P. P. is a 32-year-old man who presents to the occupational health clinic for a physical before beginning employment at a local hospital. The patient is in good health, has no complaints of pain, and exercises on a daily basis. His body mass index 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. 1. How does the nurso 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?

1. As the examiner enters the room, he or she should wash hands in the patient's presence. Standard Precautions are used for all patients, and Transmission-Based Precautions are used with patients who have documented or suspected transmitted infections. Designate "clean" and "used" areas for handled equipment. All equipment carried by the examiner should be cleaned with alcohol between patients.

Rationale: The single most important step to decrease the risk of microorganism transmission is thorough handwashing after physical contact with patients or body fluids. A stethoscope and other equipment can become a common vehicle for transmission of infection

2.  While conducting an inspection, the provider uses the patient's body as his or her own control to determine symmetry between the right and left sides of the body. Perform the inspection in a well-lighted room.

Rationale: Inspection is critical observation of the patient in a systematic, deliberate manner that begins as a general survey the moment the practitioner meets the patient. It is the first technique used in the performance of a physical assessment. Good lighting, adequate exposure, and, at times, the use of special instruments aid in the completion of a good inspection.

3.  Fingertips for fine tactile discrimination. Grasping with the thumb and fingers to determine position, shape, and consistency of an organ or mass. Temperature is best determined with the dorsa (back) of the hands and fingers. Vibration is assessed with the base of the fingers (metacarpophalangeal joints) or ulnar surface of the hand. Palpitation is used to assess temperature, moisture, change in size, vibrations, pulsations, rigidity or spasticity, crepitation, presence of lumps or masses, and the presence of tenderness or pain may also be found.

Rationale: Palpitation uses fingertips, grasping actions, and the dorsa of the fingers and hands as well as the base of the fingers. Palpitation follows and confirms points noted during inspection. Palpation applies the sense of touch to assess texture, temperature, moisture, organ location and size, as well as any swelling, vibration or pulsation, rigidity or opacity, crepitation, presences of lumps or masses, and presence of tenderness or pain.

4.  Percussion is used to assess underlying structures. Percussion is used most frequently to assess the thorax and abdomen. Direct percussion, most commonly used to assess the adult sinuses and thorax of an infant, is the technique of striking the finger or hand directly against the body. With indirect percussion, the examiner's interphalangeal joint is placed firmly against the patient's skin with the remainder of the hand lifted off the skin. The middle finger of the dominant hand is used as the striking force (plexor). The striking finger, using the action of the wrist, hits directly at right angles to the stationary finger on the portion in contact with the skin surface.

Rationale: Percussion is the technique of striking a part of the body with short, sharp taps of the fingers. The location, size, position, and density of the underlying organs can be assessed by the change in percussion sounds elicited. The sounds are assessed for amplitude, pitch, quality, and duration. To elicit the best tones and to avoid pain, short fingernails are a must.

5. Auscultation (listening to sounds produced by the body) is done with both the unassisted sense of hearing and with special instruments, usually a stethoscope. Sounds heard with the ear alone include speech, percussion tones, difficult breathing, coughing, and loud abdominal sounds. The stethoscope should always be put on bare skin, not over clothing.

hope this helps

1.)

Most important thing to prevent from infection is hand-washing after physical contact with patients.

2.)

Inspection is critical observation of the patient in a systematic, deliberate manner that begins as a general survey the moment the practitioner meets the patient. It is the first technique used in the performance of a physical assessment. Good lighting, adequate exposure, and, at times, the use of special instruments aid in the completion of a good inspection.

3.)

Palpitation uses fingertips, grasping actions, and the dorsa of the fingers and hands as well as the base of the fingers.

Palpation applies the sense of touch to assess texture, temperature, moisture, organ location and size, as well as any swelling, vibration or pulsation, rigidity or opacity, crepitation, presences of lumps or masses, and presence of tenderness or pain.

4.)

Percussion is the technique of striking a part of the body with short, sharp taps of the fingers. The location, size, position, and density of the underlying organs can be assessed by the change in percussion sounds elicited. The sounds are assessed for amplitude, pitch, quality, and duration. To elicit the best tones and to avoid pain, short fingernails are a must.

5.)

Auscultation (listening to sounds produced by the body) is done with both the unassisted sense of hearing and with special instruments, usually a stethoscope. Sounds heard with the ear alone include speech, percussion tones, difficult breathing, coughing, and loud abdominal sounds. The stethoscope should always be put on bare skin, not over clothing.

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