Assignment No.

Name: Kamran Dost

Subject: Health Assessment

Date: 1st February, 2023

Q 1. Identify the general principles of conducting an examination.

Following are principles of conducting a physical exam:
 A nurse should look neat and clean and smell good.
 Hand washing is a must.
 All necessary equipment should be available beforehand.
 Try to see the patient walking to assess mobility
 Introduce yourself and ask for introduction.
 Explain the procedures and ask for permission before proceeding.
 Maintain privacy.
 Fully expose the body parts to be examined.
 Always ask for any discomfort or tenderness.
 Always follow the basic pattern of examination i.e. inspection, palpation, percussion and
auscultation.
 Spot as many abnormal physical signs.
 Thank patient after the procedure.
(https://www.slideshare.net/satyammahaseth/02-1-principles-of-history-taking-and-physical-examination)

Q 2. Identify the equipment needed to perform a physical examination.

The equipment needed to perform a physical examination is:

audioscope, examination light,

laryngeal mirror, nasal speculum,

otoscope, ophthalmoscope,

penlight, percussion hammer,

sphygmomanometer, stethoscope,

thermometer, tuning fork.

(https://www.gwinnettcollege.edu/physical-examination-instruments-and-supplies-a-medical-assisting-guide).

Q 3. Describe the appropriate technique of inspection, palpation, percussion &

auscultation.
 Assignment No. 3

Inspection:

Inspect each body system using vision, smell, and hearing to assess normal conditions and
deviations. Assess for color, size, location, movement, texture, symmetry, odors, and sounds as
you assess each body system.

Palpation:

Palpation requires you to touch the patient with different parts of your hands, using varying
degrees of pressure. Because your hands are your tools, keep your fingernails short and your
hands warm. Wear gloves when palpating mucous membranes or areas in contact with body
fluids. Palpate tender areas last.

Types of palpation:

Light palpation

 Use this technique to feel for surface abnormalities.

 Depress the skin ½ to ¾ inches (about 1 to 2 cm) with your finger pads, using the lightest
touch possible.
 Assess for texture, tenderness, temperature, moisture, elasticity, pulsations, and masses.

Deep palpation

 Use this technique to feel internal organs and masses for size, shape, tenderness,
symmetry, and mobility.
 Depress the skin 1½ to 2 inches (about 4 to 5 cm) with firm, deep pressure.
 Use one hand on top of the other to exert firmer pressure, if needed.

Percussion:

Percussion involves tapping your fingers or hands quickly and sharply against parts of the
patient's body to help you locate organ borders, identifies organ shape and position, and
determines if an organ is solid or filled with fluid or gas.

Types of percussion:

Direct percussion

This technique reveals tenderness; it's commonly used to assess an adult's sinuses.

 Using one or two fingers, tap directly on the body part.

 Ask the patient to tell you whom areas are painful, and watch his face for signs of
discomfort.

Indirect percussion
 Assignment No. 3

This technique elicits sounds that give clues to the makeup of the underlying tissue. Here's how
to do it:

 Press the distal part of the middle finger of your non dominant hand firmly on the body
part.
 Keep the rest of your hands off the body surface.
 Flex the wrist of your nondominant hand.
 Using the middle finger of your dominant hand, tap quickly and directly over the point
where your other middle finger touches the patient's skin.
 Listen to the sounds produced.

Auscultation:

Auscultation involves listening for various lungs, heart, and bowel sounds with a stethoscope.

Getting ready

 Provide a quiet environment.

 Make sure the area to be auscultated is exposed (a gown or bed linens can interfere with
sounds.)
 Warm the stethoscope head in your hand.
 Close your eyes to help focus your attention.

How to auscultate

 Use the diaphragm to pick up high-pitched sounds, such as first (S1) and second (S2) heart
sounds. Hold the diaphragm firmly against the patient's skin, using enough pressure to
leave a slight ring on the skin afterward.
 Use the bell to pick up low-pitched sounds, such as third (S3) and fourth (S4) heart
sounds. Hold the bell lightly against the patient's skin, just hard enough to form a seal.
Holding the bell too firmly causes the skin to act as a diaphragm, obliterating low-pitched
sounds.
 Listen to and try to identify the characteristics of one sound at a time.

(https://journals.lww.com/nursing/Fulltext/2006/11002/Assessing_patients_effectively__Here_s_how_to_do.5.aspx)

Q 4. Discuss the procedure & sequence for performing a general assessment of a client.

