Bates Chapter 6 (Physical examination: Getting started) Questions and Answers 100% Verified

1. maximize patient comfort 2. maintain patient safety 3. avoid unnecessary changes in position 4. enhance clinical accuracy and efficiency - 4 goals to organize and examination 2x2 gauze pads - used during tongue examination auscultation - Use of the diaphragm and bell of the stethoscope to detect the characteristics of heart, lung, and bowel sounds, including location, timing, duration, pitch, and intensity. For the heart this involves sounds from closure of the four valves, extra sounds from blood flow into the atria and ventricles, and murmurs. ________________ also permits detection of bruits or turbulence over arterial vessels. bell of a stethoscope - smaller cupped side of the stethoscope and transmits lower pitched sounds cardinal techniques of examination - will always be used in this order, in all systems, with the exception of the abdomen. cotton - tests the sense of light touch diaphragm of the stethoscope - larger flatter side higher pitched sounds doppler - detect blood flow and pulses draping a patient - Your goal is to visualize one area of the body at a time. This preserves the patient's modesty and helps you focus on the area being examined.With the patient sitting, auscultate the lungs with the gown untied in back. For the breast examination, uncover the right breast and keep the left chest draped. Re-drape the right chest, then uncover the left chest and proceed to examine the left breast and heart. For the abdominal examination, only the abdomen should be exposed. Adjust the gown to cover the chest and place the sheet or drape at the inguinal area. To help the patient prepare for potentially awkward segments, briefly describe the plan before starting, for example, "Now I am going to move your gown so I can check the pulse in your groin area." gooseneck lamp - examination light provides additional light inspection - close observation of the details of the patient's appearance, behavior, and movement such as facial expression, mood, body build and conditioning, skin conditions such as petechiae or ecchymoses, eye movements, pharyngeal color, symmetry of thorax, height of jugular venous pulsations, abdominal contour, lower extremity edema, and gait. inspection, auscultation, percussion, palpation A follows I so as not to increase bowel motility with palpation - ABDOMEN examination sequence why different? inspection, palpation, percussion, and auscultation - 4 cardinal techniques of examination key situations where hand hygiene should be performed - a. Before touching a patient, even if gloves will be worn b. Before exiting the patient's care area after touching the patient or the patient's immediate environment c. After contact with blood, body fluids or excretions, or wound dressings d. Prior to performing an aseptic task (e.g., placing an IV, preparing an injection) e. If hands will be moving from a contaminated-body site to a clean-body site during patient care f. After glove removalnasal speculum - opens the nasal passage to visualize the nose near vision card - tests near vision opaque card - cover the eye not being examined ophthalmoscope - visualize the interior of the eye, especially the retina otoscope - visualize the ear canal and the ear drum palpation - Tactile pressure from the palmar fingers or finger pads to assess areas of skin elevation, depression, warmth, or tenderness; lymph nodes; pulses; contours and sizes of organs and masses; and crepitus in the joints. Metacarpal/phalangeal joint or ulnar surface of the hand is used to detect vibration. penlight - provides additional light for viewing various areas of the body and check eyes percussion - Use of the striking or plexor finger, usually the third, to deliver a rapid tap or blow against the distal pleximeter finger, usually the distal third finger of the left hand laid against the surface of the chest or abdomen, to evoke a sound wave such as resonance or dullness from the underlying tissue or organs. This sound wave also generates a tactile vibration against the pleximeter finger. Preparing for the Physical Examination - Reflect on your approach to the patient. Adjust the lighting and the environment. Check that the equipment is available and in working order. Make the patient comfortable. Choose the sequence of examination. pulse oximeter - measures oxygen saturationq tip or broken tongue blade - tests the sense of sharp touch q tips, paper clips - test two point discrimination Reflect on your approach to the patient - the skillful nurse is thorough without wasting time, systematic but flexible, and gentle yet not afraid to cause discomfort should it be required. The skillful nurse examines each region of the body and at the same time is aware of the whole patient, notes the wince or worried glance, and shares information that calms, explains, and reassures. Avoid showing distaste, alarm and negative reactions reflex hammer - tests strength of reflex right - what side of the patient do you assess? snellen chart - aka visual acuity card test distance vision speculum - cone shaped attachment, attached to the otoscope to examine the ear sphygmomanometer - measure blood pressure stadiometer - measures height and must be installed at the correct height and mounted to the wall to achieve accurate measurements stethoscope - a medical instrument for listening to the sounds generated inside the body substances with distinct odor (vanilla, coffee) - tests the sensory perception of smell and tasteTangential lighting - optimal for inspecting structures such as the jugular venous pulse, the thyroid gland, and the apical impulse of the heart. It casts light across body surfaces that shows contours, elevations, and depressions, whether moving or stationary, into sharper relief.