Test 1 Learning Objectives Chpts. 2, 3, 4, 8 https://boostgrade.info/chapter-02-cultural-competence/ Chapter 2: Cultural Assessment ❖ Describe the basic characteristics of culture ➢ Learned: Learned from birth through process of language acquisition and socialization ➢ Shared: Shared by all members of the same cultural group ➢ Adapted: Adapted to specific conditions related to environmental and technical factors and to the availability of natural resources ➢ Dynamic: Dynamic and ever changing ❖ Describe the steps to cultural competence ➢ * * * CULTURAL COMPETENCY INVOLVES UNDERSTANDING YOUR OWN CULTURE AND HEALTH ➢ Performing cultural self-assessment is an integral part of becoming culturally competent ➢ Asking each patient about cultural beliefs will increase your cultural competence while decreasing the potential for stereotyping based on previous experiences with a client from a similar background. ➢ Culturally Sensitive ■ Implies that caregivers possess some basic knowledge of and constructive attitudes toward the diverse cultural populations found in the setting in which they are practicing ➢ Culturally Appropriate ■ Implies that the caregivers apply the underlying background that must be possessed to provide a given person with the best possible health care ➢ Culturally Competent ■ Implies that the caregivers understand and attend to the total context of the individual’s situation, including awareness of immigration status, stress factors, other social factors, and cultural similarities and differences ➢ Cultural Care ■ Provision of health care across cultural boundaries; it considers the context both in which the patient lives and the situations in which the patient’s health problems arise ❖ Describe the concept of heritage consistency ➢ Someone who is heritage consistent lives a lifestyle that reflects his or her traditional heritage, not the norms and customs of the new country ■ ❖ ❖ ❖ ❖ I.e., A woman that follows the traditions that her mother followed regarding meals Explain the concept of ethnicity ➢ Ethnicity refers to a social group that may possess shared traits, such as a common geographic origin, migratory status, religion, language, values, traditions or symbols, and food preferences Discuss the influence of religion and spirituality on health and illness perception ➢ Spirituality ■ Broader term that encompasses something larger than one’s own existence with a belief in transcendence ■ Refers to each person’s unique life experiences and his or her personal effort to find purpose and meaning in life ■ * * * Arises out of each person’s unique life experience and his or her personal effort to find purpose in life ➢ Religion ■ Refers to an organized system of beliefs as a shared experience that can assist in meeting one’s individual spiritual needs ➢ Just as positive religious coping has been linked to positive health, negative religious coping is associated with poor health outcomes Discuss areas of potential cultural conflicts between nurses and patients of different ethnic groups ➢ * * * The omission of questions about spiritual and religious practices can raise barriers to holistic care ➢ In addition to seeking help from you as a biomedical/scientific health care provider, pts may also seek help from folk or religious healers ■ Spirituality is included in the perceptions of health and illness ➢ Hispanics may rely on Curandero, espiritualista (spiritualist), yerbo (herbalist), or partera (lay midwife) ➢ Blacks may mention having received assistance from a houngan (a voodoo priest), spiritualist, or “old lady” (an older woman who has successfully raised a family and who specializes in child care and folk remedies) ➢ American Indians may seek assistance from a shaman or medicine man ➢ Asians may mention that they have visited herbalist, acupuncturists, or bonesetters ➢ Amish will often see a braucher (a folk healer who uses herbs and tonics in the home or community context) ■ Braucher: refers to sympathy curing, which is sometimes called pow-wowing in English Discuss components of the health belief system and their influence on health practices and illness expressions ➢ Biomedical (scientific) T heory: Assumes that all events in life have a cause and effect ■ Germ theory: Microorganisms such as bacteria and viruses cause specific disease conditions ➢ Naturalist (holistic) Theory: Believe that human life is only one aspect of nature and a part of the general order of the cosmos; they believe that the forces of nature must be kept in natural balance or harmony ■ Found most frequently among American Indians and Asians ■ Yin/Yang Theory: Health exists when all aspects of the person are in perfect balance ● Some Asians believe this theory ■ Hot/Cold Theory: 4 humors of the body - blood, phlegm, black bile, and