HA handout 3 Physical assessment Flashcards
Before performing any procedure:
General Guidelines:
◈ Wash your hands
◈ Greet the patient
◈ Introduce yourself
◈ Explain the procedure
Techniques in Physical assessment
Inspection
Auscultation
Percussion
Palpation
◈ using vision, smell and hearing to assess normal conditions
◈ assess for color, size, location, movement, texture, symmetry, odors, and sounds as you assess each body system
1) INSPECTION
Use good lighting preferably _____________ flourescent lights can alter the true color of the skin. Dim light can overlooked abnormalities
sunlight
● involves listening for various lung, heart, and bowel sounds with a stethoscope
● The sounds detected using auscultation are classified according to the intensity (loud or soft), pitch (high or low), duration (length), and quality (musical, crackling, raspy) of the sound.
2) AUSCULTATION
◈ involves tapping your fingers or hands quickly and sharply against parts of the patient’s body to help locate organ borders
◈ identify organ shape and position, determine if an organ is solid or filled with fluid or gas
PERCUSSION
Functions of Percussion
◈ Eliciting pain
Determining location, size, and shape
Determining density:
Detecting abnormal masses
Types of Percussion
1) DIRECT PERCUSSION
2) INDIRECT PERCUSSION
3) BLUNT PERCUSSION
Percussion helps to detect inflamed underlying structures. If an inflamed area is percussed, the client’s physical response may indicate or the client will report that the area feels tender, sore, or painful.
Eliciting pain
Percussion note changes between borders of an organ and its neighboring organ can elicit information about location, size, and shape.
Determining location, size, and shape
Percussion helps to determine whether an underlying structure is filled with air or fluid or is a solid structure.
Determining density
Percussion can detect superficial abnormal structures or masses. Percussion vibrations
Detecting abnormal masses
- -this technique reveals tenderness
- using one or two fingers, tap directly on the body part
- ask the patient to tell you which areas are painful, an watch his face for signs of discomfort
DIRECT PERCUSSION
- elicits sounds that gives clues to the make-up of the underlying tissue
- press the distal part of the middle finger of your non-dominant hand firmly on the body part
- keep the rest of your hands off the body surface
- flex the wrist of your nondominant hand
- using the middle finger of your dominant hand, tap quickly and directly over the point where your other middle finger touches the patient’s skin
- listen to the sounds produced
INDIRECT PERCUSSION
- used to detect tenderness over organs (e.g., kidneys) by placing one hand flat on the body surface and using the fist of the other hand to strike the back of the hand flat on the body surface
BLUNT PERCUSSION
◈ requires to touch the patient with different parts of your hands, using varying degrees of pressure
◈ because hands are tools, keep your fingernails short and hands warm
◈ wear gloves when palpating mucous membranes or areas in contact with body fluids
◈ palpate tender areas last
4) PALPATION
Parts of the hand use in palpation
fine discriminations: pulses, texture, size, consistency, shape crepitus
fingerpads
hand parts used in palpation
vibrations, thrills, fremitus
ulnar or palmar surface
parts of the hand used in palpation
temperature
dorsal surface (back)
Types of Palpation
LIGHT PALPATION
MODERATE PALPATION
DEEP PALPATION
BIMANUAL PALPATION
- To perform light palpation, place your dominant hand lightly on the surface of the structure. There should be very little or no depression (less than 1 cm).
- Feel the surface structure using a circular motion.
- Use this technique to feel for pulses, tenderness, surface skin texture, temperature, and moisture
LIGHT PALPATION
◈ Depress the skin surface 1 to 2 cm (0.5 to 0.75 inch) with your dominant hand, and use a circular motion to feel for easily palpable body organs and masses.
◈ Note the size, consistency, and mobility of structures you palpate.
MODERATE PALPATION
◈ Place your dominant hand on the skin surface and your nondominant hand on top of your dominant hand to apply pressure (Fig. 3-2.
◈ This should result in a surface depression between 2.5 and 5 cm (1 and 2 inches).
◈ This allows you to feel very deep organs or structures that are covered by thick muscle.
DEEP PALPATION
- Use two hands, placing one on each side of the body part (e.g., uterus, breasts, spleen) being palpated (Fig. 3-3).
- Use one hand to apply pressure and the other hand to feel the structure.
- Note the size, shape, consistency, and mobility of the structures you palpate.
BIMANUAL PALPATION
infant 0-6
6-12 months heart rate
100-160
infant 0-6 and 6-12
respiration
30-60
24-30
