WHEN YOU PERFORM a physical assessment, you'll use four techniques: inspection, palpation, percussion, and auscultation. Use them in sequence—unless you're performing an abdominal assessment.
WHEN YOU PERFORM a physical assessment, you'll use four techniques: inspection, palpation, percussion, and auscultation. Use them in sequence—unless you're performing an abdominal assessment.
WHEN YOU PERFORM a physical assessment, you'll use four techniques: inspection, palpation, percussion, and auscultation. Use them in sequence—unless you're performing an abdominal assessment.
OMAN COLLEGE OF HEALTH SCIENCES STEPS OF HEALTH ASSESSMENT Collection of subjective data WHAT TO Collection of objective data KNOW Validation of data Documentation of data Assessment is the first and most critical phase of the nursing process. Systematic, rational method of planning and providing individualized nursing care. Purpose WHAT TO KNOW To Identify a client’s health status and Actual or potential health care problems or needs To establish plans to meet the identified needs To deliver specific nursing interventions I. Collection of subjective data Data collection is the process of gathering information about a client's health status. Types of Data Subjective data Objective data Subjective data that can be elicited and verified only by the client. SUBJECTIVE DATA ARE sensations or symptoms (e.g., pain, hunger), feelings (e.g., happiness, sadness), Collecting perceptions, Subjective desires, Data preferences, beliefs, ideas, values, and personal information The major areas of subjective data include Biographical information (name, age, religion, occupation) Physical symptoms related to each body part or system (e.g., eyes and ears, abdomen)
Collecting Past health history
Subjective Data Family history Health and lifestyle practices (e.g., health practices that put the client at risk, nutrition, activity, relationships, cultural beliefs or practices, family structure and function, community environment) The information is obtained through interviewing.
Collecting Therefore, effective interviewing
Subjective Data skills are vital to accurate and thorough collection of subjective data. A meeting of people face to face, INTERVIEWING especially for consultation. Meeting between nurse and patient. GOALS It collects subjective data –what the person says about him or her self To record a complete health history. Establish rapport and trust Successful Gather complete and accurate data interview about the person’s health state Teach the person about the health state Build rapport for a continuing therapeutic relationship Begin teaching for health promotion and disease prevention. Communication is exchanging information so that each person closely understand the others. No understanding or no conveyed The process of meaning…. no communication. communication Communication is not just talk or hear but all behaviour, conscious or unconscious, verbal or nonverbal . Verbal communication- words you speaks or vocalization, the tone of voice Nonverbal communication –body language
1. Sending Example: posture, gestures, facial
expression, eye contact, foot tapping, touch etc Nonverbal communication more reflective of your true feelings. Words and gestures must be interpreted in a specific context to have meaning. You have a specific context in mind when you send your words. 2. RECEVING The receiver put his or her own interpretation on them based on his or her past experience, culture, and self concept as well as current physical and emotional state. 2. RECEVING Needs to bring into the interview 3. Internal a)Empathy Factors b)The ability to listen 3. Internal Factors
a) Empathy Recognising and accepting the others
person’s feelings without criticism. Feeling with the person rather than feeling like the person. 3. Internal Factors
b) Ability to listen Active listening and demanding
Complete attention No more important than patient during interview. 1. Introducing interview 2. The working phase Techniques of 3. Closing the interview communication 1. Introducing interview Keep beginning short if you are nervous Address the patient using his or her surname and shake hands if that Techniques of seems comfortable communication : Introduce yourself and state your Introducing Interview role in the agency Give the reason for this interview After this brief introduction , ask an open ended question (‘tell me how I can help you?’) 2. The working phase Data gathering phase Question and Responses to what the patient has said. Techniques of communication : Two type of question Working Phase I. I. Open ended : Use open ended question to begin interview and to introduce a new section of questions, and use it whenever the person introduce new topic II. Closed or direct question: ask for specific information Elicit a short, one or two word answer, Yes or No or forced choice. Techniques of Advantage and disadvantage communication : Direct question limit his or her Working Phase answer Need direct questions to speed up the interview III.Responses: Assisting the Narrative to encourage free expression of the patient Techniques of Nine types of verbal responses communication : First five responses( facilitation, Working Phase silence, reflection, empathy, clarification,) involve nurse reactions to the facts or feelings the person communicate. III.Responses: Assisting the Narrative – Last four responses (confrontation, Techniques of interpretation, explanation, communication : summary), start to express your own Working Phase thoughts and feelings i. Facilitation : encourage the patient to say more, to continue with story. Example: say yes. Hmm, eye contact etc ii.Silence : time to think, organise what he Techniques of or she wishes to say without interruption communication: from you. Working Phase iii.Reflection: repeating part of what the person has just said. Its focuses further attention and helps the person continue in his own way. Example: I have two little ones at home. I am so worried they are not getting care they need.
