Chapter 8: Assessment Techniques and Safety in the Clinical Setting

Airborne Precautions

Infection control measures for diseases spread through tiny airborne particles (e.g., TB, measles, chickenpox), requiring special masks and negative-pressure rooms.

Amplitude

The loudness or softness of a sound heard during percussion or auscultation.

Auscultation

Listening to sounds produced by the body, usually with a stethoscope.

Bell

The small, concave part of the stethoscope used to hear low-pitched sounds like murmurs.

Contact Precautions

Measures used for infections spread by direct or indirect contact (e.g., MRSA, C. diff), requiring gloves and gowns.

Diaphragm

The flat side of the stethoscope used to hear high-pitched sounds like breath, bowel, and normal heart sounds.

Droplet Precautions

Infection control for illnesses spread by large respiratory droplets (e.g., influenza, pertussis), requiring masks within close range.

Dull

A percussion note that is soft and muffled, heard over dense organs like the liver.

Duration

the length of time a note lingers

Inspection

The careful visual examination of the patient’s body as the first step of assessment.

Palpation

Using touch to assess factors such as texture, temperature, moisture, swelling, or tenderness.

Percussion

Tapping on the body surface to produce sounds that reflect underlying structures.

Pitch or frequency

The number of vibrations (or cycles) per second of a note

Quality or timbre

A subjective difference in a sound as a result of the sound's distinctive overtones

Resonant

A clear, hollow percussion sound typically heard over healthy lung tissue.

Standard Precautions

The basic infection prevention practices used with all patients, including hand hygiene and protective equipment.

Transmission-based precautions

Additional infection control measures (airborne, droplet, contact) used for patients with known or suspected infections.

Tympany

A loud, high-pitched, drumlike percussion sound heard over air-filled structures like the stomach or intestines.

Assessment (4 parts)

1. Inspection

2. Palpation

3. Percussion

4. Auscultation

Step 1: Inspection

• Starts with General Survey

• Use your vision

• Try not to rush

• Compare right to left

• Ensure good lighting and necessary instruments

Step 2: Palpation 

• Texture, temperature, moisture, organ location / size, and any swelling, vibration, pulsations, rigidity, spasticity, crepitation, presence of lumps or masses and tenderness or pain.

  • Fingertips - best for tactile discrimination skin texture, swelling, pulsation and lumps

  • Back of hands - temperature, not as thick as palms

  • Base of fingers - bony, best for vibration

• Palpate the painful areas last

Step 3: Percussion

• Not something we do frequently anymore - testing, imaging has replaced this

• A stationary and striking hand - assessing for a quality of sound

Step 4: Auscultation

• Personal instrument

• Utilize the diaphragm and bell

  • Low frequency - bell

  • High frequency - diaphragm

• Remove extra sounds in the room

• Warm the equipment

• Never listen through clothing

• Avoid artifacts - jewelry, finger tapping, etc. 

• What am I hearing? What should I be hearing?

Setting

• Any precautions?

• Hand hygiene

• Warm, comfortable, private, well lit

• Comfortable height of examination table

• Clean environment

Precautions and Personal Protective Equipment

• Transmission-based precautions are additional precautions used with certain infectious agents

  • Contact

  • Contact Plus

  • Droplet

  • Airborne

Standard precautions = precautions you take with every patient encounter, such as handwashing and wearing gloves