1. 1. SUBMITTED TO: SUBMITTED BY: RESP. UMESH SIR MISS ABHILASHA VERMA B. Sc. NSG. PART-III (2011-2012)
2. 2. 1. INTRODUCTION: A health assessment is type of survey that ask question about your health & life style. It is a risk appraisal that focus on your health with an emphasis on education & behavior changes. Health assessment is very important in any health care setting.
3. 3. HEALTH ASSESSMENT IN ARMY
4. 4. 2. TYPES; COMPREHENSIVE HEALTH ASSESSMENT ; It includes health history & complete physical examination, & is usually done when a client enters a health care setting. ONGOING PARTIAL ASSESSMENT ; Is one that conducted at regular intervals during care of client. A FOCUSED HEALTH ASSESSMENT ; Is conducted to assess a specific health problem. AN EMERGENCY ASSESSMENT ; Is type of rapid focused assessment conducted to determined potentially fatal situations.
5. 5. 3. PURPOSE; 1) To get a clear picture of clients health status & health related problems. 2) To get a holistic view of client. 3) To establish a database of clients normal abilities, risk factors, that can contribute to dysfunction. 4) To alleviate or manage existing health problem. 5) To encourage continuation of healthy pattern. 6) To help to formulate a conclusion or problem statement. 7) To making accurate treatment decision.
6. 6. 4) TERMINOLOGY: 1)DIAGNOSIS; It is determination of nature & extent of a disease. 2)PROGNOSIS; It is forecast of course & duration of a disease. 3)AETIOLOGY; It is science of cause of disease. 4)PATHOLOGY; The branch of medicine treating a disease. It also indicates the changes that can take place in the structure & function of body during course of disease.(any deviation from normal). 5)SIGNS ; The presense of disease that can be seen or elicited , e.g.,fever.
7. 7. 6)SYMPTOMS; Any evidence as to the nature or location of a disease as noted by patient. when symptoms noted by patient alone, it is called subjective symptoms, e. g. pain. When symptoms noted by observer it is called objective symptoms . e.g. jaundice. 7)SYMPTOMATOLOGY; study of sign & symptoms of disease. 8)COMPLICATION; Another disease process arising during a course of disease.
8. 8. 5.FRAMEWORK ; The three major frame works are; 1)Functional health frame work. 2)Head to toe framework. 3)Body system framework.
9. 9. 6.COMPONENT: There are two components: < Health history . < Physical examination.
10. 10. **HISTORY :
11. 11. 7.HEALTH HISTORY: 1)BIOGRAPHIC DATA: Name, address,gender,age,marital status,occupation,religion,income,education 2)CHIEF COMPLAINS: Clientss own words.
12. 12. 3)HISTORY OF PRESENT ILLNESS: On set ,sign and symptoms, duration,treatment taken if any,for the same.other complaints such as loss of appetite, insomnia,disorder of stomach.find out client health habits eating, sleeping etc. 4) PAST MEDICAL HISTORY: Childhood illness- mumps, measles and so on. Allergies,mental disease, accidents, injuries, surgeries,blood transfusions.
13. 13. 5)FAMILY HISTORY: Informations about all family members (father ,mother,grandparents,brothers and sisters) living or dead, causes of death( if dead) condition of there health (if living), family history of any illness, e.g diabetes mellitus,cancer, heart disease etc. 6) LIFE STYLE: Smoking alcoholism,substance abuse. Food habits, likes and dislike,pattern of sleep and exercise.
14. 14. 8.DEFINITION : It is thorough inspection or detailed study of entire body or some part of body to determine the general,physical,mental condition of body.
15. 15. 9.PURPOSE : 1)To understand the physical and mental well being of patient. 2) To detect the disease in its early stage. 3)To determine cause and extent of disease. 4)To understand any changes in the condition of disease any improvement and regression.
16. 16. 5) To determine the nature of treatment or nursing care needed for patient. 6)To safeguard the patient and its family by noting the early signs specially in case of communicable disease. 7) To contribute to the medical research. 8) To find out whether the person is medically fit or not fit for perticular task.
17. 17. 10.METHODS OF EXAMINATION: 1) INSPECTION 2) PALPATION 3) PERCUSSION 4) AUSCULTATION 5) MANIPULATION 6) TESTING OF REFLEXS
18. 18. A).INSPECTION: *Visual examination of body is called inspection. *It is the observation with naked eyes to determine the structure and function of body.
