3120 Ch 8 Assessment Techniques and Safety

Order of physical exam skills

Inspection, palpation, percussion, auscultation

Inspection

Always first, begins when you first meet the person, requires good lighting and adequate exposure, occasional use of instruments (stethoscope, opthalomoscope, otoscope, penlight, etc)

Palpation

Use touch to assess temp, texture, moisture, swelling, vibration/pulsation, crepitation, rigidity/spasticity, organ location/size, presence of lumps/masses, pain or tenderness

Palpation- patient comfort

Start light to detect surface characteristics and may help patient relax

Deep may be uncomfortable for patient, suggest relaxation techniques

Palpation technique

Slow and systematic, calm, gentle, warm hands, short nails, identify tender parts and palpate last

Fingertips- texture, moisture, swelling

Grasping w thumb and finger- joint position, size, shape, consistency of mass

Dorsa of hand- temp

Ulnar surface base of fingers- vibrations

Percussion

Info about size/location/shape of organ, density, deep tendon reflex w hammer, fist/blunt tenderness (kidney pain)

Percussion sounds

Amplitude- loud sounds come from air-filled areas, soft/dull sounds come from fluid/solid areas

Duration- long from air-filled areas, short from dense areas

Percussion technique

Place middle finger flat and firm on skin, tap with other middle finger making 90 degree angle 2x in each spot, notice differences in spots

Auscultation

Listening to heart, blood vessels, lungs, abdomen

Basic principles of auscultation

Eliminate extra noises, keep environment and stethoscope warm, place over skin (not clothes), rubbing body hair may be mistaken for abnormal lung sounds, avoid artifacts

Stethoscope use for auscultation

Diaphragm firm for high-pitched sounds

Bell light seal for soft/low-pitched sounds (heart murmur)

Standard equipment for vital signs

Thermometer, stethoscope, sphygmomanometer, pulse ox, platform scale with height attachment, pain rating scale

Otoscope

Funnels light into ear canal onto tympanic membrane, comes with different sized attachments, use largest comfortable for patient, short broad speculum for viewing nares

Ophthalmoscope

Illuminates internal eye structures, system of lenses and mirrors enables you to look through pupil at fundus/background of eye

Equipment used to test cranial nerves

Cotton balls, test tubes, cups of water, coin/paper clip, safety pin/toothpick, substance for smell and taste, gloves

Alcohol-based hand sanitizer

Kills more organisms more quickly, less damaging to skin than hand washing

Developmental considerations- infants

Erikson stage of development: trust vs mistrust

Caregiver hold and help with anxiety, remove clothing, warm environment, 1-2 hours after feeding, start w least invasive first, save eyes/ears/nose/throat/startle reflex for last

Developmental considerations- toddlers

Erikson stage of development: autonomy vs shame/doubt

Don’t like to be restrained, caregiver help/hold, praise cooperation, least invasive first

Developmental considerations- perschool age

Erikson stage of development: initiative vs guilt

Caregiver present, kid usually cooperative, explain steps and allow them to help, curious, first- thorax/abdomen/genitalia/extremities, last- ears/nose/throat/eyes/head

Developmental considerations- school-age

Erikson stage of development: industry vs inferiority

Kid usually cooperative, progress head to toe exam like with adult

Developmental considerations- adolescents

Erikson stage of development: identity vs confusion

Work around clothes, examine alone need feedback that body is developing normally, healthy teaching, head to toe as with adults, genitalia last, peer acceptance and values important

Developmental considerations- aging adults

Erikson stage of development: integrity vs despair

Limit number of position changes, allow rest periods, slow pace, head to toe exam