Assessment and Technique and Safety in the Clinical Setting (Chapter 8) Flashcards
what is inspection
Careful, through observations
what is the very first step of the assessment process
inspection
when does inspection process begin
moment you meet individual
why do we compare patients right side with left side
looking for similarities, differences, and symmetry
we want to use good
lighting
what tools will we use
penlight, oto, opthalmoscope
what can change sounds
listening over clothing
palpation uses the sense of
touch
what do we assess during palpation
texture, temp, moisture, organ location and size
can we determine the disease state of an organ by palpating
no
we can detect what during palpation
swelling, vibration, pulsation, rigidity, crepitation, lump, mass, tenderness, or pain
light palpation
use to detect surface characteristics
deep palpation
use intermittent pressure to examine abdominal contents
what type of palpations do we start with
light and then do deep
what do we use fingertips for during palpation
fine discrimination such as texture, swelling, pulsation, presence of lumps
what do we use a grasping action for during palpation
finger and thumb can be used to detect shape, size, position, and consistency of an organ
what do we use the base of fingers for during palpation
ulnar surface to detect vibration
what do we use the dorm of our hands for during palpation
detect temp changes
why would we do bimanual palpation
compare both sides
why would we use the dorm of hand for temp
thinner skin and more sensitive
during palpation we want to ask the patient if there are any tender areas and palpate these areas
LAST
why do we want to palpate tender areas last
this could change vital signs
we can’t treat if we do not know so ask if in
pain
flow of palpation
top to bottom
left to right
Simultaneously
compare symmetry
what are some common areas of palpation
lymph nodes (neck) simultaneous
sinuses (simultaneous)
abdomen (clockwise pattern) Quadrants
spine (top to bottom)
pulses (simultaneous right and left or individually)
uterus (bimanual)
heart (fingertips over precordium)
if there is no vibration in fistula what do we call it
dead fistula
characteristics assessed by palpation
texture
temp
moisture
organ location and size
swelling
vibration or pulsation
rigidity
crepitation
presence of lumps or massess
presence of tenderness or pain
what is the 3rd step after palpation
percussion
percussion
tapping the skin with short, sharp strokes that produce a vibration to assess underlying structures
percussion emits a sound that depicts
size, location, density of an organ
percussion mapping location and size
sound will change as you move off/away from an organ
percussion density
sound will change as you precise over air, fluid, or solid structures
abnormal mass can be detected up to ___ cm deep
5
pain can detect underlying
inflammation
tendon cen elicit a _______ _______ ________
deep tendon reflex
how does the stationary hand look during percussion
hyperextend middle finger
place distal portion firmly against skin
lift the rest of the hand off the skin to avoid dampening vibrations
how does the striking hand look during perucssion
use the tip of the middle finger of dominant hand to strike 2 times
place forearm close to skin
keep upper arm and shoulder steady
action is all in wrist
bounce your middle finger off the stationary finger just behind the nail bed, lift off quickly
use enough force to get clear note
move systematically
how will structures with more air sound
louder, longer, deeper sound because it can vibrate freely (ex: lungs)
denser, more solid structures will sound like
softer, higher, shorter because they cannot vibrate easily (ex: liver)
resonant
over lung fields, sound clear and hollow
hyperresonant
over child lungs or COPD
tympany
over abdomen (air filled areas) sounds drum like
dull
over organs (liver) sounds like a muffled thud
flat
over bone, muscle, tumor, sounds come to a dead stop
Diaphragm of the stethoscope is used to detect what
high pitched sounds (lungs, abdomen, heart)
bell is red to detect
low pitched sounds (vascular sounds, extra, heart sounds) soft
what do we want to do before placing stethoscope on patient
clean with alcohol and warm it
how should the ear pieces face
toward your nose
how do we place the diaphragm
place firmly
how do we place the bell
place lightly
what side do we want to preform the exam on
right side of patient
for the older adult we want to go at a ____ pace
slow
older adults may need what in between areas of exams
rest periods
the bell of the stethoscope
A. is used for soft, low pitched sounds
B. is used for high pitched sounds
C. is held firmly against the skin
D. magnifies sound
A
which of the following techniques used the sense of touch when assessing a patient
A. palpation
B. Inspection
C. Percussion
D. Ascultation
A
what is the order for the full exam
inspection
palpation
percussion
auscultation