19. 19. B.)PALPATION: 1)It is the feeling of body or a part with the hands to note the size and position of the organs. 2In palpation the finger pads are used not the finger tips.
20. 20. C.)PERCUSSION: 1) It is the examination by tapping with the finger on the body to determine the condition of the internal organs by the sounds that are produced. 2) It is done by placing a finger of the left hand firmly against a part to be examined[chest or abdomen] and tapping with the finger tips of right hand.
21. 21. PERCUSSION HAMMER
22. 22. USE OF PERCUSSION HAMMER
23. 23. D.)AUSCULTATION: It is the listening to sounds with in the body with the aid of a stethoscope,foetoscope or directly with the ear placed on the body.
24. 24. E.)MANIPULATION : It is the moving of a part of the body to note its flexibility. Limitation of movements is discoverded by this method.
25. 25. F.).TESTING OF REFLEXES: The response of tissues to external stimuli is tested by means of percussion hammer,safety pin,wisp of cotton,hot and cold water etc.
26. 26. 11.)HEAD TO FOOT EXAMINATION : The observation of the patient starts as the patient walks into the examination room.
27. 27. **General appearence : NOURISHMENT :Well nourished or mal nourished or under nourished. BODY BUILD :Thin or obese. HEALTH:Healthy or unhealthy. ACTIVITY:Active or dull(tired).
28. 28. Well nourished baby :
29. 29. Abnormalities in nutrition : Under nourished Baby : Malnourished Baby :
30. 30. **Thin , Normal & obesity :
31. 31. **Mental status examination : CONSCIOUSNESS: Conscious, unconscious,delirious,talking incoherently. LOOK: Anxious or worried,depressed,etc.
32. 32. **Delirious : **Anxity :
33. 33. **Posture: BODY CURVES: Lordosis , kyphosis & scoliosis. MOVEMENT : Any limp.
34. 34. *Before : *After : Scoliosis .
35. 35. **Height & weight : Height measured in inches(in),feet(ft),centimeter(cm),& meter(m). A scale for measurement attached to standing weight scale. Weight measured in ounce(oz),pound(lb),gram(gm),kilogram(kg).
36. 36. **Skin condition : COLOUR : Pallor,jaundice,cynosis,flushing ,etc. TEXTURE;Dryness,flaking,wrinkling,excessive moisture. TEMPETURE:Warm,cold,clammy. LESIONS:Macules,papules,vesicles,wounds.ect.
37. 37. **jaundice :
38. 38. **cyanosis :
39. 39. **flushing :
40. 40. **Head & face: Shape of skull & fontanels(noted in newborn). Skull circumference: -Scalp; Cleanliness,condition of hair,dandruff,pediculi,infection like ring worm. -Face; Pale,flushed,puffiness,fatigue,pain,fear,anxity,enla rgement of parotid gland.
41. 41. **enlargement of parotid gland:
42. 42. **ring worm infection :
43. 43. **Eyes : Eye brows: Normal or absent. Eyelashes: Infection & sty. Eye lids: Oedema, lesion, ectropion(eversion), entropion(inversion). Eye balls: sunken or protuded. Conjuctiva: Pale,red,purulent. Sclera: Jaundiced.
44. 44. **sty :
45. 45. **jaundiced :
46. 46. **Ectropion. **Entropion.
47. 47. **Red & Purulent conjuctiva.
48. 48. Protuded : Absent eye brows :
49. 49. **SUNKEN EYE BALL :
50. 50. Cornea & iris: Irregularities & abrasions. Pupils: Dialated,constricted,reaction to light. Lens: Opaque & transparent. Fundus: Congestion & haemorrhagic spots. Eye muscles: Strabismus(squint). VISION: Normal,myopia(shortsight) & hyperopia(long sight).
51. 51. Opaque lens :
52. 52. **Ears: External ear: Discharges,cerumen obstruction. Tympanic membrane: Perforation,lesion,buldging. Hearing : Hearing acuity.
53. 53. **Tympenic perforation :
54. 54. **Nose: External nares : Crust or discharge. Nostrils: Septal deviation & inflammation of mucus membrane.
