Chapter 27Slide 2Practice Makes Perfect!!!Have Appropriate EquipmentFor a Pelvic/Rectal ExamAge ConsiderationsLegal ConsiderationsEthical Considerations: TerminologySequence: Begin with Health HistoryGeneral AppearanceMeasurementsSkinHead and FaceEyesEarsNose and SinusesMouth and ThroatNeckNeck VesselsUpper ExtremitiesChest: Posterior and LateralChest: AnteriorHeartSlide 24Female BreastsMale BreastsAbdomenInguinal AreaLower ExtremitiesNeurologicMusculoskeletalNeurologic System: ExtremitiesMale GenitaliaFor adult male: Male RectumFemale GenitaliaCompletion of ExaminationAssessing the Bedridden and Comatose PatientsDocumentationLab and Diagnostic DataSlide 40Chapter 27Chapter 27The Comprehensive Health The Comprehensive Health AssessmentAssessmentPractice Makes Perfect!!!Practice Makes Perfect!!!Repeated examinations will make the choreography Repeated examinations will make the choreography smoothersmootherHave appropriate equipment ready!Have appropriate equipment ready!Ask person:Ask person:1) Empty bladder (save specimen, if needed)1) Empty bladder (save specimen, if needed) 2) Disrobe, leave on underpants and put on gown2) Disrobe, leave on underpants and put on gownHave Appropriate EquipmentHave Appropriate EquipmentScaleScaleSkinfold calipersSkinfold calipersBP cuffBP cuffStethoscope with bell and Stethoscope with bell and diaphragmdiaphragmThermometerThermometerPenlightPenlightOtoscope/OpthalmoscopeOtoscope/OpthalmoscopeTuning forkTuning forkNasal speculumNasal speculumMaterials to check taste & Materials to check taste & smellsmellTongue depressorTongue depressorDisposable sharp object Disposable sharp object –Or split a tongue bladeOr split a tongue bladePocket vision screenerPocket vision screenerSkin-marking penSkin-marking penFlexible tape measureFlexible tape measureRuler marked in cm’sRuler marked in cm’sReflex hammerReflex hammerCotton ballsCotton ballsExam glovesExam glovesFor a Pelvic/Rectal ExamFor a Pelvic/Rectal ExamExam glovesExam glovesVaginal speculumVaginal speculumWater-soluble lubricantWater-soluble lubricantMaterials for cytological studyMaterials for cytological studyGuiac test equipmentGuiac test equipmentAge ConsiderationsAge ConsiderationsSequence: Head to toe formatSequence: Head to toe formatBe aware of:Be aware of:–Differences in approachDifferences in approach–TimingTiming–Special developmental considerationsSpecial developmental considerationsLegal ConsiderationsLegal ConsiderationsDocumentDocumentRespect pt’s Respect pt’s confidentialityconfidentialityRespect pt’s privacy Respect pt’s privacy rightsrightsReport disease(s) that Report disease(s) that are considered a are considered a public health concernpublic health concernAsk permission to Ask permission to perform various perform various assessments.assessments.Know agency’s Know agency’s policies and standards policies and standards of practiceof practiceKnow state Nurse Know state Nurse Practice ActPractice ActEthical Considerations: TerminologyEthical Considerations: TerminologyAutonomyAutonomyBeneficenceBeneficenceNonmalificenceNonmalificenceJusticeJusticeFidelityFidelityVeracityVeracityUtilitarianismUtilitarianismSequence: Begin with Health HistorySequence: Begin with Health HistoryComplete or limited based on:Complete or limited based on:–Type of visitType of visit–DiagnosisDiagnosis–FacilityFacilityGeneral AppearanceGeneral AppearanceAppears stated ageAppears stated ageLOCLOCSkin colorSkin colorNutritional statusNutritional statusPosturePostureAny deformitiesAny deformitiesMobilityMobility–GaitGait–ROM of jointsROM of joints–Use of assistive devicesUse of assistive devices–Any involuntary movement?Any involuntary movement?Facial expressionFacial expressionMood and affectMood and affectSpeech:Speech:–ArticulationArticulation–PatternPattern–Content appropriateContent appropriate–Native languageNative languageHearingHearingPersonal hygienePersonal hygieneMeasurementsMeasurementsWeightWeightHeightHeightVital signsVital signsSkinfold thickness, if indicatedSkinfold thickness, if indicatedSkinSkinExamine trunk (posterior & anterior)Examine trunk (posterior & anterior)Examine all extremitiesExamine all extremitiesInspect nailsInspect nailsHead and FaceHead and FaceInspect and palpate scalp, hair and Inspect and palpate scalp, hair and craniumcraniumInspect faceInspect facePalpate Palpate –Temporal arteryTemporal artery–TMJTMJPalpate sinusesPalpate sinusesEyesEyesVision (CN II): distance and nearVision (CN II): distance and nearTest visual fields by confrontationTest visual fields by confrontationTest extraocular muscles (CN III, IV & VI)Test extraocular muscles (CN III, IV & VI)–Corneal light reflexCorneal light reflex–Six cardinal positions of gazeSix cardinal positions of gazeInspect external eye structuresInspect external eye structuresInspect conjunctivae, sclera, corneas, irisesInspect conjunctivae, sclera, corneas, irisesTest pupilTest pupil–SizeSize–Response to light and accommodationResponse to light and accommodationWith ophthalmoscope, inspect ocular fundusWith ophthalmoscope, inspect ocular fundus–Red reflex, disc, vessels and retinal backgroundRed reflex, disc, vessels and retinal backgroundEarsEarsTest hearing (CN VIII)Test hearing (CN VIII)–Voice-whisper testsVoice-whisper testsInspect external earInspect external ear–Position and alignmentPosition and alignment–Skin conditionSkin condition–Auditory meatusAuditory meatusPalpate auricle and push tragus: tender?Palpate auricle and push tragus: tender?With otoscope, inspect:With otoscope, inspect:–CanalCanal–Tympanic membrane for color, position, landmarks and Tympanic membrane for color, position, landmarks and integrityintegrityPerform Weber and Rinne tests, if indicatedPerform Weber and Rinne tests, if indicatedNose and SinusesNose and SinusesInspect external noseInspect external nose–symmetry, lesionssymmetry, lesionsTest patency of each nostrilTest patency of each nostrilWith speculum, inspect naresWith speculum, inspect nares–nasal mucosanasal mucosa–septumseptum–turbinatesturbinatesMouth and ThroatMouth and ThroatNote breath odorNote breath odorInspect lips and mouthInspect lips and