Response: you feel worried and anxious
Techniques of about your children. communication: Working Phase “You seem a little angry today. Would you like to talk about it?". iv.Empathy: recognizes a feeling and put it in words. The patient feels accepted and can deal with the feeling openly. Example : Techniques of Patient: I direct 20 employee every day, and now communication: here I am having to call on you for every little Working Phase things Empathic response: It must be hard. One day having so much control, and now feeling dependent on someone else. v. Clarification: use when the person's word choice is confusing. Example: ‘’tell me what do you mean by ‘tired blood’ ’’. vi.Confrontation: Techniques of observed certain action, feelings or communication : Working Phase statement and focus the person's attention on it. Give honest feedback about what see or feel. Focus on a discrepancy EXAMPLE : you say it does not hurt, but when I touch you here you grimace. vii.Interpretation : Based on your inference or conclusion Its links event, makes associations or Techniques of implies cause communication : Example : ‘’it seems that every time you feel Working Phase the stomach pain, you have had some kind of stress in your life’’ viii.Explanation You share factual and objective information. This may be for orientation to the Techniques of agency settings. communication: Example: “Your dinner comes at 5.30. Working Phase You cannot eat because the food may alter the test results”. ix.Summary Final review of what you understand the person Type of validation in that the person agree with it or correct it. Techniques of Occurs at the end of the interview. communication: Closing the Example: Is there anything else you would Interview like to mention? Are there any questions you would like to ask? Are there any other areas I should have asked about? ix.Summary cont "During our discussion today, we have discussed the roles of diabetic Techniques of communication: medications, exercise, diet and other Closing the factors as they interact with each other Interview and how these interactions impact on the successful management of diabetes." Traps (messages) are obstacles to obtaining complete data and to establishing rapport. 1. Providing false assurance or reassurance Example : A woman says, oh I just know this lump is going to turn out to be cancer. False Response : Now u do not worry, I am sure you Traps of will be all right. interviewing Closes of communication True response: you are really worried about the lump, aren’t you ? It must be hard to wait for the biopsy results? “It must be difficult not to know what the surgeon will find. What can I do to help?” 2.Giving unwanted advice: Example : “Dr. Kline just told me that my only Traps of chance of getting pregnancy is to have interviewing an operation. I just do not know. What would you do?” Correct response: Reflection Nurse: Have an operation? Patient: Yes, and I’m afraid of being put to sleep. What if I don’t wake up? Traps of Nurse: “What concerns do you have?” interviewing “What are the pros and cons of this choice for you?” “What is holding you back?” 3. Using avoidance language Use euphemisms (mild or indirect word) such as Passed on instead of death to avoid Traps of reality or to hide their feelings interviewing Using direct language is the best way to deal with frightening topics. 4. Engaging in distance Impersonal speech to put space between a threat and the self. Example: “There is a lump in the left breast.” (using “the” instead of “my” -- Traps of denying association with her diseased interviewing breast and protect herself from it). Health professionals use distancing too , to soften reality. Its shows that you also are afraid of the procedure. 5. Using professional Jargon Myocardial infarction : heart attack
Traps of Express your questions in lay
interviewing terms to make sure your patient understands you. 6. Using leading or biased questions Wrong: "You"re not hurting in your stomach, are you?“ Traps of Either he is forced to answer interviewing Or he feels guilty when he must admit the other answer. Correct: "Are you having any stomach problems? 7. Talking too much Good rule for interviewer is to Listen more than talk. 8. Interrupting Often when you think you know what the person will say, you interrupt and cut the person of. Traps of This does not show you are clever rather it signals that interviewing you are impatient or bored with the interview. “Let’s not talk about your insurance problems it’s time for your walk” “After your walk let’s talk some more about what’s going on with your insurance company.” 9. Using ‘’Why’’ Questions cont Traps of “Why are you so upset?” interviewing . “You seem upset. What’s on your mind?” 9. Using ‘’Why’’ Questions Wrong: Why did you wait so long before to the emergency department?