Preparing for the examination:

 Assignment No. 3

 A nurse should adjust from full to focused physical examination as needed based
on medical history, patient condition and findings.
 The general survey can be done with the client sitting or standing.
 Ask the client to remove shoes and any heavy outer clothing before you measure height
and weight.
 When weighing a hospitalized client, always weigh at the same time of the day,
with
 the same scale, and with the client wearing the same clothing

 Provide optimal conditions for the examination:

 Find a comfortable and quiet place.
 Ensure privacy: Ask other patients and possibly even family members (depending on
patient preference and extent of exam) to leave the room.
 Disinfect hands prior to touching the patient.
 Introduce yourself and your title and explain the procedure.
 Always address patient by his/her name (ask first if it is unknown).
 During the examination, inform the patient about further steps.
 Examination tools include pens, stethoscope, penlight, tongue depressor, reflex hammer
and if necessary, otoscope and ophthalmoscope.
Basic techniques:
 Inspection
 Palpation
 Percussion
 Auscultation
 Functional examination

Sequence:
An example of a full exam sequence consists of:
 Asking the patient to be seated:
 General appearance and vital signs.
 Head and neck examination
 Neurological examination
 Pulmonary examination
 Possibly musculoskeletal examination (depending on patient concern)
 Ask the patient to lie supine with upper body at a 30–45° angle
 Cardiovascular examination
 Peripheral portion of neurological examination (reflexes, muscle tone, peripheral
sensation)
 Lying flat
 Abdominal examination
 Possibly musculoskeletal examination (depending on patient concern)
 Breast examination as indicated (inspection should have occurred while seated)
 Assignment No. 3

 Pelvis , prostate or rectal exam as indicated

(https://www.amboss.com/us/knowledge/Physical_examination)

Q 5. Compose a statement which reflects an overall impression of a client's health status.

“A 45 years old moderately obese male pathan, well oriented to time, place and person
has arrived walking towards the nursing counter holding his abdomen. His speech is clear and he
looked agitated because of pain. He is wearing neat weather appropriate clothing and fully
described his problem”.

Q 6. Discuss the guidelines for documenting physical examination.

The Centers for Medicare & Medicaid Services (CMS) has documentation guidelines (DG) for
what it wants in the patient chart(s) including, but not limited to:

 Specific abnormal and relevant negative findings of the examination of the affected or
symptomatic body area(s) or organ system(s) should be documented. A notation of abnormal
without elaboration is insufficient.
 Abnormal or unexpected findings of the examination of the unaffected or asymptomatic
body area(s) or organ system(s) should be described.
 A brief statement or notation indicating “negative” or “normal” is sufficient to document
normal findings related to unaffected area(s) or asymptomatic organ system(s).
 The medical record for a general multisystem examination should include findings about
eight or more of the 12 organ systems.

(https://www.the-rheumatologist.org/article/how-to-document-the-physical-exam/2/)

Those systems with positive or pertinent negative responses must be individually documented.
For the remaining systems, a notation indicating all other systems are negative is permissible. In
the absence of such a notation, at least ten systems must be individually documented.

(https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnedwebguide/downloads/97docguidelines.pdf)

Q 7. Document the PE findings of patients in PE documentation sheet on an ongoing basis

During the PE of face, mouth and neck, a nurse can write a note “Facial movements are
symmetrical. Nares are patent and no drainage is present. Uvula and tongue are midline. Teeth
and gums are in good condition. Patient is able to swallow without difficulty. Trachea is midline.
There is no enlargement of the lymph nodes.

Q 8. Describe the component of health history that should be elicited during the assessment
of skin, head & neck.
A nurse can ask the patient about the following and ask for details if any patient had suffered
from any condition.
Skin assessment:
 Assignment No. 3

obtain a history of the patient's bathing routine and skin care products. Document the soaps,
shampoos, conditioners, lotions, oils, and other topical products that the patient uses routinely.
Ask the patient:

 about skin changes such as xerosis (skin dryness), pruritus, wounds, rashes, or changes in
skin pigmentation or color
 if skin appearance changes with the seasons
 about any changes in nail thickness, splitting, discoloration, breaking, and separation
from the nail bed. A change in the patient's nails may be a sign of a systemic condition.
 about allergies, including those to medications, topical skin and wound products, and
food.

https://journals.lww.com/nursing/fulltext/2010/07000/performing_a_skin_assessment.20.aspx

Head assessment:

Have you ever been diagnosed with a medical condition related to your head such as headaches,
a concussion, a stroke, or a head injury?

Neck assessment:

Have you ever been diagnosed with a medical condition related to your neck such a thyroid or
swallowing issue?
Are you currently taking any medications, herbs, or supplements for headaches or for your
thyroid?
Have you had any symptoms such as headaches, nosebleeds, nasal drainage, sinus pressure, sore
throat, or swollen lymph nodes?
(https://wtcs.pressbooks.pub/nursingskills/chapter/7-4-head-and-neck-assessment/)

Q. 9 Describe specific assessments to be made during the physical examination of the skin,
head and neck.
Skin assessment:
 macule, a flat, nonpalpable area color change that's brown, red, white, or tan
 patch, a flat, nonpalpable lesion with changes in skin color,
 papule, an elevated, palpable, firm, circumscribed lesion
 plaque, an elevated, flat-topped, firm, rough, superficial lesion
 nodule, an elevated, firm, circumscribed, palpable area
 cyst, a nodule filled with an expressible liquid or semisolid material
 vesicle, a palpable, elevated, circumscribed, superficial, fluid-filled blister
 bulla, a vesicle 1 cm or larger, filled with serous fluid
 pustule, which is elevated and superficial filled with pus
 wheal, a relatively transient, elevated, irregularly shaped area of
 scale, a thin flake of dead exfoliated epidermis
 crust, the dried residue of skin exudates such as serum, pus, or blood
 Assignment No. 3

 excoriation, loss of epidermis, usually due to scratching.

