nursing assessment

1. PREPARATION OF PATIENT
FOR
HEALTH ASSESSMENT

2. INTRODUCTION
• Nurse should develop a systematic
approach to physical examination
Head to toe approach
Starting at the head and neck ,progressing
down the body and examining the feet last
Body system approach
Examining each system in a predetermined
order (Eg: musculoskeletal system
,cardiovascular, and neurological system)

3. • Prepare your self
• Prepare the environment
• Prepare the client

4. Preparing your self (Nurse)
• Theoretical knowledge of Anatomy and
Physiology.
• Examination techniques and equipments
• Therapeutic communication and
documentation
• Seek help from your instructor fellow
students and other health care professionals .

5. Preparing the environment
• Time should be
convenient for nurse
and client.
• Area should be well
lighted.
• Equipment should be
organized.
• Provide privacy.

6. Preparing the environment
• Room should be
warm enough to be
comfortable for the
client.
• Family and friends
should not be
present unless
client ask for some
one .

7. Preparation of environment
includes…
• Positioning
• Draping
• instrumentation

8. POSITIONING
• Sitting/fowler’s

9. SUPINE AND PRONE

10. STANDING

11. DORSAL RECUMBENT

12. SIM’S POSITION

13. LITHOTOMY

14. KNEE-CHEST POSITION

15. DRAPING
• Drapes should be arranged so that the area
to be assessed is exposed and other body
area covered.
• Exposing the body frequently embarrassing
to clients.
• Drapes are made of paper ,cloth or bed linen.

16. •Provide warmth
•Provide privacy

17. INSTRUMENTATION
• All equipments needed for examination
should be,
– Clean
– Good working order
– Readily accessible
– Equipment frequently set upon trays ready for
use

18. Articles / Instruments
• Flash light
• Nasal speculum
• Ophthalmoscope
• Otoscope
• Percussion hammer
• Turning fork
• Vaginal speculum
• Cotton applicators
• Gloves
• lubricant
• Tongue blades
(depressor)

19. Articles / Instruments
• Pulse oxymeter
• Scale with height measurement road
• Specimen container
• Sterile swab
• Stethoscope
• Tape measure
• Thermometer
• Wrist watch
• Sphygmomanometer

20. Flash light Nasal speculum

21. Ophthalmoscope Otoscope

22. Percussion hammer Turning fork

23. Vaginal speculum Cotton applicators

24. Gloves Lubricant

25. Tongue depressor Pulse oxymeter

26. Scale with height
measure road
Specimen containers

27. Stethoscope Tape measure

28. Thermometer Wrist watch

29. SNELLENS CHART SPHYGMOMANOMETER

31. PREPARATION OF CLIENT
• Clients physical comfort is vital for a
successful examination
• Emptying bladder and bowel
• Dressing and draping the patient properly
• Routinely ask for clients comfort

32. PSYCHOLOGICAL
PREPARATION
•Remain calm
•Explain each procedures
•Allow client to feel free to ask
questions and mention any discomfort