Chapter 3: Examination Techniques and Equipment Flashcards
Infection Precautions and Latex Allergy
Precautions:
Standard Precautions
Transmission-Based Precautions
Latex allergy:
Occurs when the body’s immune system reacts with proteins found in latex
Skin/mucous membrane contact or airborne exposure
Rash, itching, blisters, asthma, GI symptoms, lung damage, anaphylaxis
Healthcare workers and patients with multiple surgeries at risk
Patient Positions and Draping
Seated
Supine
Prone
Dorsal recumbent
Lateral recumbent
Lithotomy
Sims
Examination Technique: Inspection
Process of observation beginning with the initial meeting of the patient and continuing through the history and physical examination
Guidelines
Provide for privacy.
Ensure adequate lighting.
Inspect in an unhurried and careful manner.
Expose what you want to inspect.
Validate findings with patient.
Examination Technique: Palpation
Use of hands and fingers to gather information through the sense of touch
Hand areas:
Palmar surface of the fingers and finger pads: Position, texture, size, consistency, fluid, crepitus, form of a mass, or structure
Ulnar surfaces of hand and fingers: Vibration
Dorsal surface of hand: Temperature
Examination Technique: Percussion
One object striking against another produces vibrations and sound waves.
Tapping finger causes vibrations by impact on underlying tissues.
Sound waves arise from vibrations and produce percussion tones (resonance).
Tone is related to density of underlying tissue.
Percussion Tones
Tympany―loud, high, drumlike
Gastric bubble
Hyperresonance―very loud, low, booming
Emphysematous lungs
Resonance―loud, low, hollow
Healthy lung tissue
Dullness―soft, moderate, thudlike
Over liver
Flatness―soft, high, dull
Over muscle
Percussion Techniques
Immediate (direct)―Finger strikes directly against body.
Mediate (indirect)―Middle finger of dominant hand is hammer; middle finger of nondominant hand is placed on body and struck.
Fist―Nondominant hand is placed on body and struck with fist of dominant hand.
Most commonly used to elicit tenderness arising from the liver, gallbladder, or kidneys.
Examination Technique: Auscultation
Listening for sounds of the body
Environment should be free of noise and distractions.
Place stethoscope on bare skin, not over clothing.
Listen for intensity, pitch, duration, and quality.
Concentrate on one sound at a time.
Patients With Mobility Impairment and Disabilities
Mobility impairment transfers:
Pivot transfer
Two-person transfer
Cradle transfer
Equipment: Slide board and Lifts
Spinal cord disabilities:
Bowel and bladder concerns
Autonomic hyperreflexia
Hypersensitivity; spasticity
Cognitive delay; chronic pain
Feeding concerns
Patients With Sensory Impairment
Impaired vision
Identify yourself clearly.
Orient patient to surroundings.
Canes and guide animals
Impaired hearing or speech
Allow patient to choose appropriate form of communication.
Sign language interpreter
Lipreading
Writing
Talk To You (TTY)
Height and Weight Measurement
Adult
Standing platform scale with height attachment
Electronic scale
Child (when able to stand)
Stadiometer: stature-measuring device -Movable headpiece attached to a rigid measurement bar and platform
Infant
Weight on platform scale sitting or lying
Height on measuring device with rigid headboard and movable footboard
Thermometer
Electronic temperature measurement has decreased the time required for accurate temperature readings
Disposable sheath-covered probe can be used in oral, rectal, or axillary regions.
Rectal temperature is preferred in infants 0 to 90 days of age.
Infrared thermometer
Stethoscope
Required for amplification in auscultation
Four types:
Acoustic
Stereophonic
Magnetic
Electronic
Technique:
Stabilize stethoscope between the fingers.
Diaphragm use—press firmly against the skin.
Bell use—place evenly and lightly on the skin.
Sphygmomanometer
Blood pressure is measured indirectly with a stethoscope and either an aneroid or mercury sphygmomanometer.
Electronic sphygmomanometer does not require the use of a stethoscope.
It does not, however, indicate the quality, rhythm, and other characteristics of a pulse and should not be used in place of touch in assessing pulse.
Cuff bladder should encircle 80% or more of the patient’s arm circumference.
Cuff too small-falsely elevated BP
Pulse Oximeter
Measures the percentage of hemoglobin saturated with oxygen (oxyhemoglobin)
Measures how much oxygen the blood is carrying as a percentage of the maximum it could carry
Requires a reasonably translucent site with a good circulation
Finger
Toe
Pinna
doppler
Ultrasonic stethoscopes used to pick up pulses not heard with stethoscope
Detects blood flow rather than sounds
Common uses
Detect systolic blood pressure
Auscultate fetal heart activity
Locate vessels
Take weak pulses
Assess vessel patency
Portable Ultrasound
Compact portable units analyze echoes and transform them into a two- or three-dimensional image of the organs or tissues.