yellow bile - regulate basic bodily functions and are described in terms of temp., dryness, and moisture ● Many Hispanic, Arab, and Asian groups embrace this theory ➢ Magicoreligious: The world is an arena in which supernatural forces dominate; the fate of the world and those in it depends on the action of supernatural forces for good & evil ■ Ex. of magical causes of illness include beliefs in voodoo or witchcraft, whereas faith healing is based on religious beliefs ❖ Examine the sources that influence the culture and beliefs the student embraces ➢ Step 1: Explore your own personal history so as to develop cultural sensibility ■ Use thoughtful reasoning, responsiveness, and discrete interactions ➢ Step 2: Think about the components of culture that you experience in your own daily life ■ Only when we acknowledge our own values and beliefs are we able to fully help others https://boostgrade.info/chapter-03-the-interviewfree/ Chapter 3: The Interview ❖ State the factors that affect communication ➢ Internal Factors ■ Liking others ● Using a genuine approach ■ Empathy ● Develop an understanding and sensitivity for others feelings ● Always be empathetic, not sympathetic ● An empathetic response recognizes the feeling and puts it into words ◆ It names the feeling, allows its expression, and strengthens rapport ■ The Ability to Listen ● Using an “active” process ■ Self-Awareness ● Be aware of “implicit bias” ➢ External Factors ■ Ensure Privacy ● Aim for “geographic” privacy but ensure “psychological” privacy ■ Refuse/Avoid Interruptions ● Minimize and/or refuse ■ Physical Environment ● Reduce noise by turning off the TV, radio, and other unnecessary equipment (multiple stimuli is confusing) ● The interviewer and pt should be approx 4-5 ft apart ● Room should be well-lit ● “Equal status” seating ◆ Always be eye level w/ the patient ■ Dress ● Appearance and comfort ■ Note-Taking ● Keep to a minimum, offer “focused” attention ❖ Describe the phases of an interview ➢ Introduction ■ Keep it short and formal ● I.e., “Mrs. H., my name is Mrs. C. I’ll need to ask you a few questions about what happened.” ■ Address the person using his/her surname, and shake hands (if appropriate) ■ Introduce yourself and state your role in the agency (if a student, say so) ■ AIDET ● Acknowledge, introduce, duration, explanation, thank you ■ Give the reason for the interview ● Make sure that you indicate the reason for the interview to lessen the client’s exasperation ■ Review notes from other health care team members before beginning the interview ■ After a brief introduction, ask an open-ended question, and then let the person proceed ➢ Working Phase ■ Data-gathering phase ■ Verbal skills include your ability to form questions appropriately to the patient and your responses to the answers given by the client ■ Two types of questions: ● Open-ended: asks for narrative information ◆ States only the topic to be discussed but in general terms ● ◆ Use it to begin the interview, to introduce a new section of questions, and whenever the person introduces a new topic Closed-ended: asks for specific information ◆ They elicit a one- or two-word answer, a “yes” or “no”, or a forced choice ◆ Useful to fill in any details that were initially left out after the person’s opening narrative ◆ Useful when needing specific facts such as past medical history or during the review of systems ◆ Ask 1 direct question at a time ◆ Choose language the client understands (using regional phrases or colloquial expressions) Each has a different place and function in the interview ● ➢ Termination ■ Ending should be gradual thereby allowing for adequate closure to allow for final expression ■ To ease into the closing, ask the person: ● “Is there anything else you would like to mention?” ● “Are there any questions you would like to ask?” ● “We’ve covered a number of concerns today. What would you most like to accomplish?” ■ This gives the person the final opportunity for self-expression. Once this opportunity has been offered, you will need to make a closing statement that indicate that the end of the interview is imminent, such as: ● “Our interview is just about over” ■ At this point no new topics should be introduced and no unexpected questions should be asked ■ * * * Summary provided as final statement ● Should include positive health aspects, any health problems that have been identified, any plans for action, and an explanation of the subsequent physical examination ■ As you part from your clients, thank them for the time spent and their cooperation ❖ State the ten traps of interviewing ➢ Providing false assurance or reassurance ➢ Giving unwanted advice ➢ Using authority ➢ Using avoidance language ➢ Engaging in distancing ➢ Using professional jargon ➢ Using leading or biased