(https://journals.lww.com/nursing/fulltext/2010/07000/performing_a_skin_assessment.20.aspx)

Head assessment:

Head - Inspection
Facies:
Examination of the head includes inspection of the face, skin, hair, scalp and skull. Begin by
observing facial features, understanding that they may vary by sex and race. Inspect
the eyebrows, eyelids, palpebral fissures, nasolabial folds and mouth, noting any asymmetry.
Remember that certain disease states can affect these features (e.g. hypothyroidism, acromegaly).
Many genetic disorders cause characteristic facies identified through careful inspection. When
inspecting the facies, note if the patient appears his stated age, older or younger, if he appears in
good or poor general health, and if there is any generalized swelling or periorbital edema.

Skin:
Facial skin should also be carefully inspected, noting color, pigment changes, texture, hair
distribution, rashes or lesions.
Hair: Inspect and palpate the hair, noting its texture, distribution, quantity and pattern of hair
loss if any. Part the hair in several places, looking for scalp scaliness, lumps, lesions or nits.
Skull:
Inspect the skull, noting the general size, shape and symmetry.

(https://accesspharmacy.mhmedical.com/data/interactiveguide/physexam/heent/headinspection.html)

Neck assessment:

Inspection: Examination of the neck includes inspection for any scars, masses, glandular or
nodal enlargement. Inspect the trachea, noting any deviation. Next inspect the thyroid gland as
the patient swallows, noting any enlargement.
Palpation: Evaluate by palpation the lymphatic chains as well as the presence of any masses in
the neck. When evaluating lymph nodes for pathology, note their size,
shape, consistency, mobility, and tenderness. Note if only one region has enlarged lymph nodes
or if all nodes are enlarged. It is easy to mistake a band of muscle for a lymph node just as it is
easy to miss abnormally enlarged lymph nodes if a careful exam is not performed. A lymph node
can be rolled from side to side and up and down whereas a band of muscle cannot. Palpate the
thyroid gland noting size, shape, consistency as well as presence of any nodules.

(https://accesspharmacy.mhmedical.com/data/interactiveguide/physexam/heent/neckexamination.html)

Q 10. Apply braden scale to assess the bed sores of patient Document findings

Developed 1984 by Braden and Bergstrom  Six elements that contribute to either higher
intensity and duration of pressure or lower tissue tolerance to pressure therefore increasing the
risk of pressure ulcer development.
 Assignment No. 3

- Sensory perception - Mobility (ability to change own position) - Nutrition

- Moisture - Friction and shear - Activity

Each item is scored between 1 and 4 guided by a descriptor. The lower the score, the greater the
risk.

15 + = low risk 13-14 = moderate risk 12 or less = high risk Below 9 = severe risk

(https://www.oxfordhealth.nhs.uk/wp-content/uploads/2015/08/Braden-teaching.pdf)

Q 11. Describe age related changes in the above systems & differences in assessment
findings.

Skin:

 With aging, the outer skin layer (epidermis) thins.

 The number of melanocytes decreases.
 Aging skin looks thinner, paler, and clear (translucent).
 Changes in the connective tissue reduce the skin's strength and elasticity. This is known
as elastosis.
 The blood vessels of the dermis become more fragile.
 Sebaceous glands produce less oil as you age.
 The subcutaneous fat layer thins so it has less insulation and padding.
 The sweat glands produce less sweat.
 Growths such as skin tags, warts, brown rough patches are more common in older people.
(https://medlineplus.gov/ency/article/004014.htm)

Head:
Since most bones in the body stop growing after puberty, experts assumed the human skull
stopped growing then too. But using CT scans of 100 men and women, the researchers
discovered that the bones in the human skull continue to grow as people age. The forehead
moves forward while the cheek bones move backward. As the bones move, the overlying muscle
and skin also move, subtly changing the shape of the face.
(https://alumni.duke.edu/magazine/articles/cranium-changes#:~:text)

Neck:
The most common signs of an aging neck are the development of vertical muscle bands,

sagging skin, and excess fat deposits. Muscle bands occur due to the regular use of the platysma

muscle, with the vertical lines representing the muscle edges.

 Assignment No. 3

Excess fat is also a common issue and can be considered age-related because in many cases the

development of these fat deposits is the result of hormonal changes in the body. Another very

common sign of an aging face and neck is the development of brown spots on the skin. These

can be caused by sun damage, genetic factors, and health issues like obesity and diabetes.

(https://www.californiaskininstitute.com/cosmetic-dermatology/aging-face-and-neck )