Objective Assessment Techniques [TMU - NSE 103 - WEEK 1 - IPPA - LAB - W2026]

Objective Assessment

  • Definition: The objective assessment involves the processes of observing and measuring health status to identify normal and abnormal findings.

  • Key Components:

    • Recognizing abnormal cues: The ability to notice indications that deviate from expected health status.

    • Acting on abnormal cues: Taking the necessary steps based on identified abnormal findings to ensure patient safety and care.

  • Source: (Lapum & Hughes, 2024)

Trauma-informed Approach (Review)

  • Definition: A trauma-informed approach recognizes the presence of trauma symptoms and acknowledges the role it may play in a patient’s life.

  • Connection to Physical Touch: Considerations surrounding the appropriateness of physical touch in the context of trauma, emphasizing the need to understand individual triggers surrounding personal experiences of trauma.

  • Source: (Lapum & Hughes, 2024)

Preparing for the Objective Assessment

  • Key Preparations:

    • Bathroom: Ensure patients have access to a bathroom prior to assessment, minimizing discomfort.

    • Prepare the Environment:

    • Maintain privacy and warmth to create a comfortable atmosphere for the patient.

    • Consider body positioning and mechanics to optimize assessment efficacy.

    • Developmental Considerations: Tailor assessments according to patient age and developmental stage, recognizing children or elderly may have different needs.

    • Care Partners: Involve care partners as appropriate for support during assessments.

  • Note: It is essential to always perform assessments on bare skin to ensure accurate results.

  • Source: (Lapum & Hughes, 2024)

Infection Prevention and Control (Review)

  • Objective: To prevent and reduce the transmission of microorganisms during healthcare assessments.

  • Key Actions:

    • #1 Action: Hand hygiene is crucial and remains the most effective way to prevent infection.

    • Additional measures include:

    • Personal protective equipment (PPE): Use appropriate PPE based on assessment needs.

    • Cleaning equipment: Ensure all tools and instruments are cleaned and sterilized before use.

  • Source: (Lapum & Hughes, 2024)

Anatomical Locations

  • Application: Familiarization with anatomical structures is vital for accurate assessment.

  • Techniques: Use of personal hands to determine anatomical positioning and proper alignment during assessments.

  • Anatomical Position: Adopt the anatomical position as a reference point, which involves standing upright with arms at the sides and palms facing forward.

  • Anatomical Reference Points: Important landmarks for physical examination.

  • Source: (Lapum & Hughes, 2024)

Inspection

  • Purpose: A systematic approach to observe visible body structures to identify normal and abnormal findings.

  • Technique: Conduct a bilateral comparison; assess the client overall first and then evaluate specific body areas.

  • Note: Record both normal findings and any abnormalities that may arise during inspection.

  • Source: (Lapum & Hughes, 2024)

Palpation

  • Definition: The use of hands and fingers to assess physical characteristics of body structures.

  • Permission to Touch: Always obtain permission prior to touching the patient.

  • Bilateral Comparison: Compare findings on both sides of the body to identify any discrepancies.

  • Importance: Document both normal and abnormal findings during palpation.

  • Source: (Lapum & Hughes, 2024)

Palpation – Dorsal Aspect of Hands

  • Temperature: Refers to the degree of heat or cold an object possesses. Use the dorsal surface of hands to assess the temperature of surfaces (e.g., skin).

  • Source: (Lapum & Hughes, 2024)

Palpation – Use of Fingertips

  • Texture: Assessment of the smoothness or roughness of a surface.

  • Thickness: Evaluating how thin or thick an object is during palpation.

  • Moisture: Determining the amount of wetness or liquid present on a surface.

  • Swelling and Masses: Use fingertips to assess swelling and masses; a grasping motion can determine the size and density of a mass.

  • Pain/Tenderness: Best assessed with fingertips while keeping hands and wrist parallel to the body; always assess a painful area last.

  • Fingertips Usage: Commonly used to assess various glands, organ location, size, and density.

  • Pulsatility: Refers to the pulsations associated with the cardiovascular system; typically assessed by placing the pads of three fingers over a pulse location. Also used to evaluate apical impulse with the index finger.

  • Crepitus: This term describes abnormal sounds or sensations, such as subcutaneous crepitus, when air becomes trapped in subcutaneous tissues.

  • Source: (Lapum & Hughes, 2024)

Palpation – Cupping of Hand or Grasping of Fingers/Thumbs

  • Assessment: Used for bones, muscles, trachea, and testicles using a gentle grasping motion.

  • Crepitation: An abnormal grating sound or sensation felt over joints where bones meet during the assessment.

  • Source: (Lapum & Hughes, 2024)

Palpation – Metacarpophalangeal Joints or Ulnar Surface of Hands

  • Vibration: A subtle oscillating movement indicative of varying health states, often felt over the lungs as tactile fremitus.

  • Pulsatility: Abnormal pulsations over the heart, referred to as "thrills," during assessments.

  • Source: (Lapum & Hughes, 2024)

Percussion

  • Definition: A technique involving tapping on the body to elicit sounds that can reveal information about underlying structures.

  • Sound Types: Sounds generated during percussion depend on the consistency of underlying structures:

    • Air-filled: Associated with normal lung tissue.

    • Fluid-filled: Indicating the presence of fluid within body cavities or structures.

    • Dense: Related to solid organs or mass.

  • Note: Document normal and abnormal findings noted during percussion.

  • Source: (Lapum & Hughes, 2024)

Percussion Technique

  • Indirect Percussion: Involves using both hands:

    • Non-dominant hand: Placed firmly on the body surface.

    • Dominant hand: Utilized to strike the non-dominant hand to produce sounds.

  • Sound Characteristics:

    • Flatness: Depicts bones such as the clavicle, ribs, and sternum.

    • Resonance: Normal lung sounds in adults.

    • Hyperresonance: Sounds indicative of normal lung in children.

    • Dullness: Sounds associated with dense organs like the liver, spleen, and heart.

    • Tympany: Sounds indicative in the abdominal area (e.g., intestines and stomach).

  • Source: (Lapum & Hughes, 2024)

Auscultation

  • Definition: Listening to body sounds with a stethoscope to gather information about health status.

  • Sound Types: Two main types of sounds are distinguished:

    • High-pitched sounds: Often associated with more acute or critical assessments.

    • Low-pitched sounds: Typically indicative of non-critical or chronic conditions.

  • Steps in Using the Stethoscope: Proper technique includes opening and closing the diaphragm or bell to match the type of sound being assessed.

  • Source: (Lapum & Hughes, 2024)

Closing the Objective Assessment

  • Summary: At the conclusion of the objective assessment, summarize findings and key points discovered during the process.

  • Next Steps: Outline the next actions based on assessment results.

  • Inquire and Questions: Allow time for any questions from the patient regarding their assessment, clarifying any uncertainties or concerns.

  • Note: Be attentive to both normal and abnormal findings noted during the assessment process.

  • Source: (Lapum & Hughes, 2024)