSESSMENT
INSPECTION
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
PALPATION
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.
LIGHT PALPATION
DEEP PALPATION
PERCUSSION
TYPE OF PERCUSSION• DIRECT PERCUSSION
INDIRECT PERCUSSION
AUSCULTATION
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)
OLFACTION
EQUIPMENTS
• STETHOSCOPE
OPHTHALMOSCOPE
OTOSCOPE
SNELLEN CHART
NASAL SPECULUM
VAGINAL SPECULUM
TUNING FORK
PERCUSSION HARMER
SPHYGMOMANOMETER
POSITIONING• Sitting/fowler’s
STANDING
SUPINE AND PRONE
DORSAL RECUMBENT
Sim’s
LITHOTOMY
KNEE-CHEST
PREPARING THE ENVIRONMENT
PREPARING THE PATIENT• PSYCHOLOGICAL PREPERATION
PHYSICAL PREPERATION
ARTICLES REQUIRED
• Screen to provide privacy• Bowl for antiseptic lotion• Kidney tray and paper bag• Weighing machine and height scale• Patient gown
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
ARTICLES REQUIRED
• Torch• Ophthalmoscope• Snellen’s chart• Book for colour blindness• Pen• Flash card• Autoscope with speculum of different sizes• Percussion Hammer• Tuning fork
ARTICLES REQUIRED
• Nasal speculum• Mouth gag• Laryngeal mirror• Tongue depressor• Stethoscope• Inch tape
ARTICLES REQUIRED
• Sterile tray for vaginal examination• Proctoscope• VITALS TRAY
ARTICLES FOR NEUROLOGICAL EXAMINATION
• Powder, soap• Snellan’s chart• Pencil or pen • Cotton wicks• Torch• Tuning fork• Salt, sugar
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
GENERAL SURVEY• Identification data• Gender and race• Age• Signs of distress• Body type• Posture• Gait
GENERAL SURVEY
• Body movements• Hygiene and grooming• Body odour• Affect and mood• Speech• Substance abuse:
VITALS SIGNS
HEIGHT AND WEIGHT:
ASSESSING INTEGUMENT SYSTEM• Assessing skin• Skin color Erythema
CYANOSIS
Jaundice
Pallor
Vitiligo
Inspect skin vascularity
• Ecchymosis
Petechiae
C Inspect skin lesion
Palpate skin temperature, texture, moisture and turgor
EDEMA
PITTING EDEMA
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
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
ABNORMALITIES OF NAIL• Koilonychias (spoon nail)• clubbing• Paranychia• indentations called (beau’s line)
ASSESSING HAIR AND SCALP• color, • texture and distribution. • Thickness and lubrication of hair
INSPECT THE SCALP • Cleanliness, color, dryness, • Lump, lesions, • Lice (pediculus humanus capitus)• Dandruff etc
HEAD AND NECK• ASSESSING THE SKULL• for size, symmetry• any nodules or masses
INSPECT THE FACE
ASSESS THE EYE• Inspect external eye structure• Position and alignment• Exophthalmoses • strabismus
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
ASSESS THE EYE• Eye lashes : sty.• Eye balls• Conjunctiva and sclera{ Paleness, redness or
purulent,jaundice}
ASSESS THE EYE
• Cornea and iris :arcus senilis• Pupil : PEERLA.
ACCOMMODATION
PUPILLARY REFLEX TO LIGHT
VISUAL ACUITY
INSPECT INTERNAL EYE STRUCTURES
EXTRA OCULAR MOVEMENTS
PERIPHERAL VISION
EARS• AURICLES• EAR CANAL AND TYMPANIC MEMBRANE
HEARING• WEBER’S TEST: • RINNE, S TEST:
NOSE AND SINUSES
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:
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
ASSESS THE NECK
PALPATE TRACHEA AND LYMPH NODES
PALPATE THE THYROID GLAND
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
PALPATE THE THORAX
PERCUSS THE THORAX
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.
ABNORMAL BREATH SOUNDS
• WHEEZE• RHONCHI• CRAKLES• FRICTION RUB
CARDIO VASCULAR SYSTEM • INSPECT NECK AND PRECORDIUM • PALPATE THE PRECORDIUM• AUSCULATATE HEART SOUND
AUSCULATATION
ASSESSING THE BREAST AND AXILLA
• INSPECT BREAST AND AXILLA • PALPATION OF BREAST AND AXILLA
ASSESSING THE ABDOMEN
QUATRANTS OF ABDOMEN
INSPECT THE ABDOMEM
AUSCULTATE BOWEL SOUNDS
PERCUSS THE ABDOMEN
PALPATE THE ABDOMEN
ASSESS MUSCULO SKELTAL SYSTEM• INSPECT AND PALPATE MUSCLE
MUSCULO SKELTAL SYSTEM• PALPATE THE BONES• INSPECT AND PALPATE THE JOINTS• INSPECT SPINAL CURVES• kyphosis• Lordosis• Scoliosis
ASSESSING MALE AND FEMALE GENITALIA
• INSPECT AND PALPATE FEMALE GENITALIA
INSPECT AND PALPATE RECTUM AND ANUS
NEUROLOGICAL SYSTEM
MENTAL AND EMOTIONAL STATUS:
BEHAVIOR AND APPEARANCE
LANGUAGE
INTELLECTUAL FUNCTION
• Memory• Knowledge• Abstract thinking• Association• Judgment
CRANIAL NERVE FUNCTION
• Olfactory nerve(1):• Optic nerve(2)• Occulomotor(3)• Trochlear(4)• Trigeminal(5)• Abducens(6)
CRANIAL NERVE FUNCTION
• Facial(7)• Auditory(8).• Glossopharyngeal(9)• Vagus(10) • Spinal accessory(11• Hypoglossal(12)
MOTOR FUNCTION
• Balance and gait• Romberg’s test• Motor function and coordination
SENSORY FUNCTION
REFLEX FUNCTION
• Biceps reflex• Triceps reflex• Knee and patellar reflex• Ankle/ Achilles tendon reflex• Babinski reflex• Abdominal reflex
PERIPHERAL VASCULAR SYSTEM ASSESSMENT
• ALLEN’S TEST• BUERGER’S TEST• CAPILLARY REFILL• HOMAN’S SIGN• PALPATE PERIPHERAL PULSES
DOCUMENTATION OF DATA
AFTER CARE OF THE PATIENT
AFTER CARE OF ARTICLES