Ch.8: Assessment Techniques and Safety in the Clinical Setting Flashcards
The skills requisite for the physical examination. IN ORDER ARE
Inspection
Palpation
Percussion
Auscultation
Inspection:
ALWAYS COMES FIRST**
concentrated watching (whole then body systems)
begins the moment you first meet the person “general survey”
SYMMETRY
Palpation:
confirms points from previous step
sense of touch: texture, temp, moisture, organ location, and size, (Swelling, vibration, or pulsation, tenderness)
Technique: start with light palpation, accustom them to touch. Intermittent better*
Palpation techniques
fingertips- fine tactile discrimination (swelling, pulsation)
action of thumb and fingers- detect position/shape
dorsa of hands and fingers- temperature
base of fingers- best for vibrations
Percussion:
tapping the person’s skin with short, sharp strokes to assess underlying structures
Maps location and size of an organ, signaling density, detecting abnormal mass
Auscultation:
listening to the sounds produced by the body such as the heart and blood vessels and the lungs and abdomen
use of stethoscope
Diaphragm of stethoscope
flat edge-best for high pitch sounds, breath, bowel and normal heart sounds
Bell of stethoscope
deep, hollow, cup-like: best for low, soft pitched sounds such as extra heart sound or murmurs
Before listening to the body sounds, you must
eliminate extra room noise, make room warm, clean the stethoscope, friction(no-no), NEVER LISTEN THROUGH A GOWN, avoid you own "artifact"
funnels light into the ear Cana and onto the tympanic membrane.
Five specula each a different size are available to attach to the head. (short, broad-nares) & ( largest one- ear)
otoscope
illuminates the internal eye structure (small spot for undiluted pupils) & (large full spot for dilated pupils)
ophthalmoscope
measure range of motion
goniometer
augment pulse or blood pressure measurement
dopler sonometer
test sensation in the foot
monofilament
to asses urine retention
bladder scanner
True or false: you must clean your stethoscope end piece with an alcohol wipe only before every patient contact
FALSE:
Before and After every patient contact*** combine with hand hygiene routine
HAND WASHING:
most important step to decrease risk of microorganism transmission
Wash BEFORE & AFTER every physical patient encounter / contact with blood& bodily fluids / contact with contaminated equipment / removing gloves
use when hands are visibly soiled / when patients are infected with spore forming organisms
ALCOHOL USE:
more quickly and highly effective against gram-positive & negative bacteria
TRUE OR FALSE: wearing gloves is NOT a protective substitute for washing hands.
TRUE:
because gloves may have undetectable or become torn during use or hands may become contaminated as gloves are removed
General Approach:
an examiner must be confident, self-assured, considerate, and unhurried to reduce the anxiety of the patient
Hands on:
begin by measuring their vitals, height/weight
ICEBREAKER
GOWN CHANGE (make sure to knock)
WASH/ CLEAN HANDS
Begin by touching their hands and inspecting for skin color, nail beds, joints (knuckles)
One step at time (avoid distractions)
maintain privacy/modesty
do not hesitate to write
occasionally brief teaching about the person’s body
ok to linger, reassure them
SUMMARIZE YOUR FINDINGS & SHARE NECESSARY INFO, thank them
Before you leave a hospitalized person you must
lower the bed (lowest level) call light nearby return bedside table make sure they are comfy wash hands
How does working with various developmental/age apply in the assessment?
- different sequences are act upon depending on the level
- different ways of acting/ behavior towards each age group
- parent interaction
- modesty
With an ill-person it may be necessary to just examine the body areas appropriate to the problem, thus collecting a
mini-datebase
