Assessment Techniques and Safety in The Clinical Setting

Question 1

What is the first step in the assessment process?

Answer 1

IPPA

Inspection. Careful, thorough observation

Question 2

What do you do during Inspection?

Answer 2

Symmetry
Compare the patient’s right with the left side.

Look for similarities/differences

Question 3

Should you use dark or good lighting during inspection?

Answer 3

Good lighting

Question 4

What should we do during inspection to make sure that we are respecting the patient and keeping them comfortable?

Answer 4

Obtain adequate exposure. Only show the amount of body that you need to expose, keep other areas covered.

Question 5

What is the second step of assessment?

Answer 5

IPPA

Palpation; using sense of touch.

Question 6

What are things we assess with palpation?

Answer 6

texture
temperature
moisture
organ size & location
Swelling
vibration or pulsation
rigidity or spasticity
presence of lumps
presence of tenderness or pain

Question 7

What is light palpation used for?

Answer 7

used to detect surface characteristics

Question 8

What is deep palpation used for?

Answer 8

used for intermittent pressure to examine abdominal contents

Question 9

What is bimanual palpation used for?

Answer 9

Used to assess deeper structures

Question 10

What do we use the fingertips for?

Answer 10

For fine discrimination of texture, swelling, pulsation, presence of lumps

Question 11

What is a grasping action of finger and thumb used for?

Answer 11

used to detect the shape, size, position, and consistency of an organ

Question 12

What are the base of the fingers or ulnar surface used for?

Answer 12

To detect vibration

Question 13

What do we use the dorsum for?

Answer 13

to detect temperature changes

Question 14

Before palpating, what should you ask the patient?

Answer 14

Ask if they have any tender areas and then palpate these areas last.

Question 15

What type of palpation should you always begin and end with?

Answer 15

Always begin with light palpation and move to deep palpation last

Question 16

What is the flow of palpation?

Answer 16

Top to bottom

left to right

Question 17

What are common areas for palpation?

Answer 17

Lymph nodes (neck)
sinuses
abdomen
spine
pulses
uterus
heart

Question 18

How do you palpate the lymph nodes?

Answer 18

both sides of neck simultaneously

Question 19

How do you palpate the sinuses?

Answer 19

Both sides simultaneously

Question 20

How do you palpate the abdomen?

Answer 20

in a clockwise pattern

Question 21

How do you palpate the spine?

Answer 21

top to bottom

Question 22

How do you palpate pulses?

Answer 22

simultaneously right and left

or individually

Question 23

How do you assess the uterus?

Answer 23

bimanually

Question 24

How do you palpate the heart?

Answer 24

Fingertips over the pericardium

Question 25

What is the third step of assessment?

Answer 25

IPPA Percussion

Question 26

What is percussion?

Answer 26

Tapping the skin with short, sharp strokes that produce a vibration (with a characteristic sound) to assess underlying structures.

Question 27

T/F: Percussion can *map the location and size* of an organ.

Answer 27

TRUE It can map the location and size of an organ as the sound will change as you move off/away from the organ.

Question 28

T/F: Percussion cannot measure the density of an underlying structure.

Answer 28

FALSE percussion can measure the density of an underlying structure. Sounds will change as one percusses over air, fluid, or solid structures.

Question 29

Can percussion detect an abnormal mass?

Answer 29

yes: can be detected up to 5 cm deep.

Question 30

T/F: Percussion can determine the disease state of a structure. Example: the kidney

Answer 30

FALSE Percussion cannot determine the disease state but can depict the location, size, and density of an organ.

Question 31

T/F: Percussion can detect underlying inflammation.

Answer 31

TRUE Percussion can facilitate pain, indicating underlying inflammation.

Question 32

T/F: Percussion cannot elicit a deep tendon reflex.

Answer 32

FALSE Percussion can most definitely elicit a deep tendon reflex.

Question 33

What does the stationary hand do in the percussion technique?

Answer 33

It is usually the hyperextended middle finger, with the distal portion firmly against the skin. Make sure to lift the rest of the hand off the skin to avoid dampening vibrations.

Question 34

What does the striking hand do in the percussion technique?

Answer 34

the top of the middle finger of the dominant hand will strike the stationary finger 2 times just behind the nail bed. Make sure to lift off quickly and use enough force to get a clear note.

Question 35

Resonant

Answer 35

over normal lung tissue, sounds clear and hollow.

Question 36

Hyperresonant

Answer 36

Abnormal in adults, a sign of emphysema normal over a child's lungs

Question 37

Tympany

Answer 37

over abdomen (air-filled areas), sounds drum like

Question 38

Dull

Answer 38

over organs (liver), sounds like a muffled thud

Question 39

Flat

Answer 39

over bone, muscle, and tumor; the sound comes to a dead stop.

Question 40

Structures with more air will produce

Answer 40

A louder, longer, and deeper sound. It vibrates freely ex. lungs

Question 41

Denser more solid structures will produce

Answer 41

A softer, higher, shorter sound. It cannot vibrate as easily. ex. liver

Question 42

What is the fourth step of assessment?

Answer 42

IPPA Auscultation; using sense of hearing

Question 43

What is auscultation?

Answer 43

Using a stethoscope to block out room sounds so that you can hear sounds produced by the body.

Question 44

What kind of sounds is the diaphragm of a stethoscope used for?

Answer 44

high pitched sounds ex. lungs, abdomen, heart

Question 45

What kind of sounds is the bell of the stethoscope used for?

Answer 45

low pitched sounds ex. vascular sounds, extra heart sounds, murmurs.

Question 46

Which of the following techniques uses the sense of touch when assessing the patient? A Palpation B Inspection C Percussion D Auscultation

Answer 46

A. Palpation