UNIT 1: Introduction to the course & Assessment techniques Flashcards
IPPA
Inspection
Palpation
Percussion
Auscultation
What is Inspection?
Inspection is concentrated watching. It begins with a general inspection of the whole body and then localized to each body system.
- Inspection is always performed 1st.
What senses does inspection use?
It uses visual, auditory, and olfactory senses and detects majority of the physical signs
Palpation: What do the fingertips best assess?
Best for fine tactile discrimination such as skin texture, swelling, pulsation, and determining presence of lumps
What is Palpation?
Palpation is when you apply your sense of touch to gently and systematically assess texture, temperature, moisture, organ location/size, as well as swelling, vibration/pulsation, rigidity/spasticity, crepitation, lumps/masses, and tenderness and pain.
Palpation: What does a grasping action between the fingers and thumb best assess?
Best for detecting the position, shape, and consistency of an organ or mass.
Palpation: What does the dorsa (backs) of hands and fingers best assess?
Best for determining temperature because the skin is thinner on the dorsa than on the palms
Palpation: What does the base of the fingers (metacarpophalangeal joints) or the ulnar surface of the hand best assess?
Best for vibration
What is Percussion?
Percussion is tapping the person’s skin with short, sharp strokes to assess the underlying structures.
These strokes make specific sounds that depicts the location, size, and density of the underlying organ.
Palpation Technique/Procedure:
- Warm hands
- Identify any tender areas and palpate them last.
- Start with light palpation using fingertips.
- then work your way through the different parts of the hands while slowly palpating with deeper and continuous pressure
What is percussion used for?
- Mapping out the location and size of an organ
- Signalling the density of a structure (air, fluid, or solid)
- Detecting an abnormal mass if it fairly superficial
- Eliciting pain if the underlying structure is inflamed
- Eliciting a deep tendon reflex with the percussion hammer.
Direct (immediate) Percussion:
In direct percussion, the striking hand contacts the body wall directly.
2 methods of percussion:
a) Direct (immediate)
b) Indirect (mediate)
Indirect (mediate) Percussion:
(used more often) Involves both hands where the striking hand contacts the stationary hand (stationary hand is on the person’s skin)
Auscultation:
Auscultation is listening to sounds produced by parts of the body, such as the heart and blood vessels, the lungs, and the abdomen. Some sounds can be heard with just the ear but most need to be channeled through a stethoscope.
Stethoscope:
A medical instrument that helps you listen to sounds within the body. The stethoscope does not magnify sound but blocks out extraneous room sounds. Has 2 main parts:
- Bell
- Diaphragm
What is the Bell of a stethoscope?
A deep, hollow, and cup-like end piece that you press light to seal onto surface; it is best for low-pitched sounds (extra heart sounds or murmurs)
What is the Diaphragm of a stethoscope:
The larger, flat end that you press firmly to the surface; it is best for high-pitched sounds (breath, bowel, and normal heart sounds)
Percussion Notes (5)
- Resonant
- Hyper-resonant
- Tympany
- Dull
- Flat
Percussion Notes: Resonant Characteristics
Amplitude: Medium-loud
Pitch: Low
Quality: Clear; hollow
Duration: Moderate
Percussion Notes: Hyper-Resonant Characteristics
Amplitude: Louder
Pitch: Lower
Quality: Booming
Duration: Longer
Percussion Notes: Tympany Characteristics
Amplitude: Loud
Pitch: High
Quality: Musical and drum-like
Duration: Sustained longest
Percussion Notes: Dull Characteristics
Amplitude: Soft
Pitch: High
Quality: Muffled thud
Duration: Short
Percussion Notes: Flat Characteristics
Amplitude: Very soft
Pitch: High
Quality: An instant stop of sound; absolute dullness
Duration: Very short
Characteristics of Percussion Notes:
Amplitude
Pitch
Quality
Duration
What does an Environmental Scan mean/include?
What do you see?
- devices attached to the patient
- equipment
- environmental hazards
- biomedical hazards
- patient safety concerns
- possible distractions/interruptions
Setting and what it includes?
Setting = Context of care
- the space
- exam: bed or table?
- Equipment
- safer environment (i.e., routine practices)
What do you need to consider during IPPA?
- the patient’s emotional state
- cultural sensitivity
- Sequence of the assessment:
- Measurement and vital signs
- Begin with hands
- Then exam steps
- Summarize findings
Equipment needed for a physical exam:
Platform scale
Sphygmomanometer
Stethoscope w bell/diaphragm
Thermometer
Data collection device
Pulse oximeter
Flashlight/penlight
Otoscope/ophthalmoscope
Nasal speculum
Tuning fork
Tongue depressors
Pocket vision screener
Skin marking pen
Flexible tape measure
Reflex hammer
Sharp object
Cotton balls
Gloves
Hand sanitizer/access to a sink
Lubricant
Watch/timing device
2 Tiers of Precautions:
Routine practices + Additional precautions
Routine Practices:
Intended to be used for all patients at all times and in all settings to reduce risk of infection.
Applies to: blood; non-intact skin; mucous membranes; all body fluids, secretions, and excretions EXCEPT sweat.
Age-Specific Considerations: Infants
Position: keep parents close; lay flat on table
Preparation: 1-2hrs after feeding
Sequence: Least invasive 1st; if asleep listen to heart, lungs, abdomen (Moro/startle reflex last
Additional Precautions:
Used when routine practices cannot fully manage the transmissions of the organisms in the health care setting
Types of Transmission Routes:
- Contact (direct, indirect, droplet)
- Airborne
- Common vehicle
- Vector borne
Age-Specific Considerations: Toddler
Position: sitting up on parents lap; parent aid in transitioning
Preparation: engage parent 1st, then child; parent should help undress child
Sequence: collect objective data 1st, keep an eye on the child; least invasive 1st->invasive last
Age-Specific Considerations: Pre-school age
Position: keep parent close, may hold child
Preparation: use short simple sentences, allow for play w equipment; compliment child for cooperating
Sequence: leave eye/ear/throat exam for last
Age-Specific Considerations: Adolescent
Position: use bed or table; parent may not be present
Preparation: be aware of comments regarding the body; engage in health teaching when possible
Sequence: progress from head to toe
Age-Specific Considerations: School-age
Position: use bed or table; parent may/may not be present
Preparation: talk about what you are doing and how the body works; child can undress self
Sequence: progress from head to toe
Age-Specific Considerations: Aging adult
Position: use bed or table; use fewest position changes
Preparation: consider breaking up a complete exam; note sensory changes, hearing loss, and accommodate for them
Sequence: progress from head to toe
