Ch 9. Physical Exam Flashcards
Skills of physical examination are
inspection, palpation, percussion, and auscultation
What is the first assessment performed FIRST. The the following order
1) Inspection
2) Palpation
3) Percussion
4) Ausultation
Light v. Deep palpation
Light = indenting skin 1in-1.5 inches Deep = 1.5 inches or more
Characteristics Assessed by Palpation
Texture Temperature Moisture Organ location and size Swelling Vibration or pulsation Rigidity or spasticity Crepitation lumps or masses tenderness or pain
Palpation: when to use fingertips
best for fine tactile discrimination like skin texture, swelling, pulsation, and determining presence of lumps
Palpation: when to use base of fingers
Base of fingers (metacarpophalangeal joints) or ulnar surface of the hand—best for vibration
Palpation: when to use back of hand
The dorsa (backs) of hands and fingers—best for determining temperature because the skin here is thinner than on the palms
Palpation: when to use finger/thumb grasp
A grasping action of the fingers and thumb—to detect the position, shape, and consistency of an organ or mass
What can tapping detect?
Location, size, density of underlying organ, detect an abnormal mass, elicit pain, elicit deep tendon reflex (reflex hammer)
Tapping over a sinus, if they have a sinus infection they are going to feel pain
Characteristics of percussion notes Resonant Hyperresonant Tympany Dull Flat
Resonant - clear/hollow; moderate duration
Hyperresonant - booming; longer duration
Tympany - musical/drum like; sustained longest duration
Dull - muffled thud; short duration
Flat - instant stop to sound; very short duration
Bell of stethoscope detects
low pitched sounds, extra heart sounds, or murmured
diaphragm
high pitched breath, bowl and normal heart sounds
Toddlers Assessment considerations
on parent’s lap; use of security objects; enhance autonomy; demonstrate procedures on parent first
Preschoolers Assessment considerations
limited body image; allow play with equipment; use games; compliment on cooperation
School-Age Assessment Considerations
desire approval; sense of modesty; demonstrate equipment; interest in how body works