Traps of Correct: I see you started to have chest pains
early in the day. What happened between the interviewing time the pains started and the time you came to the emergency department. ‘’WHY’’ QUESTIONS SOUND WHINING, ACCUSATORY AND JUDGMENTAL LEARN TO LISTEN WITH EYES AND EARS 1. Physical appearance 2. Posture 3. Gestures
NON VERBAL 4. Facial expression
SKILLS 5. Eye contact 6. Voice 7. Touch LEARN TO LISTEN WITH EYES AND EARS 1.Physical appearance Inattention to dressing or grooming suggests the person is sick to maintain self care or has an emotional dysfunction such NON VERBAL as depression. SKILLS Professional uniform may create a positive stereotype (comfort, expertise, or ease of identification) or negative stereotype (distance authority, or formality). Professional Image 2.Posture Note the patient position Open position: shows relaxation and physical comfort and NON VERBAL willingness to share information. SKILLS Closed position: looks defensive and anxious You should appear calm and unhurried. 3.Gestures Nodding or an open turning out of the hand shows acceptance, agreement , attention and NON VERBAL understanding. SKILLS Pointing a finger occurs with anger and vehemence. Pain may be shown by pointing one finger to the exact spot. LEARNS TO LISTEN WITH EYES AND EARS 4.Facial expression Variety of relevant emotions and conditions Expression may look alert , interested and NON VERBAL relaxed, look anxious, angry and suspicious. SKILLS Nurse own expression should reflect attentive, sincere and interested in the patient. Expression of boredom, distraction, criticism and disbelieved may dissolve rapport . LEARNS TO LISTEN WITH EYES AND EARS 5.Eye contact Lack of eye contact suggests that the person is shy, withdrawn, confused, bored or depressed. NON VERBAL But do not stare down. SKILLS Don’t have a fixed penetrating look but rather have an easy gaze towards the person’s eyes. (see culture) LEARNS TO LISTEN WITH EYES AND EARS 6. Voice Besides the spoken words, meaning comes through the tone of voice, the intercity and rate of speech., the pitch and pauses. NON VERBAL SKILLS Example: an anxious person often speaks in a loud, fast voice, high pitched. Soft voice indicates shyness and fear LEARNS TO LISTEN WITH EYES AND EARS 7. Touch Meaning of touch is influenced by the person’s age, gender, cultural background, past experience and current settings. NON VERBAL Meaning of touch is easily misinterpreted SKILLS Do not touch during interview unless you know the person well and are sure how it will be interpreted. Appropriate touch communicates effectively such as a touch of the hand or arm to signal empathy. Should end gracefully Abrupt and awkward closing can destroy rapport an leave the person in negative impression of the whole interview. To ease into closing, ask,
3. Closing the“Is there anything else you would like to mention?”
interview “Are there any questions you would like to ask” “Our interview is just about over.” “Let me see if I have this correct: You came to the hospital with chest pain, which started an hour ago, after eating lunch. “(This is time to give your summary of what you have learned during the interview.) A complete nursing assessment includes both the collection of subjective data and the collection of objective data.
