General Survey and Physical Exam

general survey

the initial part of the assessment (inspection)

general survey

starts with the first time the nurse walks into the room and becomes in contact with the patient

-continues with each interaction and throughout the examination

general survey

helps create an overall impression of your patient

-ensure room is warm, comfortable and relaxing

-begin immediately when meeting a patient

-make mental notes

-introduce yourself, wash hands, check pt identification

-shake hands (caring and assessment)

-what is your first impression? outstanding features? does pt respond to name? eye contact, smile, clear speech? hand moist? extend arm? temp? texture? strength? deformities? conversation? look ill or well?

how to begin with the general survey

1. Wash hands (alcohol hand scrub sufficient), introduce self and role, and inform patient of objective

2. Identify patient* (look at ID band, verify name & DOB) and provide privacy (shutting door/curtain)

3. Physical appearance: (age, gender, level of consciousness, skin color, facial features, signs of acute distress)**

4. Body structure: (stature, nutrition, symmetry, posture, position, obvious physical deformities)**

5. Behavior: (facial expression, mood and affect, speech, dress, personal hygiene)*

Shift assessment introduction and general survey competency steps

inspection (always first), palpation, percussion, auscultation

physical exam assessment techniques

inspection

begins with initial contact and continues for each body system

-conscious observation

-first with general survey and each body part

-Overall characteristics = Age, gender, level of alertness, body size and shape, skin color, hygiene, posture, and level of comfort or anxiety; Note odors

-Adequate exposure = Draping

-Adequate lighting = Color, texture, and mobility; permission

-Remove stuff to see = Devices (if appropriate)

-Need to use adequate descriptions = overall shape (and typically symmetry)

inspection techniques

-finger pads = used for fine discrimination (pulses, lymph nodes, lumps, texture, edema)

-palmar surface of fingers and finger joints = used for firmness, contour, position, size, pain, and tenderness

-dorsal side of hand = used for temperature

-ulnar surface of hand = used for vibratory tremors (over chest)

palpation techniques

-light:

• begin with first, warm hands, avoid tender areas until last

• finger pads of dominant hand (circular, 1cm depth, intermittent vs. continuous)

• surface characteristics (texture, surface lesions or lumps, or inflamed areas of skin)

-moderate to deep:

• explain to patient

• size, shape, and consistency of abdominal organs (pain, tenderness, or pulsations)

• palmar surface of fingers, 1-2 cm (moderate)

• palmar surface of fingers, with extended fingers of non-dominant hand, 2-4 cm (bimanual deep)

• observe for guarding, grimacing, or tension

palpation exam

-assess underlying structures for location, size, density of underlying organs

-elicit tenderness or sound

-drum stick on a drum

-direct = sinus tenderness

-indirect = lung percussion

-blunt percussion = organ tenderness, CVA tenderness

percussion techniques

dullness = heart, liver, spleen

flatness = bone or muscle

resonance = air filled lungs (hollow)

hyperresonance = emphysematous lung (hyperinflated)

tympany = air filled stomach (drumlike)

percussion sounds

listening to sounds produced by the body

-heart, blood vessels, lungs, abdomen

-quiet environment, little to no distractions

-stethoscope = diaphragm for high pitched sounds, bell for low pitched sounds

auscultation technique

-interior structure of eye

-firm against your eye

-darken room

-remove glasses

-same eye, same hand

steps for ophthalmoscope

ear canal and tympanic membrane

-proper size speculum

-ear up for adults, down for children

steps for otoscope

conductive vs, sensorineural hearing loss

-vibration sense with neuromuscular system

-hold base, strike

steps for tuning form

used to test reflexes

-wrist action

-firm yet gentle

steps for reflex hammer