physical assessment Flashcards
What is the order of IAPP for physical assessments?
The order is: Inspection, Palpation, Percussion, Auscultation. However, for abdominal assessments, the order is: Inspection, Auscultation, Percussion, Palpation to avoid altering bowel sounds.
What is inspection and when is it performed?
Inspection involves concentrated observation of the patient and is always the first step.
What do you inspect for during physical assessments?
Symmetry, posture, gait, facial expression, dress, skin color, contour (convex or concave), deformities, smoothness, roughness, etc.
What is palpation and how is it done?
Palpation involves using touch to assess texture, temperature, moisture, organ location/size, swelling, vibration, lumps, tenderness, pulsation, and rigidity. Begin with light palpation and progress to deep palpation.
What part of the hand is used for palpating texture?
Fingertips.
What part of the hand is used to check temperature?
The back of the hands (dorsal surface).
How do you assess vibration or pulsation?
Use the base of the fingers or the fingertips.
What should you do before deep palpation?
Begin with light palpation and palpate tender areas last.
What is bimanual palpation?
Palpation using both hands, often to assess deep or larger organs/masses.
What is percussion?
Percussion is tapping on the body’s surface to assess underlying structures by listening for characteristic sounds that indicate the type of tissue (air, fluid, dense organ, etc.).
What is the main purpose of percussion?
To determine the location, size, density, and presence of underlying organs or masses.
What types of percussion sounds are common?
Resonant (air in lungs), tympany (air in a hollow organ), dull (dense organ like liver), flat (bone or muscle).
What is an example of when percussion is useful?
It is often used in the gastrointestinal system, such as assessing the liver or stomach, and to check for CVA tenderness in the kidneys.
What is auscultation?
Auscultation is listening to body sounds, typically using a stethoscope, to assess for normal or abnormal sounds such as breath, heart, and bowel sounds.
What does the diaphragm of the stethoscope assess?
The diaphragm is used for high-pitched sounds like breath, bowel, and normal heart sounds. Press it firmly on the skin.
What does the bell of the stethoscope assess?
The bell is used for low-pitched sounds like murmurs or bruits. Press it lightly on the skin.
What are auscultation tips?
Always place the stethoscope directly on the skin, ensure privacy, clean the stethoscope between patients, minimize external noise, and warm the stethoscope before using it.
Resonant
Low-pitched, hollow sound; heard over normal lung tissue.
Tympany
High-pitched, drum-like sound; heard over air-filled hollow organs like the stomach or intestines.
Dull
Soft, thud-like sound; heard over dense organs like the liver or fluid-filled areas like an impacted intestine.
Flat
Very soft, flat sound with no resonance; heard over solid structures like bone, muscle, or a tumor.
Pediatrics
- Use the least invasive techniques first.
- Engage in playful methods (e.g., “Say ahhhh!” or “Simon says” for ROM).
- Keep the environment friendly and fun (e.g., ticklish areas).
Teens
- Acknowledge their desire for independence.
- Be mindful of awkwardness; approach with sensitivity.
Elders
- Ensure proper lighting for visibility.
- Minimize distracting sounds during the assessment.
- Limit position changes to avoid discomfort; assess from the front if the patient is bed-bound.
- Prioritize obtaining a few quality auscultation points (3-4) rather than risking a full assessment.
Standard Stethoscope
- Used for auscultation of body sounds.
Diaphragm
- Used most often.
- Press firmly on the patient’s skin.
- Best for high-pitched sounds: breath, bowel, and normal heart sounds.
Bell
- Used less frequently.
- Press lightly on the skin (or it will function as a diaphragm).
- Best for low-pitched sounds: murmurs, extra heart sounds, and bruits.
Key Points
- Some stethoscopes only have one end (diaphragm or bell).
- Always warm the stethoscope before use.
- Minimize external noise (from clothing, hair, etc.).
- Avoid listening through a gown for accurate sound transmission.