questions ➢ Talking too much ➢ Interrupting ➢ Using “why” questions ❖ Discuss the meaning of common nonverbal modes of communication ➢ When verbal and nonverbal messages are congruent, the verbal message is reinforced !!! ■ When they are incongruent, the nonverbal message tends to be the true one because it is under less conscious control ➢ Physical Appearance ■ Image as an initial perception ■ It is important that you consider physical appearance when you first encounter a client ● Inattention to dressing or grooming suggests that the person is too sick to maintain self-care or has an emotional dysfunction such as depression ● Choice of clothing can also send a message projecting such varied images as role (student, worker, or professional) or attitude (casual, suggestive, or rebellious) ■ Professional uniforms can create a positive or a negative image ● You should always aim for your clothing to convey you as a competent professional ➢ Posture ■ Interpretation of body language affecting engagement ■ Always note the client’s position at the beginning of the interview ● Open position with extension of large muscle groups → relaxation, physical comfort, and a willingness to share info ● Closed position with arms and legs crossed → defensive and anxious ● Changes in posture during the interview suggests a different comfort level with the new topic ■ Always be aware of your own posture ● Calm, relaxed posture → conveys interest ● Standing and hastily filling out forms while peeking at watch → communicates that you’re busy with other important things than the client ➢ Gestures ■ Sending messages - be aware ■ Be aware of your own gestures and the gestures of the client ● Nodding the head or openly turning out the hand → shows acceptance, attention, or agreement ● Wringing the hands or picking the nails → often indicates anxiety ■ Hand gestures can reinforce descriptions of pain ➢ Facial Expression ■ Reflects emotion and conditions ■ Look at patient’s facial expression: does it match what he/she is saying, or is it incongruous? ■ Your expression should reflect a person who is attentive, sincere, and interested ● Avoid expressions that may be construed as boredom, disgust, distraction, criticism, or disbelief ● A negative facial expression can severely damage your rapport with the client and may lead him/her to stop communicating ➢ Eye Contact ■ Maintain within the realm of interest but be mindful of cultural diversity ■ Lack of eye contact → suggests the person is shy, withdrawn, confused, bored, intimidated, apathetic, or depressed ■ Maintain eye contact but do not stare at the person ● Have an easy gaze w/ occasional glances away vs a fixed, penetrating look ■ One exception to this is when you are interviewing someone from a culture that avoids direct eye contact !!! ● Asian, American Indian, Indochinese, Arabian, and Appalachian people may consider direct eye contact impolite or aggressive, and they may avert their eyes during the interview ● American Indians often stare at the floor during the interview, which is a culturally appropriate behavior, indicating that the listener is paying close attention to the speaker ➢ Voice ■ Be aware of tone, intensity, and rate of speech ■ Be aware of the tone of your voice and that of the client ● Speaking louder and faster than normal → people that are anxious ● Speaking in a soft voice → people that are shy or fearful ● Speaking in a loud voice → may indicate hearing impairment ➢ Touch ■ Interpretation of touch is influenced by age, gender, cultural background, past experience, and current setting ● Do NOT use touch during the interview unless you know the person well and are sure how it will be interpreted ❖ Discuss working with or without an interpreter to overcome communication barriers ➢ * * * It is important to consider the meaning of the spoken language AND nonverbal communication ➢ Although it is convenient to ask an Ad Hoc interpreter to translate for you (out of convenience), there are many disadvantages: ■ Client’s confidentiality is violated because the client may not want his/her info shared ■ Although fluent in that specific language → most likely unfamiliar with medical terminology, hospital or clinic procedures and medical ethics ■ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ In some cultures full disclosure of a diagnosis such as cancer is taboo, so an Ad Hoc interpreter may edit the diagnosis or not fully disclose info Always work with a bilingual team member or trained medical interpreter (when possible) ■ Knows interpreting techniques ■ Knowledgeable about cultural beliefs and health practices ■ Can bridge the cultural gap and advise you concerning the cultural appropriateness of your recommendations When a trained interpreter is unavailable, telephone translation