Assessment Techniques and Safety in The Clinical Setting Flashcards
What is the first step in the assessment process?
IPPA
Inspection. Careful, thorough observation
What do you do during Inspection?
Symmetry
Compare the patient’s right with the left side.
Look for similarities/differences
Should you use dark or good lighting during inspection?
Good lighting
What should we do during inspection to make sure that we are respecting the patient and keeping them comfortable?
Obtain adequate exposure. Only show the amount of body that you need to expose, keep other areas covered.
What is the second step of assessment?
IPPA
Palpation; using sense of touch.
What are things we assess with palpation?
texture
temperature
moisture
organ size & location
Swelling
vibration or pulsation
rigidity or spasticity
presence of lumps
presence of tenderness or pain
What is light palpation used for?
used to detect surface characteristics
What is deep palpation used for?
used for intermittent pressure to examine abdominal contents
What is bimanual palpation used for?
Used to assess deeper structures
What do we use the fingertips for?
For fine discrimination of texture, swelling, pulsation, presence of lumps
What is a grasping action of finger and thumb used for?
used to detect the shape, size, position, and consistency of an organ
What are the base of the fingers or ulnar surface used for?
To detect vibration
What do we use the dorsum for?
to detect temperature changes
Before palpating, what should you ask the patient?
Ask if they have any tender areas and then palpate these areas last.
What type of palpation should you always begin and end with?
Always begin with light palpation and move to deep palpation last
What is the flow of palpation?
Top to bottom
left to right
What are common areas for palpation?
Lymph nodes (neck)
sinuses
abdomen
spine
pulses
uterus
heart
How do you palpate the lymph nodes?
both sides of neck simultaneously
How do you palpate the sinuses?
Both sides simultaneously
How do you palpate the abdomen?
in a clockwise pattern
How do you palpate the spine?
top to bottom
How do you palpate pulses?
simultaneously right and left
or individually
How do you assess the uterus?
bimanually
How do you palpate the heart?
Fingertips over the pericardium
What is the third step of assessment?
IPPA
Percussion
What is percussion?
Tapping the skin with short, sharp strokes that produce a vibration (with a characteristic sound) to assess underlying structures.
T/F: Percussion can map the location and size of an organ.
TRUE
It can map the location and size of an organ as the sound will change as you move off/away from the organ.
T/F: Percussion cannot measure the density of an underlying structure.
FALSE
percussion can measure the density of an underlying structure. Sounds will change as one percusses over air, fluid, or solid structures.
Can percussion detect an abnormal mass?
yes: can be detected up to 5 cm deep.
T/F: Percussion can determine the disease state of a structure.
Example: the kidney
FALSE
Percussion cannot determine the disease state but can depict the location, size, and density of an organ.
T/F: Percussion can detect underlying inflammation.
TRUE
Percussion can facilitate pain, indicating underlying inflammation.
T/F: Percussion cannot elicit a deep tendon reflex.
FALSE
Percussion can most definitely elicit a deep tendon reflex.
What does the stationary hand do in the percussion technique?
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.
What does the striking hand do in the percussion technique?
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.
Resonant
over normal lung tissue, sounds clear and hollow.
Hyperresonant
Abnormal in adults, a sign of emphysema
normal over a child’s lungs
Tympany
over abdomen (air-filled areas), sounds drum like
Dull
over organs (liver), sounds like a muffled thud
Flat
over bone, muscle, and tumor; the sound comes to a dead stop.
Structures with more air will produce
A louder, longer, and deeper sound. It vibrates freely
ex. lungs
Denser more solid structures will produce
A softer, higher, shorter sound. It cannot vibrate as easily.
ex. liver
What is the fourth step of assessment?
IPPA
Auscultation; using sense of hearing
What is auscultation?
Using a stethoscope to block out room sounds so that you can hear sounds produced by the body.
What kind of sounds is the diaphragm of a stethoscope used for?
high pitched sounds
ex. lungs, abdomen, heart
What kind of sounds is the bell of the stethoscope used for?
low pitched sounds
ex. vascular sounds, extra heart sounds, murmurs.
Which of the following techniques uses the sense of touch when assessing the patient?
A Palpation
B Inspection
C Percussion
D Auscultation
A. Palpation
