IMM Week 3 (IMM 6-8)

IMM 6 - Intro to physical assessment

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clinical assessment meaning

evaluation of a patients physical condition based on information gathered from physical examination, lab and diagnostic test results, and pt health hx

when is physical assessment used in the pt care process

• gathering pt information in the pt assessment phase

• monitoring and follow up in the evaluation phase

what is physical assessment

the act of evaluating the body and its functions from head to toe

what type of data does physical assessment give us and what is that data used for

objective data that is required to make informed decisions about a pts health related probelms

why do pharmacists learn about physical assessment

• evolution of the profession and demand for cognitive services - some regualrly use in practice

• all pharmacists should have a basic understanding - all have to interpret data

• pharmacists share the responsibility for patient outcomes

barriers for pharmacists in relation to physical assessment

• need for adequate training - nonconsensus in canadian curricula

• increased workload and lack of infrastructure (eg. renumeration, lack of time, physical layout of pharmacy) - needs to be a mechanism to allow for time and space to preform physical assessment

• distraction to traditional pharmacist roles - pt concerns abt wait time for Rx’s

• infrequent use of skills to maintian competency - needs to be a mechanism to monitor skill competency

• conflicts with other health care providers

benefits of physical assessment training for pharmacists

general approach of physical assessment

bedside manners (6)

• do info gatehring BEFORE seeing pt

• respect mask guidelines/infection control precautions

• practice hand hygeine before AND after

• introduce yourself

• confirm ID of pt (name, DOB, etc)

• ensure pt is comfortable through the exam (privacy, observe bdy language, communicate throughout!)

4 fundamental physical assessment techniques

• inspection

• palpation

• percussion

• auscultation

inspection

observation fo physical signs, behavior, and movement displayed by pt

inspection stimuli can be

visual, olfactory, or auditory

percussion

• tapping of fingers on body surfaces to assess density of underlying structures (4-5 cm below skin surface)

• using fingers to indirectly strike the body surface to elicit sounds that vary in quality according to density of the underlying tissues

percussional sounds are described as (from least to most dense)

• tympanic - percussion of a hollow air filled structure as example

• hyperresonant

• resonant

• dull

• flat - percussion of thigh as example

lung vs liver percussion sounds

• lungs - resonant = healthy

• liver - dull = healthy

palpation

using sense of touch and tactile pressure to feel areas that cannot be seen

what parts of hands to use for what aspects of palpation

• pads of fingers - to distinguish hard and soft areas (eg for eval of mass)

• palm of hand - to detect presence or absence of vibrations (eg lungs)

• backside fo finegrs - to eval temp (eg demarcating limits of superifical cellulitis)

auscultation

listening to sounds originating from within an organ or body cavity by use of a stethoscope

ausculatory findings usually generated by

substances (like fluid or air) moving through body systems

what does auscultation identify

presence or absence of sounds

effectiveness of auscultatory exam is determined by

quality of the stethoscope and skill of examiner

what technique would get these example findings

percussion

what technique would get these example findings

auscultation

what technique would get these example findings

inspeciton

what method would get these example findings

palpation

t or f - the order in which PA techniques are performed is the same for all areas of body being examined

FALSE - varies depending on what part fo the body you’re examining

what body system follows this order

inspection > auscultation > percussion > palpation

abdomen - bc palpation can activate the activity of the GI tract and skew your ascultatory results

what body system follows this order

inspection > palpation > percussion > auscultation

most body areas

the scope of the pharmacist physical exam is determined by

• pt hx

• previous knowledge of the pt

• magnitude and severity of the pt problem

• need for thoroughness

• clinical settinf (inpatient vs outpatient)

• time

what is a good level of understanding for PA is suffieicnt for phamracists

for most - a general understanding is enough (some need extensive but this is dependent on the practice setting and the pharmacist role within that setting)

vital signs includes the measurement of

• HR

• RR

• BP

• temp

• Ht

• Wt

what does VS data provide

critical information that may influence the remainder of your physical examination and clinical assessment

order of ROS

• VS

• CNS (NEURO and PSYCH)

• DERM
  HEENT

• RESP

• CV

• GI

• GU

• MSK

• PVS

what method/s do we use for PSYCH

inspection ONLY

majority of information for PA assessment is captured by

observation

what does psych PA involve

conducting an MSE

MSE stands for

mental status exam

MSE parts

• appearance and behavior

• speech and language

• mood

• thoughts and perceptions

• cognition

NEURO exam involves what method/s

• inspection

• palpation

what does neuro exam involve the examination of (5)

• MSE

• cranial nerve function

• motor function

• sensory function

• reflexes

how to determine the amount of detail appropriate for the pt when conducting neuro exam

varies widely, depends on the pt

neuro is often integrated with the PA of other systems like:

• HEENT - may assess CN relating to head and neck

• PVS and MSK - may assess motor/sensory function and reflexes

DERM assessed with what method/s

• inspection

• palpation

these are exmples of what system and what method

inspection, DERM

rhse are exmaple sof what system and method

palpation derm

HEENT includes what body parts

structures of the head and neck (ie skull, sclap, face, neck, nose, sinuses, ears, mouth, pharynx, eyes)

what methods we use for HEENT

• inspection

• palpation

what system and method

HEENT inspection

system method

HEENT AGAIN HAHAHAHAHAHA inspection

method system

HEENT LMFAOOOOO inspection

method system

HEENT palpation this time tho omg did you get pranked dummy

methods used for RESP assessment

• inspection

• palpation

• percussion

• auscultation

RESP inspection

• through on insp-exp cycle

• shape and movement fo chest, use of accessory muscles, body position

RESP palpation

test chest expansion and tactile fremitus

tactile fremitus

vibrations

RESP percussion

assesses underlying tissues to see if they are filled with air or fluid

RESP auscultation

• assesses air flow through trachobronchial tree

• assesses for breath sounds and adventitous sounds

CV methods

• inspection

• palpation

• auscultation

what method and system

CV inspection

method and system

palpation CV

auscultation CV looking for what

method for GI

• inspection

• auscultation

• percussion

• palpation

method system

GI inspection

auscultation GI

percussion GI

GI palpation

GU inspected by what method/s

• inpection

• palpation

method system

inspection GU

method system

palpation GU

MSK inspected by what method/s

• inspection

• palpation

method and system

inspection MSK

method system

MSK palpation

PVS includes assessment of what

arteries, veins, lymphatic system and lymph nodes

what method/s for PVS

• inspection

• palpation

• auscultation

method system

PVS palpation

method system

PVS auscultation

system

PVS

system

MSK

system

GI

system

GI

system

CV haha

system

CV (bonus points if ou thought inspection)

system

RESP

system

HEENT

system

HEENT

system

HEENT

system

HEENT

system

DERM

system

DERM

what physical assessment techniques you perform or consider as part of pt assessment should be based on

pt hx

things to consider when doing physical assessment from ehad to toe

summary of fundamental techniques and systems

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temporal pulse

above anf towards outside the eye

brachial pulse

inner side of biceps

radial pulse

inner wrist under the line of thumb

carotid pulse

side of neck

apical pulse

apex of heart

dorsalis pedis pulse

over the instep of the foot