services (such as AT&T) can be used 24 hrs a day NOTE THAT being bilingual does NOT always mean that the interpreter is culturally aware !!! If possible, ask the interpreter to meet with the patient beforehand to establish rapport and to determine the client’s age, occupation, educational level, and attitude toward health care Place the interpreter next to the client, but speak directly to the client * * * Always document who was used as the interpreter and whether it was the client’s choice ! ! ! TWO TYPES OF INTERPRETING: ■ Line-by-line ● Takes more time but it ensures accuracy ● Use this style for most of the interview ● Speak only 1-2 sentences at a time ■ Summary ● Progresses faster and is useful for teaching relatively simply health techniques with which the interpreter is already familiar Be alert for verbal and nonverbal cues as the client talks IMPORTANT INFO THAT IS NOT AN OBJECTIVE!!! ❖ NINE TYPES OF VERBAL RESPONSES !!! ➢ FIRST 5 !!! The client leads; involve your reactions to the facts or feelings that the person has communicated ■ Facilitation, silence, reflection, empathy, clarification ● Reflection: Echoes the pts words - repeating part of what the pt has just said; can also help express the feelings behind a pts words ● Clarification: Should be used when the pts word choice is ambiguous or confusing; used to summarize the pts words or to simplify the words to make them clearer ➢ LAST 4 !!! You lead; you start to express your own thoughts and feelings ■ Confrontation, interpretation, explanation, summary ● Confrontation: Based on direct observation ● Interpretation: Based on one’s inference or conclusion, links events, makes associations, or implies cause https://boostgrade.info/chapter-04-the-complete-healt h-historyfree/ Chapter 4: The Complete Health History ❖ State the purpose of the complete health history ➢ To collect subjective data (what the person says about himself or herself) to combine with objective data from physical exam and lab studies to form the database ➢ Provides a complete picture of patient’s past and present health status ■ EHR is very important and beneficial in keeping all health care providers up to do on the past and current health of the patient ➢ Can be used as a screening tool for detection of abnormalities ➢ Printed or electronic format that is available for review, validation, and updates ➢ Sequence may vary in terms of obtained info ➢ Focus may differ in terms of clinical practice setting and/or nature of complaint ❖ List the categories of information contained in a health history ➢ Biographic data ➢ Reason for seeking care ➢ Present health or history of present illness ➢ Past history ➢ Medication reconciliation ➢ Family history ➢ Review of systems ➢ Functional assessment or activities of daily living (ADLs) ❖ Describe the data or information that must be gathered for each category of health history ➢ Biographic Data ■ Name, address, and phone number ■ Age, birth date, and birthplace ■ Gender (identification) and relationship status ■ ■ ■ Race and ethnic origin Occupation: usual and present Primary language ● Language-concordant provider or medical interpreter ➢ Reason for Seeking Care ■ Brief spontaneous statement in pts own words describing reason for visit; States one (possibly two) S/S and their duration ■ Document reported findings ● Symptom: subjective sensation person feels from disorder documented in quotes ● Sign: objective abnormality that can be detected on physical examination or in laboratory reports ■ Focus on pts prioritized reasons for seeking care ● By asking the pt which one prompted him/her to seek help now ➢ Present Health or History of Present Illness (HPI) ■ For the well person, this a short statement about the general state of health; e.g., “I am healthy and active”. ■ For the ill person, Collect all provided data and identify COLDSPA ● Characteristics, O nset, Lo cation, Duration, Severity, Pattern, Alleviating/Aggravating factors ➢ Past History ■ Childhood illnesses: MMRV, pertussis, and strep throat (avoid recording “usual childhood illnesses”) ■ Accidents or injuries: Auto accidents, fractures, burns, penetrating wounds, head injuries (especially if associated with unconsciousness) ■ Serious or chronic illnesses: Asthma, depression, diabetes, hypertension, heart disease, HIV, hepatitis, sickle cell anemia, cancer, and seizure disorder ■ Hospitalizations: Cause, name of hospital, how the condition was treated, how long the pt was hospitalized, and name of physician ■ Operations: Type of surgery, date, name of surgeon, name of hospital, and how the pt recovered ■ Obstetric history: Number of pregnancies (gravidity), number of deliveries that reached full term (term), number of preterm pregnancies (preterm), number of incomplete pregnancies (miscarriages or abortions), and number of children living (living) ● For each complete pregnancy, note the course of the pregnancy; labor and delivery; sex, weight, and condition of each infant; and postpartum course ■ Immunizations: Routinely assess vaccination history and urge the recommended vaccines ● Recommendations for adults include: Influenza (annually), Tdap once every ten years, Varicella if no evidence of immunity, HPV, Zoster (after 60 yrs.), MMR if not immunized as a child or no evidence of immunity, Pneumococcal (after 65 yrs.), Meningococcal (based on exposure risk), Hepatitis A & B ● *** Repeat Tdap every pregnancy during 27-36 weeks’ gestation ■ Last examination date: Physical, dental, vision, hearing, ECG, chest x-ray, mammogram, Pap test, stool occult blood, serum cholesterol ■ Allergies: Note both the allergen (medication, food, or contact agent such as fabric or environmental agent) and the reaction (rash, itching, runny nose, watery eyes, difficulty breathing) ● For drug allergies, list ONLY those that are true allergic reactions, not unpleasant side effects ■ Current medications: For all currently prescribed medications, note the name (generic or trade), dose, and schedule, and ask questions about the meds ● Ask about nonprescription and over-the-counter (OTC) drugs ● Ask about herbal medications ● Inquire about substances (alcohol, tobacco, street drugs) here or later in personal habits ➢ Medication Reconciliation ■ A comparison of a list of current medications with a previous list, which is done at every hospitalization and every clinic visit ➢ Family History ■ Will be able to determine any susceptibility to certain diseases (i.e., diabetes, hypertension) ■ Highlights diseases or conditions that an individual may be at risk for as result of genetics ■ Provides age and health or cause of death of relatives ■ Ability based on results to seek early screening, make possible lifestyle adjustments, and/or undergo periodic surveillance ■ Pedigree or genogram used as standardized tool to organize data ■ When reviewing the family history data, ask specifically about coronary heart disease, high BP, stroke, diabetes, obesity, blood disorders, breast/ovarian cancer, colon cancer, sickle cell anemia, arthritis, allergies, alcohol or drug addiction, mental illness, suicide, seizure disorder, kidney disease, and TB ➢ Review of Systems ■ The purposes of this section are ● 1. To evaluate the past and present health state of each body system ● 2. To double-check in case any significant data were omitted in the Present Illness section ● 3. To evaluate health promotion practices ■ Order of examination of the body systems is head-to-toe ■ ■ ■ Only ask what was not already asked in the present illness section Need to record the “presence” or “absence” of all symptoms REMEMBER: Don’t record info that is objective data or physical findings; this should be limited to pt statements or subjective data ■ General overall health state ■ Skin, hair, and nails ■ Head ■ Eyes ■ Ears ■ Nose and sinuses ■ Mouth and throat ■ Neck ■ Breast ■ Axilla ■ Respiratory system ■ Cardiovascular ■ Peripheral vascular ■ Gastrointestinal ■ Urinary system ■ Male genital system ■ Female genital system ■ Sexual health ■ Musculoskeletal system ■ Neurological system ■ Hematologic system ■ Endocrine system ➢ Functional Assessment or Activities of Daily Living (ADLs) ■ Measures a person’s self-care ability in the areas of general physical health ● ADLs such as bathing, dressing, toileting, eating, walking ● Instrumental ADLs or those needed for independent living such as housekeeping, shopping, cooking, doing laundry, using the telephone, managing finances; nutrition; social relationships and resources; self-concept and coping; and home environment ■ Who takes care of the pt? Themselve? Another person? ■ Are they able to maintain proper hygiene? ■ Functional assessment questions provide data on the lifestyle and type of living environment the pt is accustomed ● The pt may view these questions as “private”, so it is best to ask these later in the interview after rapport is established ● Self-Esteem, Self-Concept: Education, financial status (income adequate for lifestyle and/or health concerns), value-belief system (religious practices & perception of personal strengths) ● ● ● ● ● ● ● ● ● Activity/Exercise: Daily profile reflecting usual daily activities (note ability to perform ADLs - independent or needs assistance), is there any use of wheelchair/mobility aids? Sleep/Rest: Sleep patterns, daytime naps, any sleep aids used Nutrition/Elimination: Record diet by a recall of all food & beverages taken over the past 24 hrs; indicate any food allergies or intolerances; record daily intake of caffeine Interpersonal Relationships/Resources: Social roles; support