II. Collecting Objective data include information
Objective Data about the client that the nurse directly observes during interaction with him and information elicited through physical assessment (examination) techniques. Objective data are directly observed by the examiner. Physical characteristics (e.g., skin color, posture) Body functions (e.g., heart rate, respiratory rate) II. Collecting Objective Data Appearance (e.g., dress and hygiene) Behavior (e.g., mood, affect) Measurements (e.g., blood pressure, temperature, height, weight) Results of laboratory testing (e.g., platelet count, x-ray findings) The nurse must have basic knowledge in three areas: 1. Types of and operation of equipment needed for the particular examination (e.g., II. Collecting penlight, sphygmomanometer, otoscope, Objective Data tuning fork, stethoscope) 2. Preparation of the setting, oneself, and the client for the physical assessment 3. Performance of the four assessment techniques: inspection, palpation, percussion, and auscultation Each part of the physical examination requires specific pieces of equipment. Prior to the examination, collect the necessary equipment and place it in 1. EQUIPMENT the area where the examination will be performed. This promotes organization and prevents the nurse from leaving the client to search for a piece of equipment Hospital room, outpatient clinic, physician’s office, school health office, employee health office, or a client’s home. The examination setting meets the
2. A. Preparing following conditions:
the Physical • Comfortable, warm room temperature— Setting Provide a warm blanket if the room temperature cannot be adjusted. Prepare the physical settings • Private area free of interruptions from others—Close the Preparing the door or pull the curtains if possible. Physical Setting • Quiet area free of distractions— Turn off the radio, television, or other noisy equipment. Prepare the physical settings • Adequate lighting—It is best to use sunlight (when available). However, good overhead lighting is sufficient. A portable lamp is helpful for Preparing the illuminating the skin and for Physical Setting viewing shadows or contours. • Firm examination table or bed at a height that prevents stooping—A roll-up stool may be useful when it is necessary for the examiner to sit for parts of the assessment. Prepare the physical settings A bedside table/tray to hold the equipment needed for the examination Preparing the Use some history form or note taking as Physical Setting nurse can not rely completely on memory. Keep note taking to a minimum, focus on the person. Prepare the physical settings Arrange equal-status seating. Seated at eye-level. Avoid facing patient across a desk or Preparing the table that feels like a barrier. Physical Setting 90 degrees is good, allowing you to face patient. Avoid standing, making you an authority figure. • Assess your own feelings and anxieties before examining the client. • Self-confidence in performing a physical assessment can be achieved by practicing the
2. B. Preparing techniques on a classmate, friend, or relative.
Oneself • Preventing the transmission of infectious agents • Wash your hands • Wear gloves • Wear a mask and protective eye goggles • Explain to the client that the physical assessment will follow and describe what the examination will involve. • “Mr. Smith, based on the information you have
2. C. Approaching given me, I believe that a complete physical
and Preparing examination should be performed so I can better the Client assess your health status. This will require you to remove your clothing and to put on this gown.You may leave on your underwear until it is time to perform the genital examination.” • Respect the client’s desires and requests related to the physical examination • Ask the client to urinate before the examination to promote an easier and more 2. C. Approaching comfortable examination of the abdomen and and Preparing genital areas. the Client • Ask the client to undress and put on an examination gown. Allow him or her to keep on underwear until just before the genital examination to promote comfort and privacy. • Begin the examination with the less intrusive procedures such as measuring the client’s temperature, pulse, blood pressure, height, and weight. 2. C. Approaching • Approach the client from the right-hand side of and Preparing the examination table or bed ( most the Client examination techniques are performed with the examiner’s right hand (even if the examiner is left-handed). Thank you for listening… have a nice day ahead of you!!