Basic & Advanced Physical Assessments
After successful completion of this course, you will be able to:
1. Ask appropriate questions when conducting a comprehensive health history to elicit data that will be used to guide a physical examination.
2. List the components of the comprehensive physical examination and review of systems based on red flags identified in the patient history.
3. Determine when to perform four different types of health assessments: Complete or comprehensive Interval or abbreviated Focused Special populations.
As you progress through the class, note which parts of the exam are applicable in your practice, don’t fit into your practice, or that you might want to include in your practice.
Health assessment of patients falls under the purview of both physicians and nurses. While some nurses practice in extended roles (Advanced Nurse Practitioners), others maintain a more traditional role in the acute care setting. Assessment of patients varies based on both role and setting. A cardiac care nurse will be more familiar with and attuned to cardiac issues. A nurse on a neurologic unit will be more familiar with a more complex neurologic exam.
As you progress through this course, keep in mind that exposure to a detailed health assessment may lead you to a more comprehensive and thorough exam. For instance, if you note a patient has leukoplakia (coated tongue) as you perform your general assessment, you may wonder about hygiene issues, underlying diseases, or medications that may cause this. Documenting the information, talking with the patient about it, and confirming it with the physician adds to your value as a healthcare team member, and ultimately a better patient care provider.
All assessments should consider the patient’s privacy and foster open, honest patient communications.