systems composed of family and significant others Spiritual Resources: Use FICA (faith, influence, community, address) questions to incorporate the person’s spiritual values into the health history ◆ Faith: “Does religious faith or spirituality play an important part in your life? Do you consider yourself to be a religious or spiritual person?” ◆ Influence: “How does your religious faith or spirituality influence the way you think about your health or care for yourself?” ◆ Community: “Are you a part of any religious or spiritual community or congregation?” ◆ Address: “ Would you like me to address any religious or spiritual issues or concerns with you?” Coping and Stress Management: Types of stresses in life, esp. In the past year; any change in lifestyle or any current stress; methods tried to relieve stress and whether these have been helpful Personal Habits: Tobacco, alcohol, and street drugs ◆ “Have you ever tried to quit? How did it go?” Alcohol: May wish to use a screening questionnaire to identify excessive or uncontrolled drinking such as CAGE (cut down, annoyed, guilty, eye-opener) ◆ If the pt says YES to 2 or more CAGE questions, you should suspect alcohol abuse and continue with a more complete substance-abuse assessment ◆ If the patient says NO to drinking alcohol, ask the reason for this decision (psychosocial, legal, health) Illicit or Street Drugs: Ask specifically about prescription painkillers such as OxyContin or Norco, Cocaine, Crack Cocaine, A mphetamines, Heroin, and Marijuana ◆ Indicate frequency of use and how use has affected work or family ● Environmental/Hazards: Housing and neighborhood, safety or area, adequate heat and utilities, access to transportation, and involvement in community services ● Intimate Partner Violence: Begin with open-ended questions “Do you feel safe?” ◆ If the pt says they do not feel safe, follow up with closed-ended questions: “have you ever been emotionally or physically abused?” ● Occupational Health: Ask the pt to describe their job ◆ Note the timing of the reason for seeking care and whether it may be related to change in work or home activities, job titles, or exposure history ◆ Ask the pt what they dislike about their job ❖ Describe the eight critical characteristics included in the summary of each patient symptom ➢ Characteristics: Specific descriptive terms (burning, sharp, etc.) ➢ Onset: When did the symptoms first appear? ➢ Location: Be specific; ask the person to point to the location ➢ Duration: How long did the symptoms last? Stead/Come and go? ➢ Severity: Scale of 0-10 ➢ Pattern: Is this primary symptom associated with any others? ➢ Alleviating/Aggravating factors: What makes it better/worse? https://boostgrade.info/chapter-08-assessment-techni ques-and-safety-in-the-clinical-setting/ Chapter 8: Assessment Techniques and Safety in the Clinical Setting ❖ Describe the use of inspection as a physical examination technique ➢ Inspection is concentrated watching. It is close, careful scrutiny, first of the individual as a whole and then of each body system ➢ It begins the moment you first meet the person and develop a “general survey” ➢ Inspection always comes first ➢ A focused inspection takes time and yields a surprising amount of data ➢ Everything should look bilaterally symmetrical ■ Usually the asymmetry is what will catch your eyes ➢ Inspection requires . . . to enlarge your view ■ Good lighting ■ Adequate exposure ■ ❖ ❖ ❖ ❖ Occasional use of certain instruments (otoscope, ophthalmoscope, penlight, nasal and vaginal specula) Describe the use of palpation as a physical examination technique ➢ Palpation follows and often confirms what you noted during inspection ➢ Applies your sense of touch to assess the following factors: ■ Texture, temperature, moisture, organ location and size, and any swelling, vibration or pulsation, rigidity or spasticity, crepitation, presence of lumps or masses, and presence of tenderness or pain ➢ Light palpation is initially performed to detect any surface characteristics and to accustom the person to being touched ■ Tender areas should be palpated last, not first Relate the parts of the hands to palpation techniques used in assessment ➢ Different parts of the hands are best for assessing different factors ■ Fingertips → fine tactile discrimination, as of skin texture, swelling, pulsation, and determining presence of lumps ■ Grasping action of fingers and thumb → to detect the position, shape, and consistency of an organ or mass ■ Dorsa (backs) of hands and fingers → best for determining temperature because the skin is thinner than on the palms ■ Base of fingers or ulnar surface of hand → best for vibration Differentiate between light, deep, and bimanual palpation ➢ Light ■ Light palpation → detect surface characteristics