Chapter 30

Focused Study Tips:

1.
Dullness: a thudlike sound produced by dense tissue such as the liver, spleen, or heart
Flatness: an extremely dull sound produced, during percussion, by very dense tissue,
such as muscle or bone
Resonance: a hollow sound as produced by lungs filled with air during percussion
2. List the common refractive error of the eye: Many people wear eyeglasses or contact
lenses to correct common refractive errors of the lens of the eye. These errors include
myopia (nearsightedness), hyperopia (farsightedness), and presbyopia (loss of
elasticity of the lens and thus loss of ability to see close objects)
3. Explain the air-conducted transmission process: Air conduction should be greater
than bone conduction and so the patient should be able to hear the tuning fork next to
the pinna (outer ear) after they can no longer hear it when held against the mastoid
using the Rinne Test
4. Define: Thrill is a vibrating sensation over a blood vessel that indicates turbulent
blood flow. Bruit is a blowing or swishing sound created by turbulence of blood flow
5. Describe common inflammatory visual problems: Common inflammatory visual
problems that nurses may encounter in clients include conjunctivitis, dacryocystitis,
hordeolum,
iritis, and contusions or hematomas of the eyelids and
surrounding structures.
6. Identify the positions that are frequently required during the physical assessment:
Supine Position, Prone Position, Dorsal Recumbent Position, Lithotomy Position, Knee
Chest Position, Sims Position, Sitting Position, Standing Position
7. Summarize the physical health assessment: The health examination is conducted to
assess the function and integrity of the clients body parts. Initial findings provide
baseline data against which subsequent assessment findings are compared
8. Discuss variations in examination techniques appropriate for clients of different ages:
the procedure can vary according to the age of the individual, the severity of the illness,
the preferences of the nurse, the location of the examination, and the agencys priorities
and procedures.
9. Describe suggested sequencing to conduct a physical health examination in an
orderly fashion: The health assessment is conducted in a systematic and efficient
manner that results in the fewest position changes for the client. We use Head to Toe
Assessment which prevents missing a step in the process

10. Identify the steps in selected examination procedures. We practice head to toe
assessment. Therefore, address question 10 in that manner:
General survey
Vital signs
Head
Hair, scalp, face
Eyes and vision
Ears and hearing
Nose
Mouth and oropharynx
Cranial nerves
Neck
Muscles
Lymph nodes
Trachea
Thyroid gland
Carotid arteries
Neck veins
Upper extremities
Skin and nails
Muscle strength and tone
Joint range of motion
Brachial and radial pulses
Sensation
Chest and back
Skin
Chest shape and size
Lungs
Heart
Spinal column
Breasts and axillae
Abdomen
Skin
Abdominal sounds
Femoral pulses
External genitals
Anus
Lower extremities
Skin and toenails
Gait and balance
Joint range of motion
Popliteal, posterior tibial, and pedal pulses
11. Identify expected outcomes of health assessment of the health assessment:
To obtain baseline data about the clients functional abilities
To supplement, confirm, or refute data obtained in the nursing

history
To obtain data that will help establish nursing diagnoses and
plans of care
To evaluate the physiological outcomes of health care and
thus the progress of a clients health problem
To make clinical judgments about a clients health status
To identify areas for health promotion and disease prevention.
12. dont do
13. Explain the 4 methods used in physical examination:
1. Inspection is the visual examination, which is assessing by using the sense of sight.
It should be deliberate, purposeful, and systematic. The nurse inspects with the naked
eye.
2. Palpation is the examination of the body using the sense of touch. The pads of the
fingers are used because their concentration of nerve endings makes them highly
sensitive to tactile discrimination.
3. Percussion is the act of striking the body surface to elicit sounds that can be heard
or vibrations that can be felt. There are two types of percussion: direct and indirect.
Direct=In direct percussion, the nurse strikes the area to be percussed directly with the
pads of two, three, or four fingers or with the pad of the middle finger, example tapping
sinus cavities.
Indirect=is the striking of an object (e.g., a finger) held against the body area to be
examined. Using the tip of the flexed middle finger of the other hand, called the plexor,
the nurse strikes the pleximeter,
usually at the distal interphalangeal joint or a point between the distal and proximal
joints
4. Auscultation is the process of listening to sounds produced within the body.
Auscultation may be direct or indirect. Direct=using unaided ear Indirect= using
stethoscope
14. Identify the purposes of the physical examination: Data obtained in the physical
health examination supplement, confirm, or refute data obtained during the nursing
history. Also, data obtained in the physical health examination help the nurse establish
nursing diagnoses, plan the clients care, and evaluate the outcomes of nursing care.
15. Summarize auscultated sounds that are described according to their pitch, intensity,
duration, and quality.
Normal Breath Sounds:
Vesicular Soft-intensity, low-pitched, gentle sighing sounds created by air moving
through smaller airways (bronchioles and alveoli)

Broncho-vesicular Moderate-intensity and moderatepitched blowing sounds created by

air moving through larger airway (bronc
Bronchial (tubular) High-pitched, loud, harsh sounds created by air moving through the
trachea
Adventitious Breath Sounds:
Crackles (rales) Fine, short, interrupted crackling sounds; alveolar rales are high
pitched. Sound can be simulated by rolling a lock of hair near the ear. Best heard on
inspiration but can be heard on both inspiration and expiration. May not be cleared by
coughing
Gurgles (rhonchi) Continuous, low-pitched, coarse, gurgling, harsh, louder sounds with
a
moaning or snoring quality. Best heard on expiration but can be heard on both
inspiration and expiration. May be altered by coughing
Friction rub Superficial grating or creaking sounds heard during inspiration and
expiration. Not relieved by coughing
Wheeze Continuous, high-pitched, squeaky musical sounds.
Best heard on expiration. Not usually altered by coughing
Case Study
1. Discuss the purposes of physical examination:
To obtain baseline data about the clients functional abilities
To supplement, confirm, or refute data obtained in the nursing
history
To obtain data that will help establish nursing diagnoses and
plans of care
To evaluate the physiological outcomes of health care and
thus the progress of a clients health problem
To make clinical judgments about a clients health status
To identify areas for health promotion and disease prev
2. Several positions are frequently required during the physical assessment. List client
positions and provide a description of each one;
Supine Patient or Horizontal recumbent laying flat on back with knees straight and arms
at sides. With or without a pillow under head
Dorsal recumbant: back lying position with knees flexed and hips externally rotated;
small pillow under head and soles of feet flat on bed

Sitting: a seated position, back unsupported and legs dangling freely

Lithotomy: back-lying position with feet supported in stirrups; the hips should be in line
with the edge of the table
Sims: side-laying position with lowermost arm behind the body, uppermost leg flexed at
hip and knee, upper arm flexed at shoulder and elbow
Prone: lies on abdomen with head turned to the side with or without a pillow
Standing position is not in this book bur is good for overall inspection of posture,
balance, gait. Also used to inspect male genatalia
Knee-Chest: Patient face down with head, chest, and knees on examination table,
knees bent with rear end up in the air

3. List the equipment and supplies used for a health examination: Per book
Penlight or flash light
Nasal spectulum
Otoscope
Opthalmascope
Percussion reflex hammer
Tuning fork
Vaginal speculum
Cotton applicators
Gloves
Lubricant
Tongue Blades