Chapter 3: Techniques and Equipment for Physical Assessment Flashcards
The ulnar aspect of the hand
may be used to detect vibration
A transilluminator is used to detect
fluid within a body cavity
Tones with a booming quality
A booming quality is associated with a hyperresonant tone.
The thickness of tissue can impair vibrations
causing quieter percussion tones.
1 cm is appropriate for
superficial or light palpation
Deep palpation is done
with one or two hands to a depth of 1.6 inches or 4 cm.
A Wood’s lamp is used to detect
fungal infections of the skin. Lesions of the skin appear as a fluorescent yellow-green or blue-green color.
A slit lamp might be used to detect
a foreign body embedded in the eye
Resonance
is heard over healthy lung tissue
hyperresonance
is heard in overinflated lungs (as in emphysema)
Dullness is heard
over the liver
tympany
is normally heard over the abdomen
flatness is heard over
over bones and muscle. Detecting sound changes is easier when moving from resonance to dullness (e.g., from the lung to the liver).
inspection refers to
visual examination of the body, including
body movement and posture. Data obtained by smell are
also a part of inspection
inspecting the lungs and respiratory system
the nurse
observes the shape of the chest, giving attention to breathing
(noting the rate, depth, and effort of respirations); and notices
the overall color of the skin, lips, and nail beds
a technique
referred to as tangential lighting
penlight to create shadows by directing
light at right angles to the area being inspected—
bimanual technique of palpation
uses both
hands, one anterior and one posterior, to entrap a mass or an
organ (such as the uterus, kidney or large breasts) between
the fingertips to assess size and shape
Light palpation should
always precede deep palpation
because palpation may cause tenderness or disrupt fluid, which could interfere with collecting
data by light palpation
Direct percussion involves
striking a finger or hand directly
against the patient’s body.
Indirect percussion
requires both hands and is done by different
methods, depending on which body system is being
assessed.
tympany
abdomen
resonance
healthy lung tissue
hyperresonance
inflated lungs (emphsema)
dullness
liver
flatness
bones and muscle
Listen for the sound
and its characteristics:
intensity, pitch, duration, and quality
lungs
resonant loud low long hollow
bone and muscle
flat soft high short extremely dull
viscera and liver borders
dull medium medium high medium thudlike
stomach and gas bubbles in intestines
typmanic loud
high
medium
drumlike
air trapped in lung (emphysema)
hyperresonant very loud very low longer booming
intensity
is the loudness of the sound, described as soft,
medium, or loud.
pitch
is the frequency or number of sound waves generated
per second. High-pitched sounds have high frequencies.
Expected high-pitched sounds are breath sounds,
whereas cardiac sounds are low pitched
Duration of sound vibrations
is short, medium, or long.
Layers of soft tissue dampen the duration of sound from
deep organs.
quality
refers to the description of the sounds (e.g., hollow,
dull, crackle).
several types of stethoscopes
acoustic, magnetic, electronic,
and stereophonic), the acoustic stethoscope is used routinely
for health assessment
diaphragm of stethoscope
high-pitched sounds such as breath, bowel,
and normal heart sounds. Its structure screens out lowpitched
sounds.
bell of the stehoscope
It is used to hear soft,
low-pitched sounds such as extra heart or vascular sounds
(bruit)
automated BP cuff operates
by sensing circulating
blood flow vibrations through a blood pressure cuff sensor
and converting these vibrations into electric impulses
select a blood pressure
cuff that is the correct size for the patient
If the cuff is
too wide, it underestimates the blood pressure; if it is too
narrow, it overestimates the blood pressure. Ideally the cuff
width should be 40% of the circumference of the limb to be
used. The bladder within the cuff should encircle at least 80%
of the upper arm
The pulse oximeter
used to measure the oxygen saturation in
arterial blood, consists of a light-emitting diode (LED) probe
connected by a cable to a monitor
paO2 LED light waves reflect off….
oxygenated and deoxygenated
hemoglobin molecules circulating in the blood. This reflection
is used to estimate the percentage of oxygen saturation
in arterial blood and a pulse rate.
paO2 placement
The sensor probe is taped
or clipped to a highly vascular area—typically a digit (finger
or toe), an earlobe, or the bridge of the nose
Snellen chart
a wall chart hung at a distance of 20 feet
from the patient
E chart
used for young children and non english speaking individuals
Two charts, the Rosenbaum and the Jaeger
are commonly
used to evaluate near vision
transilluminator
is used to differentiate the characteristics
of tissue, fluid, and air within a specific body cavity.
monofilament
is a small, flexible, wirelike device attached
to a handle (Fig. 3-27, A) used to test for sensation on the
lower extremities.
The Wood’s lamp produces a black-light effect
is used to
detect fungal infections of the skin or corneal abrasions
