What are the challenges to Physical assessment?
1.New techniques never seen
2.Techniques that you have done in the past that are taught different
3.Different teaching styles
4.Identifying symptoms and abnormal findings
5.Linking findings to underlying pathology
6.Interacting with variety of patients
7.Vast amount of memorization
8.Performing a complete head to toe exam within one hour
9.Learn how to document and describe your findings
What are the components of a complete physical exam?
1.Vital signs (V/S)
2. General Assessment (GA)
3.Skin, Hair and Nails
4. HEENT
5. Neck and lymphatics
6. Lungs
7. Heart
8. Abdomen
9. Genitalia
10. Musculoskeletal
11. Complete neurological
What are the steps in determining the scope of assessment?
-Decide if assessment should be comprehensive or focused
What are the different type of factors that will determine your scope of history and physical exam?
-magnitude and severity of the patients problems
- Need for thoroughness
- clinical setting
- inpatient vs outpatient
- time available
When is a comprehensive H&P done?
What is a comprehensive H&P
- A new patient in the office or hospital
- It includes ALL elements of the health history and a complete physical exam
- Helps identify/rule out physical causes
- Provides a baseline
- Platform for health promotion
- develops proficiency
When do you use a SOAP note / focused assessment
What is a SOAP note
- used for established patients
- routine or urgent care visits
- used for pertinent information
- very specific
What are the factors that determine the scope of a SOAP exam?
-Patients symptoms
- Age
-Health history
- Clinicians knowledge of disease patterns
What are the steps to making a patient comfortable and relaxed?
- Pay attention to patient comfort
-adjust bed, add pillow, give extra gown or blanket - Pay attention to patient modesty and privacy
- Close nearby doors, draw curtains, wash hands
- Drape appropriately
- Chaperone as necessary
- Confidentiality
What are the aspects of professional Demeanor
- Appearance
- neat, clean, ID badge
- Speech
- Courteous and clear
- empathize
- Body language
- Personal space
What is the proper order for a physical examination?
Head-to-toe
What are the advantages to a right sided Approach?
-Beneficial for jugular venous pressure, which is more reliable
- Palpating hand rests more comfortably on the apical pulse
- Right kidney more frequently palpable
Name and list the patient positions and draping
- Seated
- Supine
- Prone
- Dorsal Recumbent (feet planted on table, with knees up)
- Lateral Recumbent (lying on their side)
- Lithotomy (Lying on back with your legs flexed 90 degrees at your hips)
What are the four techniques of Examination
- Inspection/observe
- Palpation
- Percussion
- Auscultation
Describe the “Observation” technique for a physical exam
-looking at the body as a whole from a broader approach
- begins at the time of the first exposure to the patient
Describe the “Inspection” part of the physical exam
-Anything you will look at or observe
- Often the first technique you will perform no matter what organ system
- patient’s appearance, behavior, and movement
- skin conditions
- eye movements
- pharyngeal color
-symmetry of thorax
-gait
-lower extremity edema
Describe the “Palpation” part of the physical exam
- tactile pressure from the palmar fingers or finger pads for assessment
- way of gathering information through touch
- moment in the exam when you begin the physical invasion of the patients body
What are the aspects of Palpation
- elevation
-dpresssion
-warmth
-tenderness - assess lymph nodes and pulses
- evaluate contours and sizes of organs and masses
- crepitus in the joints
-position
-texture
-size
-consistency
What area of the hands should you use when palpating?
-tactile pressure from palmar rings or finger pads for sensitivity
- ulnar surface of hand for vibration
-dorsal surface of hand for temperature
What list and describe the two types of Palpation
- Light Palpation
- about 1 cm in depth
- performed before deep palapaton
- finger pads gain information on the skin surface or muscles
- Deep Palpation
- about 4 cumin depth
-Performed after light Palpation - evaluates masses and tenderness in the cavity
- about 4 cumin depth
Describe what Percussion is for a PE
-Use of sound waves to detect body tissue density
- striking one object against another produces vibrations and sound waves
- Striking finger causes vibrations by impact on underlying tissues
- Sound waves arise from vibrations and produce percussion tones
When completing a percussion technique through a dense medium, how loud is the percussion tone?
Quite
How is the sound of percussion determined?
It is determined by the density of the medium through which sound waves travel
- more dense the medium, the quieter the percussion tone
- fluid=less loud
- solid area=soft
List the percussion sounds from loudest to softest
- Tympany
- Hyperresonance/ hyperresonant
- Resonance/ resonant
- Dull
- Flat
Describe the Tympany percussion sound
High-pitched or drum like
- loudest of the sounds
- gastric air bubble
