NAME: NAKAWEESI MARIA

REGISTRATION NUMBER: 2020/A/KNS/2124/F

DATE: 10TH MARCH 2023

Health Assessment - Individual Assignment

1. Discuss physical assessment of a patient. Indicate the techniques and tools used.

2. Explain how health history and physical examination contribute to effective patient care

3. Discuss the non-pharmacological methods of pain management

4. Case study: Mrs. Silver is an 85-year-old newly admitted widow. She has a history of stroke,
pulmonary emboli (blood clots in the lungs), a myocardial infarction (heart attack), heart failure,
and a broken right hip over the past 8 years. In the past 3 years she was declared legally blind as
a result of macular degeneration in both eyes. She is confined to a wheelchair, unable to stand
or walk, and is very depressed because she can no longer read, her favorite pastime. When you
do a pain assessment on Mrs. Silver, you discover that she has difficulty using the numeric rating
scale of 0 to10 and becomes frustrated when people ask her to use it. She asks you to decide
the number for her because she “just doesn’t understand.” She describes her pain to you as
deep, aching pain in her right leg, hip, and shoulder that keeps her awake at night and makes it
very difficult to turn on her right side.

Mrs. Silver has an order for morphine 10 mg by mouth every 3 hours as needed; she had been taking
this at home for several months. She tells you that, when she requested the pain pill at 4 AM this
morning, the night nurse told her that she has to be very careful because she could become a drug
addict if she takes morphine. She says that she is in pain right now but is afraid to take anything. Her
 vital signs are BP 98/70, P76, R16, and T97. Her bowel sounds are slightly hypoactive. She reports
she has not had a bowel movement for 3 days.

Case study Questions

1 How often will you assess this patient’s pain, and which pain assessment tool will you use?

2 Which nonpharmacologic pain control approaches are appropriate for Mrs. Silver? Provide
rationale.

3 The patient says to her nurse, “do you think my pain medicine is causing my

ANSWERS

1. Physical assessment of a patient involves these four techniques;

 Inspection
 Palpation
 Auscultation
 Percussion

INSPECTION

Here we look at all areas of the skin, including those under clothing or gowns and ensure that the patient
is undressed from head to toe.
Lighting should be bright and be alert for any malodors from the body including the oral cavity; fecal
odor, fruity-smell, odor of alcohol or tobacco on the breath.u
We then check for asymmetry on the patient's body and observe for color, rashes, skin breakdown, tubes
and drains, scars, bruising, burns
Check if there is any weeks present and after document normal and abnormal findings.

PALPATION
Here we check for Texture,Size,Consistency,Crepitus,Any masses,Turgor,Tenderness ,Temperature and
moisture as well as dissension on different parts of the body.

We are required to touch your patient with different parts of your hand using different strength
pressures. Palpatine can be light allowing you to assess for texture, tenderness, temperature,
moisture, pulsations, and masses and can be deep palpation is performed to assess for masses
and internal organs.
AUSCULTATION

This usually involves listening to body sounds such as bowel sounds, breath sounds, and heart sounds and
it's important in examination of the heart, blood pressure, and gastrointestinal system.
A stethoscope is used for this technique.
PERCUSSION

Here a good hand and finger technique is used and is used to elicit tenderness or sounds that may
provide clues to underlying problems. Percussion is done by placing the non dominant hand in
the area where you want to percus and using the middle finger of the dominant hand to tap the
middle finger of the dominant to as you listen carefully to the sounds produced produced which
may include,Tympany ,Dullness ,Resonance,Flatness and Hyperressonance .

TOOLS REQUIRED FOR PHYSICAL ASSESSMENT

 otoscope, penlight, stethoscope (bell and diaphragm), thermometer, and sphygmomanometer
 Stretcher or bed for proper positioning during a physical exam
 Hand hygiene products, personal protective equipment if required
 Alcohol swabs, sanitizer, or soapy water to clean equipment after use, such as with stethoscopes,
to decrease the likelihood of cross-contamination of pathogens from inanimate objects (follow
any manufacturer guidelines or institutional policies)
 Computer or paper chart to document findings
 Calculation devices for BMI, conversion from pounds to kilograms, kilograms to pounds, Celsius
to Farenheight

2. ANSWERS
Health history and physical examination lead to the identification of life-threatening conditions
that can be stabilized promptly, ensuring better patient outcomes because the earlier a patient is
assessed correctly,the more likely a life-altering condition is recognizable, enabling formulation
of a proper nursing diagnosis leading to appropriate action or treatment and stabilizing care

rendered .
In health history and physical examination,Physiological abnormalities manifested by changes in
vital signs and level of consciousness often provide early warning signs that patient condition is
deteriorating thereby causing prompt intervention to prevent an adverse outcome thereby
reducing the death risk.

3. ANSWERS
  Imagery (Using the mind to visualize an experience) is some times called day-dreaming.The
images a person uses are chosen from pleasant memories so this destructs them from
perceiving the pain.
 Meditation: Here the person concentrated on a word or idea that promotes tranquility. It is
similar to imagery, except the subject matter tends to be more spiritual.Sometimes meditation
involves silent repetitions of a word such as Love or Peace.
 Destruction: This is intentional diversion of attention., switches the persons focus from
unpleasant sensory experience to the one that is neutral or more pleasant. Example talking
with the person, watching TV, participating in a hobby and listening to a music.
 Relaxation: This is a method/ technique for releasing muscle tension and quieting the mind. It
helps to reduce pain, relieve anxiety and promoting a sense of well-being. Consciously
relaxing breaks the circuits among neurons that are overloading the brain with distressing
thoughts and painful stimuli.
 Heat and cold tecnique: Application of heat or cold are well established techniques for
relieving pain.Pain caused by an injury is best Rx initially with cold application ( ice bag, or
chemical pack). Cold reduces localized swelling and decreases vasodilation, which carries
pain producing chemicals into circulation.
 Others include; Transcutaneous electrical nerve stimulation,Acupuncture (long thin needles
are inserted into skin),Percutaneous electrical nerve stimulation ( involves combination of
acupuncture and Transcutaneous electrical nerve stimulation.) and hypnosis.

4. ANSWERS
1. I will asses the patient's pain every one and a half hours and I will use the visual analogue
scale.
2. I will use the heat and cold technique because Cold reduces localized swelling and decreases
vasodilation, which carries pain producing chemicals into circulation and heat increases
circulation and blood flow which can reduce cramping and stiffness.
3. Yes, your pain medication is causing your constipation and I will advise the patient to
increase her fluid intake as well get dietary fibre intake.