55. 55. **Nose: External nares : Crust or discharge. Nostrils: Septal deviation & inflammation of mucus membrane.
56. 56. **Nasal septum deviation. Before : After :
57. 57. **Mouth & Phraynx : Lips: Redness , Swelling , Crust ,Cynosis ,Angular stomatitis ,foul smelling(odour) of mouth. Teeth: Discolourition & dental caries. Gums & Mucus membrane: ulceration , swellimg , & perforation. Tongue: Pale , dry ,lesion , sords ,furrows , tongue tie etc. Throat & Phraynx : Enlarged tonsils , redness & pus.
58. 58. **Angular stomatitis :
59. 59. **Tongue tie :
60. 60. ** Ulceration :
61. 61. ** Tongue Furrows :
62. 62. **Neck : Lymph nodes : Enlarged & Palpable . Thyroid Gland : Enlarged. Range of motion (ROM) : Flexion , extension ,rotation.
63. 63. *Enlargement of thyroid gland :
64. 64. **Chest : Throrax :Shape ,symmetry of expansion,posture. Breath sound : Sigh, swish ,rustle ,wheezing , rales ,pleural rub ,crepitations. Heart :Size , location ,cardiac murmurs. Breast : Enlarged lymphnodes .
65. 65. **Abdomen: Observation : skin rashes, scar , hernia , ascites , distension , & pregnancy. Auscultation : Bowel sounds & foetal heart sound. Palpation : liver margins , palpable spleen, tenderness at area of appendix ,inguinal hernias. Percussion : presence of gas,fluids or masses.
66. 66. **Extremities : Movement of joints. Tremors. Ankle oedema . Varicose vein . Reflexes.
67. 67. ** Back : Spina bifida. Body curves.
68. 68. **Body Curves :
69. 69. **Spina Bifida :
70. 70. **Genital & Rectum : Inguinal lymphnodes enlarged & palpable. Patency of urinary meatus & rectum. Descents of testes in infant. Vaginal discharges.
71. 71. Presence of sexually transmitted disease(STD). Haemorroides. Pelvic masses. Enlargement of prostate gland.
72. 72. **Neurological Tests: Co-odination test. Reflexes. Equilibrium tests. Test for sensation.
73. 73. 12.ROLE OF NURSE : PREPRATION OF ENVIORNMENT : 1.) Maintenance of privacy : *Prevent unnecessory exposure. *Ensure privacy. *Quite & ventilated room. *Special need for client. *Surface for placement of equipment. *Draping should be done. *Separate examination room should be needed ,keep the door closed.
74. 74. 2.)Lighting : *As for as possible natural light should be available.Because if patient is jaundiced.it may not be detected in the artificial light. *There should be adequate lighting.
75. 75. 3. Comfortable bed or examination table: *Patient should be placed comfortable through out the examination ensure possibility to body part being assessed. *There should be provision for maintenance of suitable position.
76. 76. PREPARATION OF EQUIPMENT: *All articles needed for physical examination are kept ready for the examination at hand. *Maintain good body mechanics.
77. 77. PREPARATION OF PATIENT: 1)Physical preparation:- *Keep the patient clean,shave the part if necessary. *Keep patient in a comfortable position. *Empty the bladder prior to examination. *Empty the bowel by giving enema. *Drape the patient,prevent unnecessary exposure.
78. 78. **Draping :
79. 79. 2)Mental preparation: *Patient may be quite new to hospital situation and anxious about his illness. *Explain the procedure *Remove false belief.
80. 80. **SPHYGMOMANOMETER :
81. 81. **STETHOSCOPE :
82. 82. **FOETOSCOPE :
83. 83. **TONGUE DIPRESSOR :
84. 84. **PHRAYNGEAL RETRACTOR :
85. 85. **LARYNGEOSCOPE :
86. 86. **WEIGHING MACHINE :
87. 87. **OPTHALAMOSCOPE :
88. 88. **OTOSCOPE :
89. 89. **TUNNING FORK :
90. 90. **NASAL SPECULUM :
91. 91. **PERCUSSION HAMMER :
92. 92. **VAGINAL SPECULUM :
93. 93. **PROCTOSCOPE:
94. 94. **GLOVES :
95. 95. **SNELLEN CHART: