VARIOUS PREPARATIONS FOR PHYSICAL EXAMINATION – PREPARATION OF THE ENVIRONMENT, PREPARATION OF THE EQUIPMENT, PREPARATION OF THE PATIENT, ASSISTANCE AND CARE OF AFTER EXAMINATION
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PREPARTION OF THE ENVIRONMENT
- Maintenance of privacy
- A separate examination room is needed
- Keep the doors closed. The relatives are not allowed
- Drape the patient according to the parts that are exposed
- Lighting: as far as possible natural light should be available in the examination room, because if a patient is jaundiced, it may not be detected in the artificial light. There should be adequate lighting
- Comfortable bed or examination table: the patient should be placed comfortably throughout the examination. There should be provision for the maintenance of a suitable person, e.g. a lithotomy position may be maintained when examining the genitalia. To maintain this position, a special examination table with stirrup rods is needed
- The room should be warm and without draughts
PREPARATION OF THE EQUIPMENT
All the articles needed for the physical examination are kept ready for the examination at hand.
- Sphygmomanometer
- Stethoscope
- Fetoscope
- TPR tray
- Tongue depressor
- Pharyngeal retractor
- Laryngoscope
- Tape measure
- Flash light
- Weighing machine
- Ophthalmoscope
- Otoscope
- Tuning fork
- Nasal speculum
- Percussion hammer, safety pins
- Cotton wool, cold and hot water
- Test tubes
- Vaginal speculum
- Proctoscope
- Gloves
- Sterile specimen bottles, slides
- Cotton applicators
PREPARATION OF THE PATIENT
Physical Preparation
- Keep the patient clean
- Shave the part if necessary
- Keep the patient in a comfortable position which is convenient for the doctor to examine the patient
- Empty the bladder prior to the examination. Empty the bowels by an enema if required
- Loosen the garments and change into the hospital dress, if it is the custom
- Drape the patient with extra sheets and expose only the need areas
- Avoid unnecessary exposure
Mental Preparation
- The patient may be quite new to the hospital situation and he may be anxious about his illness
- He may have false ideas about the medical examination
- It is the duty of the nurse to allay his anxieties and fears by proper explanations
- Explain the sequence of the procedure to gain his confidence and cooperation
- As far as possible a nurse should remain with a female patient during the physical examination
ASSISTANCE IN THE EXAMINATION
To take Height and Weight
- To measure the length of the baby who cannot stand, place the baby on a hard surface, with the soles of the feet supported in an upright position
- The knees are extended and the measurement is taken from the soles of the feet to the vertex of the head
- The head should be in such a position that the eyes are facing the ceiling
- After a child can stand, the height can be measured, if the child with the heels back and head against a wall
- A small flat board held from the top of the head to the wall, will give an accurate measure of the height that is the distance from the floor to the board
- The weight of a person who can stand is generally measured by a standing scale
- The patient stands on the platform and the weight is noted on the dial
- Usually the weight is taken without shoes
- To take the weight of the baby, a baby weighing scale is used, in which there is a container, where the baby can be laid
- It is important to weigh a baby unclothed weigh the clothes separately and subtract this weight
To Measure the Skull Circumference
The skull is measured at its greatest diameter from above the eyes to the occipital protuberance
Examination of the Eyes
- The examination is done in a lying or sitting position
- The examiner frequently uses a head mirror that reflects light to the patient’s face
- The first examination is one of inspection to determine the movements of the eyes, reaction to light, accommodation to near and far objects
- For detailed examination of the internal parts of the eye an ophthalmoscope is used
Examination of the Ears
- The patient may be placed either in a lying or sitting position with the ear to be examined turned towards the examiner
- Articles used for the examination are a head mirror, ear speculum of various sizes, cotton tipped applicators and autoscope
- Tuning fork is used to test the hearing
- A child needs to be carefully restrained
- Young children sit on their mother’s lap with their legs restrained between the mother’s knees and their arms held against their back
- The mother them holds the child’s head against the chest
- Very small infants can be laid on the examination table
Examination of the Nose, Throat and Mouth
- The patient is usually seated with the head resting against the back of the chair
- For the examination of the throat, a tongue depressor and a good light are needed
- For examination of the nose, a nasal speculum and a head mirror are used. Sometimes the autoscope is also used
Examination of the Neck
The neck need to be palpated for lymph nodes. In order to assess the thyroid glands, the patient is asked to swallow saliva.
Examination of the Chest
- While examining the anterior chest, the patient is placed in a horizontal recumbent position
- The chest is examined in several ways
- It is percussed to determine the presence of fluid or congested areas
- The physician listens to the sound within the chest by means of a stethoscope
- To examine the posterior chest, the patient is placed in a sitting position
- The heart and lungs are examined by percussion and auscultation
- The breasts are examined by palpation for the presence of lumps or growths
- The axillae are palpated for enlarged lymph nodes
- During the examination, the patient’s face is turned away from the doctor
Examination of the Abdomen
- Extremities are inspected, palpated and moved
- A fine tremor suggestive of hyperthyroidism can be observed, if the patient is asked to hold the arms out in front of him for a few minutes
CARE OF AFTER EXAMINATION
- Assist him to dress and help him to remain in a comfortable position in the bed
- After-care of equipment: wash the equipment with soap and water, rinse, dry and sterilize, as needed
- Replace the equipments in their usual places
- Label specimens properly and send them to the laboratory immediately
NURSE’S RESPONSIBILITIES DURING PHYSICAL EXAMINATION
- A separate examination room is needed. Keep the doors closed, screen the patient and provide privacy if he is not in a separate room. Relatives are not allowed
- Drape the patient according to the parts that are to be examined. Natural light should be available in the examination room
- There should be adequate lighting in the room. The patient should be comfortable throughout the examination
- There must be provision for the maintenance of a suitable position, e.g. lithotomy position. The room should be warm
- The nurse must stay in the room at all times while the doctor examines a female patient
- During the examination of a male patient’s genitals, the nurse must leave the room. Take the patient’s temperature, pulse, respiration and blood pressure, if recent readings are not available
- Give health teaching to the patient as need arises
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