and to accustom the person to being touched ➢ Deep ■ Deep palpation → once the patient is relaxed, apply intermittent pressure (usually on abdominal contents) rather than one long, continuous palpation ■ Avoid any situation in which deep palpation could cause internal injury or pain ➢ Bimanual ■ Bimanual palpation → requires the use of both of your hands to envelop or capture certain body parts or organs such as the kidneys, uterus, or adnexa for more precise delimitation Describe the use of auscultation as a physical examination technique ➢ Auscultation is listening to sounds produced by the body, such as the heart and blood vessels and the lungs and abdomen ■ Most body sounds are soft and must be channeled through a stethoscope ■ Stethoscope does NOT magnify sound, it AMPLIFIES sounds by blocking out extraneous sounds ■ Of all the equipment you will use, the stethoscope quickly becomes a personal instrument ■ Once you can recognize normal sounds, you can distinguish the abnormal sounds and “extra” sounds ❖ Identify the equipment needed for the screening physical examination ➢ Stethoscope ■ Diaphragm ● Best for listening to high-pitched sounds such as breath, bowel, and normal heart sounds ● Should be firmly held against the pts skin (firmly enough to leave a ring) ■ Bell ● Best for low-pitched sounds such as extra heart sounds or murmurs ➢ Otoscope ■ Directs light into the ear canal and onto the tympanic membrane that divides the external and middle ear ➢ Ophthalmoscope ■ Used to examine the internal eye structures ■ Can compensate for nearsightedness or farsightedness, but will NOT correct for astigmatism ■ Large full spot of light is used to assess dilated pupils ■ Rotating the lens selector dial brings the object into focus ➢ Penlight ➢ Nasal speculum ➢ Vaginal specula ➢ Doppler Devices ■ Used to augment pulse or BP measurements ■ Can check for pulsations over an area that the nurse cannot palpate the pulse on the pt (i.e., the radial pulse) ❖ Discuss appropriate infection control measures used to prevent spread of infection ➢ HAND WASHING!!! ➢ Single most important action to decrease the transmission of microorganisms is to wash hands promptly and thoroughly !!! ➢ Rub all hand sanitizers with 3-5 mL of alcohol for 20-30 seconds until hands dry ➢ Soap and water handwashing is mandated when coming in contact with bodily fluids, when hands are visibly soiled, and when coming into contact with C. Diff, and other spore-forming organisms → Vigorously rubbed for at least 20 seconds ➢ Gloves are not a substitute for handwashing because they may have minute holes or tears in them (not a 100% impervious to fluids and organisms) ➢ Nails tips should be no more than 1/4 “ in length → no artificial nails ➢ BEFORE TOUCHING A PATIENT . . . ■ Gel in when entering the patient’s room ■ Warm your hands ■ Wash or use hand sanitizer before performing any aseptic technique on a patient ■ Use appropriate PPE when the potential for bodily contamination is a possibility ■ Wash hands after any procedures involving bodily fluids ■ Do NOT stethoscope around neck ■ Clean stethoscope before using on patient ➢ WHEN EXITING THE PATIENT’S ROOM . . . ■ Wash hands or gel out ➢ STANDARD PRECAUTIONS ■ Hand hygiene ■ Use of gloves, gown, mask, eye protection or face shield ■ Respiratory hygiene/cough etiquette ■ ***TB is transmitted via airborne droplets. Patients should be in respiratory isolation, in a negative airflow room with the door shut. A special mask is required, usually N95, when interacting with these patients. It is a HIGHLY contagious disease!!! ❖ Discuss developmental care needed for patients ➢ SAFETY IS #1!!! ➢ The health history described in preceding chapters provides the following ■ Subjective data for health assessment ■ Objective data (signs for perceived by examiner through physical examination) ➢ Physical examination requires examiner to develop the following ■ Technical skills, the tools to gather data ■ The examiner will relate those data to his or her knowledge base and previous experience ➢ Developing skills ■ REMEMBER THIS ORDER !!!! ● Inspection, Palpation, Percussion, Auscultation ➢ USE OF THE SENSES ■ Sight ● Inspection ■ Smell ■ Touch ● Palpation, percussion ■ Hearing ● Auscultation, percussion IMPORTANT INFO THAT IS NOT AN OBJECTIVE!!! ❖ Assessment Sequence ➢ Skills are performed one at a time, in this order: ■ Inspection ■ Palpation ■ Percussion ■ Auscultation *** Except when assessing the abdomen ❖ Steps of the assessment ➢ Steps of the assessment should be organized to ensure that the pt does not change positions too often ➢ The sequence of the steps of the assessment may differ, depending on the age of the pt and the examiner’s preference ➢ Tender or painful areas should be assessed last (to relieve the pts anxiety)
