Question

T.T. is a 32-year-old man who presents to the occupational health clinic for a physical prior to beginning employment at a local hospital. The patient is in good health, has no complaints of pain. Exercises on a daily basis. BMI is 23.4, the physical exam is unremarkable, and vital signs are: T 97.5, P 68, R 16, and BP 120/60. The patient is to begin work after obtaining physical clearance. Labs and immunization reports are pending.

The nurse is preparing to perform the physical examination.

Question:

1.How does the nurse prevent the spread of infection and implement infection control measures?

2. What physical examination techniques should the nurse use for inspection?

3. What physical examination techniques should the nurse use for palpation?

4. What physical examination techniques should the nurse use for percussion?

5. What physical examination techniques should the nurse use for auscultation?

Answer 1

1. Nurses are directly involved in providing biologically safe environments for patients. That means everything from hand washing to sterilizing surgical instruments falls, at least partially, under the RN’s scope of practice.

The course of an infection influences the level of nursing care that is needed.No matter whether the patient’s infection is localized or systemic, the nurse plays a critical role in minimizing its spread. For example, the organism causing a simple wound infection can spread to involve an intravenous (IV) needle insertion site if the nurse uses improper technique during the IV dressing change. The registered nurse is responsible for giving the prescribed antibiotics and monitoring the patient’s response to the drug therapy. Other supportive therapies include providing sufficient nutrition and rest to bolster the client’s prevention against the infectious process. The complexity of care required is dependent on the body systems affected by the infection.Nurses must be particularly careful, as well, to protect themselves. If there is a break in nurse's skin, can acquire those same infections from patient. It can’t really be said enough, always wash hands before and after caring for any patient and always wear gloves when dealing with an infection.

2. The abdomen is inspected by positioning the patient supine on an examining table or bed. The head and knees should be supported with small pillows or folded sheets for comfort and to relax the abdominal wall musculature. The entire abdominal wall must be examined and drapes should be positioned accordingly. The patient's arms should be at the sides and not folded behind the head, as this tenses the abdominal wall. Good lighting is essential, and it is helpful to have tangential lighting available, for this can create subtle shadows of abdominal wall masses.

3&4

The patient is positioned supine with head and knees supported, as for Inspection and Auscultation. Take the history and perform inspection and auscultation before palpation, as this tends to put the patient at ease and increases cooperation. In addition, palpation may stimulate bowel activity and thus falsely increase bowel sounds if performed before auscultation. Ask patients with abdominal pain to point to the area of greatest pain. Then reassure them that you will try to minimize their discomfort and examine that point last.

In palpating the abdomen, one should first gently examine the abdominal wall with the fingertips. This will demonstrate the crunching feeling of crepitus of the abdominal wall, a sign of gas or fluid within the subcutaneous tissues. In addition, it will demonstrate any irregularities of the abdominal wall (such as lipomas or hernias) and give some idea as to areas of tenderness.

Deep palpation of the abdomen is performed by placing the flat of the hand on the abdominal wall and applying firm, steady pressure. It may be helpful to use two-handed palpation particularly in evaluating a mass. Here the upper hand is used to exert pressure, while the lower hand is used to feel. One should start deep palpation in the quadrant directly opposite any area of pain and carefully examine each quadrant. At each costal margin it is helpful to have the patient inspire deeply to aid in palpation of the liver, gallbladder, and spleen.

5. The patient is positioned comfortably in the supine position as described in Inspection. The stethoscope is used to listen over several areas of the abdomen for several minutes for the presence of bowel sounds. The diaphragm of the stethoscope should be applied to the abdominal wall with firm but gentle pressure. It is often helpful to warm the diaphragm in the examiner's hands before application, particularly in ticklish patients. When bowel sounds are not present, one should listen for a full 3 minutes before determining that bowel sounds are, in fact, absent.