IMM 04 and 08: Introduction to Physical Assessment Flashcards
What is a physical assessment?
the act of evaluating the body and its functions from head-to-toe
- tool used to gather objective data required to make informed decisions about a client’s health-related problems
What should you do with your physical exam findings?
integrate and correlate the findings and observations with the client’s history and your clinical knowledge and experience
Why is it important for pharmacists to know how to do physical assessments? (3)
evolution of the profession and demand for cognitive services
- pharmacists in some clinical settings routinely use physical assessment skills as they relate to specific disease states and medication therapy management
- recent rapid expansion of scope of practice (minor ailments prescribing, lab tests)
all pharmacists should have a basic understanding
- familiarity with common physical assessment terms and acronyms
- understanding of specific findings documented by others and how to interpret them in the context of medication therapy management
- need for hands-on proficiency varies depending on the client care setting
pharmacists share the responsibility for client outcomes
- physical assessment findings can contribute to solving drug therapy problems, making decisions about drug prescribing, and client monitoring
What are some of the barriers to incorporating physical assessment into pharmacy practice? (5)
- need for adequate training – no consensus recommendation exists on performance expectations in Canadian curricula
- increased workload and lack of infrastructure (ie. remuneration, lack of time, physical layout of the pharmacy) – needs to be a mechanism to allow for time and space to perform physical assessments
- distraction to traditional pharmacist roles – client concerns about affect on wait times for prescriptions
- infrequent use of skills to maintain competency – needs to be a mechanism to monitor skill competency
- conflicts with other health care providers – “professional turf” war
What are some of the benefits of pharmacists’ knowledge of physical assessment?
- understand the significance of information in the client’s chart
- enhance their assessment of the client and their drug therapy
- detect medication-related problems requiring treatment
- improve their ability to prescribe and monitor drug therapy
- manage common minor ailments
- refer clients for further evaluation, when necessary
- enhance communication with the health care team
- increase their value on the health care team
- expand their scope of practice
Describe the general approach to conducting a physical examination.
- by convention, the exam is typically done from the client’s right side
- follows a structured sequence that minimizes the number of changes in position by the client and clinician
- consider your client through the entire examination – respect their privacy, minimize their discomfort and embarrassment, communicate with them
Describe appropriate bedside manners when conducting a physical examination.
- do your information gathering – read the client’s profile or medical chart (if available) before you see the client
- respect mask guidelines – watch for infection control precautions
- practice hand hygiene – before and after the client interaction
- introduce yourself – your name and your role (ie. “pharmacy student”)
- confirm the client’s identity – name, birth date, etc.
- ensure your client is comfortable throughout the examination – maintain privacy for the client, observe the client’s body language, continue to communicate with the client
- explain what you are going to do and why
- ask for permission to touch the client
- be thorough, but don’t waste time
- remember to thank your client – let them know the examination is over, and give them an opportunity to ask questions
What are the 4 fundamental examination techniques?
- inspection
- palpation
- percussion
- auscultation
What is inspection?
observation of physical signs, behaviour, and movement displayed by client
- may be visual, olfactory, or auditory observations
- depends on the examiner’s knowledge of what to look for and how it would be manifested in the client (otherwise you may not even detect presence)
- do not underestimate the power of inspection
- ie. facial expressions, body shape (ie. chest, abdomen), skin condition, gait, edema)
What is percussion?
tapping of fingers on body surfaces to assess density of underlying structures (4-5 cm beneath skin surface)
- use fingers to indirectly strike the body surface to elicit sounds that vary in quality according to the density of the underlying tissues
- percussional sounds are described as: tympanic (least dense – hollow, air-filled), hyperresonant, resonant, dull, flat (most dense – thigh)
ie. lungs (resonant = healthy), liver (dull = healthy)
What is palpation?
using sense of touch and tactile pressure to feel areas that cannot be seen
- use pads of fingertips to distinguish hard and soft areas (ie. evaluating a mass)
- use palm of hand is used to detect presence or absence of vibrations (ie. lungs)
- use backside of fingers to evaluate temperature (ie. demarcating limits of a superficial cellulitis)
- ie. areas of skin elevation or depression
tenderness, temperature of skin (cold, clammy vs. warm), sizes of organs and masses, crepitus in the joints
What is auscultation?
listening to sounds originating from within an organ or body cavity by use of a stethoscope
- auscultatory findings usually generated by substances (ie. air, fluid, etc.) moving through body systems
- identify presence or absence of sounds
- effectiveness of the auscultatory exam is determined by the quality of the stethoscope and skill of examiner
- ie. blood pressure (blood flow through blood vessels), pulmonary (air flow through the tracheobronchial tree), GI system (bowel contents as they traverse the stomach and intestines)
In what order should the 4 fundamental techniques be performed?
order varies depending on the area of the body being examined
- for most areas: inspection → palpation → percussion → auscultation
- for abdomen: inspection → auscultation → percussion → palpation
Why is auscultation performed right after insepction?
need to do this before pushing the GI tract around during palpation to hear the proper bowel sounds
What is the scope of the physical exam determined by? (6)
- client history
- previous knowledge of client
- magnitude & severity of client’s problem
- need for thoroughness
- clinical setting (inclient vs. outclient)
- time
