Weber Chapter 3 - Nurse-Client Relationship & Client Positioning in Physical Exams

Importance of nurse-client relationship

It helps alleviate tension or anxiety.

End of interview procedure

Explain that a physical assessment will follow and describe what it involves.

Respecting client preferences during exam

Allow family/friend presence if requested; explain importance of all parts but ultimately let the client decide.

Use of consent forms

Before vaginal or rectal exams.

Procedure for urine specimen

Explain purpose/procedure, provide container.

Client comfort before exam

Ask client to urinate for comfort during abdominal/genital exam.

Client attire during exam prep

Exam gown; may keep underwear on until genital exam.

Maintaining privacy while changing

Leave the room and knock before reentering.

Beginning the exam to ease anxiety

Start with less intrusive procedures (vitals, height, weight).

Explaining procedures during the exam

Helps reduce client anxiety and promotes teaching.

Approaching the client during exams

The right-hand side.

Explaining position changes early in the exam

Prepares client for necessary changes for thorough assessment.

Sitting position usage

To assess head, neck, lungs, chest, back, breasts, axillae, heart, vitals, upper extremities.

Advantage of sitting position

Allows full lung expansion, upper body symmetry assessment.

Supine position usage

To assess head, neck, chest, breasts, axillae, abdomen, heart, lungs, extremities.

Supine position benefits

Abdominal muscle relaxation, easy pulse access.

Dorsal recumbent usage

For head, neck, chest, axillae, lungs, heart, extremities, breasts, peripheral pulses.

Dorsal recumbent limitations

Abdominal muscles are contracted.

Sims position usage

To assess rectal and vaginal areas.

Challenges with Sims position

Elderly or clients with joint problems.

Standing position usage

To assess posture, balance, gait, and male genitalia.

Prone position usage

To assess hip joint and back.

Prone position limitation

Clients with cardiac or respiratory problems.

Knee-chest position usage

To assess the rectum.

Challenges with knee-chest position

Embarrassing, uncomfortable, hard for elderly or those with heart/respiratory issues.

Lithotomy position usage

To assess female genitalia, reproductive tracts, rectum.

Considerations for lithotomy position

Client may feel exposed/embarrassed; elderly may not tolerate long; keep client draped and exam quick.