Proper Exam Techniques - Expose or Fail

[JPINFV]

For a variation on this, watch the various ways that students ask male patients to move their penis and testicles out of the way of the pubis rest on the sager splint. "Umm... sir I need you to get your... friends, out of the way so we can put this on you."

As with everything, there's a Scrubs clip that addresses this.

[spenac]

To make sure people do a proper exam I would like to make it required that all patients have all clothes removed and a hospital gown put on. This would serve the purpose of helping those that refuse to look to have no excuse not to look. It also would discourage those with no reason for being on the ambulance to maybe decide they really can go by other means to the hospital.

[Jeepluv77]

Actually skin gets warm before BP and puls changes show up. If not exposed and touched it will be missed.

Thank you, spenac. I was also taught that there could be visual differences in the skin/muscle tone(overly rigid or "squishy"), color, etc that you may or may not be able to feel through something like jeans. And that, when in doubt, you can document/mark the swelling(much like you might with something like an insect or snake bite) and you may notice if it is changing too much or too rapidly. I haven't seen it in practice yet, but I know when I do my chances of having that gut instinct that tells me something isn't right will probably be a lot more on point if I have a visual baseline. Of the injury, not just a monitor. Especially with kids as I know they can compensate until it's almost too late then just bottom out.

[logos]

You touched my booby, and I'm calling my lawyer!

I like to use the patient's hand to push back pendulous breasts (as opposed to pushing them back myself) for both auscultation and attempts to reproduce likely MSK chest pain. With this method I can then push on her hand to move them in whatever way is necessary to complete the exam.

As far as listening through clothing, I admit I do it for heart sounds when I need to, just takes too much time otherwise, but i'm in a hospital setting (not a medic...just like your forums ) so this is through a thin gown. As long as I can hear the heart sounds and document "RRR NL S1S2 no M/R/G" then that's enough for me. I don't do it for posterior lung sounds because there often seems to be some rubbing up and down of the gown that makes sounds that can easily be confused for crackles.

[RatPack]

Actually skin gets warm before BP and puls changes show up. If not exposed and touched it will be missed.

If you say so.

I will base my findings on something a little more substantial. Like BP, HR and pt. presentation.

I agree skin tempature is a vital sign, however its a poor indicator in this example.

Im not arguing the point of exposure of the affected area. Just stating there are more reliable indicators then skin tempature.

Edited March 20, 2009 by RatPack

[spenac]

If you say so.

I will base my findings on something a little more substantial. Like BP, HR and pt. presentation.

I agree skin tempature is a vital sign, however its a poor indicator in this example.

Im not arguing the point of exposure of the affected area. Just stating there are more reliable indicators then skin tempature.

Not only temp but also skin coloration changes often are seen before you get BP and pulse changes. If I wait till they crash to start treating I am behind and might never catch up.

[emt322632]

If you say so.

I will base my findings on something a little more substantial. Like BP, HR and pt. presentation.

I agree skin tempature is a vital sign, however its a poor indicator in this example.

Im not arguing the point of exposure of the affected area. Just stating there are more reliable indicators then skin tempature.

If you're waiting for changes in BP, HR and presentation, you're waiting too long...

Back to the forum...

Prior to going to nursing school I was very guilty of auscultating through clothes and not wanting patients to disrobe for an assessment. Now though, it's second nature, and really has to do with more confidence on my part. If I come across as a calm, cool and collected professional, I can gain the patient's trust and things will go alot smoother.

My nursing instructor made a very good point, though it was in regard to bathing patients, never ask. I had problems with my patients saying they didn't want a bath, and she asked me how I presented it to them. I said "I ask them..." and she simply said don't ask, don't give them the option of not bathing. So now it's "When do you want to wash up?"

So, instead of "Is it alright with you if I check your stomach and chest for injuries?" It's..." I need to check your stomach and chest for injuries..."

I haven't had any problems since...

[spenac]

..." I need to check your stomach and chest for injuries..."

I haven't had any problems since...

Exactly. Tell them your doing this or that, don't ask if you can. Act like you've done it a million times and that you expect to do it a million more. Don't be hesitant, or acting nervous. Do it like it is what is the standard practice because it is or at least should be.

Edited March 20, 2009 by spenac

[RatPack]

If you're waiting for changes in BP, HR and presentation, you're waiting too long...

Good Lord. All I stated was skin tempature is a poor indicator of internal blood loss.

Nobodys waiting for anything....

Thats it im done.

[spenac]

Good Lord. All I stated was skin tempature is a poor indicator of internal blood loss.

Nobodys waiting for anything....

Thats it im done.

No need to run away. We enjoy people discussing their different point of view. The problem with forums is at times what we mean and what everyone else interpets are often 2 very different things. Just as my comment about skin temp in my mind would also include what I saw. But you and others took that as all I meant. Then we took your statement about vitals etc as your main point rather than what it was. See how confusing this all is. Come back and enjoy being confused like the rest of us.