Chapter 8- Assessment Techniques and Safety in the Clinical Setting

Order of skills performed at one time

1. Inspection

2. Palpation

3. Percussion

4. Auscultation

Inspection

• Look at the patient

Palpation

Touch them

Percussion

Reflex hammer

Auscultation

Listen to their lungs

Why are these skills in that specific order

• Starts with least invasive

• Start with first because it can change order

When does inspection begin

when you first meet person with a general survey

• symmetry of face

• bruises or scrapes

• is color consistent with ethnicity

• non verbal cues

• nourishment

• do they look cold

• once gown is down, inspect skin and breathing

what does inspection require

• good lighting

• adequate exposure

• occasional use of instruments, including otoscope, ophthalmoscope, penlight, or nasal and vaginal specula, to enlarge your view

What does palpation involve?

Using the sense of touch to assess a patient's condition.

What aspects can be assessed through palpation?

• Texture,

• temperature (use back of hand)- forehead, is there symmetry in temperature on both legs

• moisture

• presence of tenderness or pain.

When to use fingertips for palpation

Pulses or lumps

When to use fingers or thumb for palpation

Feeling size of organ

When to use dorsa (back) of hands and fingers

Feeling temperature

When to use base of fingers or ulnar surface of hand

• Base of fingers- feeling vibrations (like a murmur)

What is the first step in palpation?

Start with light palpation to detect surface characteristics and accustom the person to being touched.

When should deeper palpation be performed?

Perform deeper palpation when needed, after light palpation.

What is the preferred method for applying pressure during palpation?

Intermittent pressure is better than one long continuous palpation.

What is percussion?

Tapping the person’s skin with short, sharp strokes to assess underlying structures.

What are the uses of percussion?

• Mapping the location and size of organs

• Signaling the density of a structure by a characteristic note

• Detecting a superficial abnormal mass

• Eliciting pain if the underlying structure is inflamed

• Eliciting deep tendon reflex using a percussion hammer

What is auscultation?

Listening to sounds produced by the body.

• heart, lungs, abdomen

• bell used for murmur

What is the purpose of the diaphragm of a stethoscope?

The diaphragm, with its flat edge, is used to listen to high-pitched sounds.

• used for listening to heart, lungs, and abdomen

What is the purpose of the bell of a stethoscope?

The bell, with its deep, hollow cuplike shape, is used to listen to soft, low-pitched sounds.

• only used for murmurs

Auscultation Basics

• eliminate extra noise

• warm your stethoscope

• avoid listening over hairy body areas

• always listen skin to skin

• avoid your own artifact

What are the four characteristics of sounds in auscultation and percussion?

• Amplitude (intensity): Loud or soft sound

• Pitch (frequency): Number of vibrations per second

• Quality (timbre): Subjective difference in tone

• Duration: Length of time the sound lingers

How does the structure of an area affect the sound produced?

A structure with more air produces a louder, deeper sound, while a denser structure produces a softer, higher-pitched sound.

• A structure with more air allows sound waves to travel more freely, creating a louder, deeper sound. The air's lower density helps the waves move more easily and vibrate with more power. In contrast, a denser structure resists vibrations, leading to softer sounds and higher pitches because the vibrations are quicker and more restricted.

Why might variations in sounds occur during clinical practice?

Variations can occur due to individual anatomical differences.

What is the single most important step to decrease microorganism transmission

Hand washing

When to wash hands

• before and after physical contact with each patient (sanitizer)

• after inadvertent contact with blood, body fluids, secretions, and excretions (soap)

• after contact with any equipment contaminated with body fluids (soap)

• after removing gloves (sanitizer)

when do you wear gloves

• when potential exists for contact with any body fluids

• wearing gloves is not a protective substitute to washing hands

• wear a gown, mask and protective eyewear when potential exists for any blood or body fluid spattering

Standard precautions for use with all patients

• hand hygeine

• use of gloves, mask, eye protection or face shield

• respiratory hygiene/cough etiquette

• PPE (gloves, gown, mask for bodily fluids)