CH 8: Assessment Techinques Flashcards
what is inspection?
careful and thorough observations
*1st step in assessment
-begins moment you meet patient
-compare R & L side: look for symmetry, similarities, differences
palpation uses?
touch
light: detects surface characteristics
deep: intermittent pressure to examine abdominal contents
*auscultate abdomen (not palpate- it can stimulate diff patterns)
light palpations in tender areas last, don’t hurt patient
palpation techniques?
slowly and systematically w calm/gentle approach
palpate tender areas last
begin w light and move to deep
what is assessed during palpation?
texture, temperature, moisture, organ location and size
*cannot determine disease state
what is detected during palpation?
swelling, vibration, pulsation, rigidity, crepitation, lump, mass, tenderness, pain
parts of hand used for palpation?
fingertips: fine discrimination such as texture, swelling, pulse, lumps
grasping (finger and thumb): detect shape, size, position, and consistency of organ
base of fingers: detect vibration
dorsum of hand (back): temp changes
bimanual: compare both sides
*don’t take pulse with thumb
palpation flow?
top to bottom
left to right
simultaneously
compare symmetrically
relaxation techniques for deep
common palpation areas?
lymph nodes (neck): simultaneous
sinuses: simultaneous
abdomen: clockwise pattern
spine: top to bottom
pulses: simultaneously or individually
uterus: bimanually
heart: fingertips over precordium
percussion?
tapping skin- short, sharp strokes to produce vibration to assess underlying structures
-sound that depicts size, location, density of organ
-sound changes when you move away from organ, maps location and size
-density: sound change as you percuss over air/fluid/solid
abnorm mass: detected up to 5 cm deep
pain: detect underlying inflammation
tendon: can elicit deep tendon reflex
*common when assessing ascites or pneumonia
percussion methods?
stationary hand: hyperextend middle finger, distal joint and tip only firmly to skin
striking hand: middle finger, hold forearm to skin, flex pointer finger so tip makes contact
percussion sounds?
structures with more air: louder, longer, deeper sound (can vibrate freely, like lungs)
denser/solid structures: softer, higher, shorter (cannot vibrate easily, like liver)
sound characteristics?
amplitude (intensity): loud or soft
pitch (frequency): number of vibrations per second
quality (timbre): subjective difference
duration: length of time sound lingers
resonant: (over lungs) clear and hollow
hyper resonant: child lungs or COPD
tympany: air filled areas (abdomen), drum like sound
dull: sounds muffled (liver)
flat: over bone, muscle, tumor, sound comes to deadstop
stethoscope detection?
diaphragm: high pitch sounds (lungs, ab, heart) place firmly
bell: low pitch (vascular sounds, extra heart sounds) place lightly
what should you do when conducting physical exam?
develop and stick to sequence
logical flow- avoid multiple position changes
forget something- go back when easiest for patient
speak to patient periodically
for older adults
slower pace
consider visual/hearing deficits
as few position changes as possible
possible rest periods
*verify patient name and DOB
standard precautions?
hand hygiene
gloves/mask/eye protection/face shield
PPE
