Preparing for the Objective Assessment

In preparation for the objective assessment, you should consider several things.

Inquire whether the client needs to go to the bathroom. Clients will be more comfortable during assessments if they have an empty bladder and bowels. This is especially true when performing assessments on the abdomen or assessments of pregnant women, because palpation may cause discomfort if the bladder or bowels are full. In addition to client comfort, it is important to anticipate other steps or possible actions when preparing for an objective assessment. For example, if the client’s reason for seeking care is pain upon urination, you will likely ask the client to collect a urine sample while they empty their bladder.

You should also prepare the environment before beginning, including organizing the necessary equipment and supplies (e.g., hand sanitizer, alcohol pads, penlight, stethoscope, drape). See Figure 2 below for an overview of equipment used.

Figure 2: Equipment

When caring for young children, you might want to engage them in helping you set up the equipment. Children are often fearful or curious about equipment, and engaging them in setting up equipment can make the assessment and equipment seem less scary and also make them more familiar with you. You might show them your stethoscope and let them touch it. Infants and toddlers may be calmer if the care partner holds them on their lap. Make sure the room is well lit for the examination, and ensure the client’s privacy by closing the curtains or the door.

Ensure the client’s privacy and warmth.

• You should close the room door and/or the curtains.
• Depending on the assessment, you may need the client to put on a gown. For example, a gown is appropriate if you are doing a complete head-to-toe assessment. Most clients wear gowns when they are in hospital, but sometimes they prefer to wear their own clothing. If a gown is required, provide it to the client and explain that it should be tied up at the back, but occasionally the front, depending on the examination being performed. You should also indicate whether all clothing should be removed or whether they can leave on socks and undergarments. For privacy, leave the room as the client changes into the gown, unless they require assistance.
• Use a drape and only expose the area of the body that you are assessing, and then cover the client back up. You can engage the client by having them hold the drape and guide them on how to cover themselves up. There are two types of drapes:
  • Disposable drapes – these are non-reusable and should be discarded in the garbage when done. They are often used in primary care clinics.
  • Reusable drapes – these are usually made of cotton or flannel and are like a small sheet. They can be disposed of in the laundry, washed, and reused.

You may need to reposition the client depending on the part of the body being examined. Consider what body positioning will be needed for you to conduct the examination. You should minimize repositioning as much as possible, especially with clients who have mobility difficulties, those who are experiencing pain, and those who may be medically unstable.  Although this applies to all clients, you should be attentive to the older adults who tend to have more mobility and balance issues than younger clients. You may involve a care partner in helping position a young child or older adult who needs assistance. With young children, it can be helpful to engage care partners in the assessment so that the child feels more comfortable with you. For example, you may encourage the care partner to hold the child in their lap as you assess so that the child is comfortable and you can obtain the best results.

Consider your own body positioning and the importance of ergonomics and body mechanics to prevent or reduce any risk of injury. For example, raise the bed to a working level: this is usually to a height between your upper thigh to your waist, depending on the task. This will help you minimize twisting your body and having to reach down or up to perform the examination.

Modify your approach to the client’s developmental stage, which does not always align with their chronological age. This will require attention to elements such as language and cognitive and socio-emotional development. At times, you may need to modify your communication so that you are appropriately engaging with the client at a level that they understand. Specifically, you might want to:

• Involve care partners (usually parents) when assessing infants and children to help position them. Use playful approaches, a friendly vocal intonation, and smile to avoid frightening children. You could play peekaboo and let children grasp objects like stethoscopes. You might incorporate their favourite objects such a teddy bear or a blanket into the physical assessment, for example by using your stethoscope on their teddy bear. Distracting children from the assessment technique and engaging them in play while performing techniques will require practice.
• You may or may not have a care partner present when performing a physical assessment of an adolescent client. It will often depend on the specific client, but you might consider offering options such as, “would you like to have your parent present for the first part of the physical exam, and then they can step out at the end?” This population will be experiencing changes in their body, so a non-judgemental and accepting attitude is important, as well as the use of permission statements.
• With older adults, you should modify your approach to their specific needs. Some older adults are quite independent and healthy, while others are experiencing significant changes in their body and its functioning. Thus, you should assess for hearing, vision, physical strength, and balance, which may affect how you explain and perform the assessment; this might also be needed for clients in other age groups.

Activity: Check Your Understanding