Physical assessment - Equipment: Nursing

As the nurse, you’ll use examination equipment as you perform a physical assessment to collect information about your patient’s health status. Several commonly used items include a stethoscope, otoscope, ophthalmoscope, penlight, and tape measure.

A stethoscope is used to auscultate, or listen to sounds made by your patient's body, like lung, heart and bowel sounds. Your stethoscope should have both a diaphragm and a bell. The diaphragm is used to detect high-frequency sounds like bowel or lung sounds, while the bell is used to detect low-frequency sounds, like heart sounds. When you’re using the diaphragm, you’ll place it firmly against your patient’s skin. But when you’re using the bell, you’ll place it lightly on your patient’s skin, since too much pressure causes the bell to act like the diaphragm, and it won’t effectively transmit low-frequency sounds.

Also remember to eliminate potential artifacts, which are extra sounds that can affect what you hear through the stethoscope. These can be caused by noises in the room, the patient’s body hair or clothing, or touching the tubing on the stethoscope. To eliminate artifacts, perform auscultation in a quiet setting, avoid bumping the tubing, and be sure to place the diaphragm or bell directly on your patient’s skin instead of auscultating through clothing. Lastly, when putting the earpieces into your ears, remember to keep them pointed in the same direction as your ear canals, which means they should be pointing toward your nose.

Next is the otoscope, which is a device that shines light into the ear to visualize the ear canal and eardrum, also known as the tympanic membrane. The base of the otoscope serves as the handle, which also contains the batteries for the light source and the on-off switch. The handle attaches to the head, which contains the magnifying lens and light source. You’ll attach an appropriately sized, disposable, plastic speculum to the head, which funnels the light into the ear canal. Before inserting the speculum into your patient’s ear, straighten the ear canal by pulling the pinna down and back for patients under three years old, and pulling the pinna up and back for patients three years old and older.