Ch. 8: Assessment Techniques and Safety in the Clinical Setting

What's the role of the examiner?

introduce yourself, state purpose of exam, ask if room is up to their standards, ensure patient is dressed properly/has privacy, and wash hands in front of patient

How can you keep a clean field?

wipe everything down before and after your patient

What's the general approach to assessing your patient?

wash hands, use gloves if needed, take basic measurements, build trust, document as you go from head to toe, and keep patient warm

How do you build trust with patient?

start by working with hands

What are the four major assessment techniques? What order are they done in?

inspection, palpation, percussion, and auscultation (in that order)

What do you do during the inspection portion?

carefully watch the patient, compare right to left, inspect each body system, START WITH HANDS!!

What do you do during the palpation portion?

use your hands to feel the body and confirm what you saw during inspection

What should you use your fingertips for during palpation?

feeling for texture, swelling, and lumps

What should you use your fingers and thumbs for during palpation?

check organs/masses shape, consistency, and position

What should you use your back of the hand for during palpation?

feeling temperature

What should you use your base of the hand for during palpation?

best for feeling vibration

What do you do during the percussion portion?

tapping the skin to make sounds that tells you whats underneath

What is amplitude?

intensity

What is pitch?

number of vibrations per second

What is quality?

difference between sounds

What is duration?

the length of time the note lingers

If there is abdominal issues what order would IPPA go in?

auscultation goes first

If there is a baby what order would IPPA go in?

auscultation, percussion, palpation, and inspection (GO BACKWARDS)

What does resonant sound like?

- hollow, low pitch, medium amp, moderate length

- found over normal lung tissue

What does hyper-resonant sound like?

- booming, lower pitch, louder amp, long length

- found over child's lung

What does tympany sound like?

- drumlike, high pitch, loud amp, longest in length

- found at stomach or the intestine

What does dull sound like?

- muffled thud, high pitch, soft amp, short length

- found in liver or spleen

What do you do during the auscultation portion?

listening to body sounds with a stethoscope

What are the parts of a stethoschope?

ear tips, ear tubes, tubing, diaphragm, (big part), and bell (small part)

What's an otoscope used for?

looking into ear canal

What's an ophthalmoscope used for?

looking at eyes

What is high fowler seating?

patient sitting with legs dangling

What is the lithotomy position?

Lying flat on the table with feet on stirrups, and legs apart

What is the semi fowler position?

The head of the bed is at 30 degrees and knees are flat

How do you assess an infant?

place baby on table (mom can hold when baby reaches 6 months), keep tools warm, do head, ears, eyes, nose, then throat

When should the baby be fed for a doctors appointment?

exam be 2 hours after fed

How do you assess a toddler?

allow to sit on parent, sit knee to knee, temp and ears won't go well, get info from parent, ask parent to undress when needed

How do you assess a preschooler?

they can answer questions, let them undress, leave underwear on, allow parents to undress, explain whats going to happen and let them examine tools

How do you assess a school age child?

sit on table, allow privacy, use small talk, demo tools before use, use head to toe sequence

How do you assess an adolescent?

privacy, they want to be normal, aware of body image, communicate abt hygiene, and assess emotional state

How do you assess a aging adult?

allow rest periods, physical touch is important, do not mistake diminished vision or hearing for confusion, be aware they have more life stressors