Produces dynamic moving images that can show the structure and movement of the body’s internal organs, as well as blood flowing through blood vessels
Used to detect cysts, tumors, fluid collection, infections, structural abnormalities of organs, and blockages in major blood vessels
Fetal Monitoring Equipment
Used to determine fetal heart rate
Four types:
Fetoscope
Leff scope
Stethoscope
Doppler
Ophthalmoscope
System of lenses and mirrors with light source and apertures enables visualization of interior structures of the eye.
Lenses vary in powers of magnification.
Magnification can be dialed up or down to compensate for myopia or hyperopia in both the examiner and patient.
PanOptic ophthalmoscope
StrasbismoScope
Photoscreening:
Detects strabismus and amblyopia.
Vision Charts
Allen picture cards
HOTV
LH Symbols (LEA Symbols)
Broken wheel cards (near vision)
Snellen alphabet (>6 years old)
Rosenbaum and Jaeger charts
Newsprint
Amsler grid
Otoscope and Tympanometer
Otoscope:
Illumination for viewing external auditory canal and tympanic membrane
Speculum attached to otoscope head directs beam of light down ear canal.
Pneumatic attachment used to evaluate fluctuating capacity of tympanic membrane
Tympanometer:
Assesses function of ossicular chain, eustachian tube, and tympanic membrane
Probe positioned at opening of ear canal measures sound energy and air pressure as each is introduced into the ear.
Tuning Forks and Hammers
Tuning forks:
Auditory function and vibratory sensation
Auditory: estimates hearing loss by noting which vibrating tuning forks can be heard (500 to 1000 Hz).
Vibratory: measured by holding vibrating fork against a bony prominence (100 to 400 Hz)
Not useful in young children
Percussion (reflex) hammer: tests deep tendon reflexes (DTRs).
Neurologic hammer: measures sensory perception.
Tape Measure and Transilluminator
Tape measure:
Determines circumference, length, and diameter in metric units/inches
Tape pulled closely without causing depression of skin
Serial measures obtained by placing tape in same location every time
Transilluminator:
Strong light source used to distinguish whether a body cavity contains fluid, air, or tissue
Vaginal Speculum
Used to view vaginal canal and cervix
Consists of two blades and a handle
Three basic types:
Graves―standard
Pederson―women with small vaginal openings
Pediatric/virginal―children, adolescents
Specula are available in either disposable plastic or reusable metal.
Operate differently
Goniometer
Determines degree of joint flexion and extension
Two straight arms that intersect and can be angled and rotated around a protractor.
Center placed over joint—arms aligned along long axis of extremity.
Degree of flexion/extension is measured on protractor.
Wood’s Lamp
A light source with a wavelength of 360 nm (black light)
Turn black light on in dark room and shine on area of body being evaluated.
Certain conditions/substances fluoresce when illuminated with black light.
Fluorescein in the eye helps identify corneal abrasion.
Used primarily to determine presence of fungi, bacteria, pigment changes and other skin lesions.
Some skin fungi glow yellow-green.
Monofilament
Tests for loss of protective sensation, particularly on plantar surface of foot
Bends at 10 g of linear pressure—patient has lost sensation if not felt when bent.
Guidelines:
Test various foot points with patient’s eyes closed.
Press and bend filament.
Have patient indicate whether filament is felt.
Scoliometer
Measures the degree of rotation of the spine to screen for scoliosis
Patient bends forward slowly, stopping when the shoulders are level with the hips (Adam’s forward bending test).
Scoliometer is placed gently across any deformity and the number of degrees of rotation noted.
Considered positive if the reading on the scoliometer is 7 degrees or more
If positive, order spine films with Cobb angles.
During palpation, which area of the hand is best for distinguishing vibration?
Palmer surface of the hand
Fingertips
Ulnar surface of the hand
Dorsal surface of the hand
ANS: C
Rationale: The ulnar surface of the hand and fingers is the most sensitive area for distinguishing vibration.
When performing indirect percussion, the stationary finger is struck:
At the ulnar surface
At the middle joint
At the distal interphalangeal joint
When it is in contact with a fist
ANS: C
Rationale: Your finger functions as a hammer, and the impact of the finger against underlying tissue produces the vibration. The sound waves are heard as percussion tones.
Expected normal percussion tones include:
Dullness over the lungs
Hyperresonance over the lungs
Tympany over an empty stomach
Flatness over an empty stomach
ANS: C
Rationale: A normal lung produces resonance percussion tones while an empty stomach is expected to produce tympany. Dull percussion tones are heard over the liver.
