BAKERSFIELD COLLEGELICENSED VOCATIONAL NURSING PROGRAM1ST SEMESTER FUNDAMENTALSSCIENTIFIC BASIS FOR NURSING PRACTICECHAPTER 33 - HEALTH ASSESSMENT AND PHYSICAL EXAMINATIONINTRODUCTIONThe physical examination is an essential component of the nurse’s tools for client assessment. The nurse methodically reviews the function and condition of each body system in order to determine the client’s physiological state of health. The examination can be an integral part of the nurse’s daily care or a distinct part of the total nursing assessment. Information gathered during the assessment provides an important data base for the client; it enables the nurse to manage specific client problems, and serves as a means to evaluate the effectiveness of nursing care.OBJECTIVESUpon completion of this unit, the student will be able to:A. Theory1. Define alopecia, atrophy, bruit, buccal, edema, hematemesis, jaundice, melena, orthopnea, PERRLA, PMI, and ptosis.2. Discuss the purposes of physical examination.3. Identify the five skills of physical assessment.4. Describe the various positions for examination.5. Identify common postural abnormalities.6. Identify adventitious breath sounds.7. Identify normal breath sounds.8. Locate and identify normal heart sounds.For each system, describe the techniques and equipment needed.B. Laboratory1. Make environmental preparation for performing a physical examination.2. Select a partner and perform a physical exam on the partner using the Bakersfield College format.ASSIGNMENTA. Read Chapter 33- Potter & Perry, Critical Thinking Exercise # 3,5 and Review Questions.B. Study Guide for Chapter 33C. View videos on lung and heart sounds Chapter 33Health Assessment and Physical Examination Purposes of Physical Examination Gather a health history. Develop nursing diagnosis and care plan. Manage client problems. Evaluate nursing care. Cultural Sensitivity Culture influences a client’s behavior. Consider health beliefs, use of alternative therapies, nutritional habits, relationshipwith family, and personal comfort zone. Avoid stereotyping. Avoid gender bias. Integration of Physical Assessment With Nursing Care Integrate examination during routine nursing care: Vital signs Bathing Range of motion Activities of daily living Inspection  Uses vision and hearing Recognizes normal and abnormal Is the simplest of five assessment skills Palpation Use hands to touch body parts. Use different parts of hands to distinguish texture, temperature and movement. Hands should be warm, fingernails should be short. Start with light palpation and end with deep palpation. Percussion Tap body with fingertips to produce a vibration. Sound determines location, size, and density of structures. Auscultation Involves listening to sounds Learn normal sounds first before identifying abnormal or variations  Requires a good stethoscope Requires concentration and practice Olfaction Used to identify the nature and source of body odors Helps to detect abnormalities Used in conjunction with other assessments Preparation for Examination Infection control Environment Equipment Physical preparation of client Psychological preparation of client Assessment of age-groups Organization of the Examination Assessment of each body system Follows the nursing history Systematic and organized Head-to-toe approach General Survey Assess appearance and behavior. Assess vital signs. Assess height and weight. Skin Color Moisture Temperature Texture  Turgor Vascularity Edema Nails Condition of nails reflects: General health State of nutrition Occupation Level of self-care Thorax and Lungs Assess anterior, posterior, and lateral. Identify anatomical landmarks. Use inspection, percussion, and auscultation. Most common sounds heard: Vesicular, bronchovesicular, bronchial Crackles, rhonchi, wheezes, pleural friction rub Fremitus  Heart Compare assessment of heart functions with vascular findings. Assess PMI. Use inspection and auscultation. Locate anatomical landmarks.Identify S1 and S2. Vascular System Assess blood pressure. Assess integrity of the peripheral vascular system. Use inspection, palpation, and auscultation. Abdomen Complex assessment because of organs located in the abdominal cavity Inspection Auscultation Palpation Musculoskeletal System Inspection: Gait, postural abnormalities Palpation: Joints and bones, muscles Range of motion Muscle tone and strength Neurological System Mental and emotional status Intellectual function Sensory function Motor function