Ch 9: assessment techniques and clinical setting

Question 1

Palpation

Fingertips best for _______ (eg ______), presence of lumps

Dorsa/back of hands: best for _________

Base of fingers (MCP) or ulnar surface: best for _____

Answer 1

Fingertips: fine tactile discrimination (texture, swelling, pulse)

Back of hands: temp

Base of fingers/ulnar surface: vibration

Question 2

Percussion

• used to map ___ and ___ of organ
• signal ____ of structure by characteristic note
• vibrations penetrate __ cm deep
• ______ determines loudness of note
• ______ determines clarity of sound

Answer 2

• maps location and size of organ
• signals density (air/fluid/solid)
• penetrates 5 cm deep
• force of blow –> loudness of note
• thickness of pt’s body wall –> clarity of sound

Question 3

Components of percussive sounds:

Answer 3

• amplitude (loud vs soft)
• pitch (high/low)
• quality (timbre)
• duration (short vs long)

Question 4

Percussion of organ filled with air (lungs) compared to dense structure:

• amplitude (loud vs soft)
• pitch (deep vs high)
• duration (short vs long)

Answer 4

louder
deeper
longer

Question 5

Hyperresonant percussion notes

amplitude
pitch
quality
duration
eg location

Answer 5

Hyperresonant

amplitude: louder
pitch: lower
quality: booming
duration: longer
normal in child’s lung
abnormal finding in adult with hyperinflated lungs

Question 6

Tympanic percussion notes

amplitude
pitch
quality
duration
eg location

Answer 6

Tympanic

amplitude: loud
pitch: high
quality: musical, drumlike
duration: longest duration
eg air-filled organ (eg stomach, intestine)

Question 7

Dull percussion notes

amplitude
pitch
quality
duration
eg location

Answer 7

Dull

amplitude: soft
pitch: high
quality: muffled thud
duration: short

eg dense organ (liver/spleen), consolidation

Question 8

Stethoscope

diaphragm is best for hearing ______ sounds
bell is best for hearing ______ sounds

Answer 8

diaphragm: high pitched
bell: low pitched (eg extra heart sounds, murmurs)

Question 9

Handwashing with soap and water is preferred over alcohol based hand rub when hands are _____ and patients are infected with ________

Answer 9

Handwashing:

• hands are visibly soiled
• pts infected with spore-forming organisms (eg Cdiff, noroviruses)

Question 10

Allow ___ min rest before taking BP

Take ___ BP measurements separated by ___ min, discard first reading, then average

Verify BP in (one/both?) arms once

Answer 10

5 min rest

3 BP measurements separated by 2 min

verify in both arms

Question 11

BP cuff

width should equal ____ % of circumference of pt’s arm
length should equal ____%

Answer 11

width: 40%
length: 80%