Week 2: Skills of Physical Assessment

Question 1

What are the 5 skills of physical assessment? (IPPA +1)

Answer 1

1. Inspection
2. Palpation
3. Percussion
4. Auscultation
5. Olfaction

Question 2

What do you do in inspection? (4)

Answer 2

• concentrated watching, close/careful scrutiny
• Compare right and left sides (symmetry)
• use good lighting
• ensure adequate patient exposure while maintaining dignity (use gowns and sheets)

Question 3

What instruments do you use during inspection? (4)

Answer 3

• penlight
• otoscope
• opthalmoscope
• specula (vaginal, nasal)

Question 4

What is palpation? (2)

Answer 4

• touch
• can confirm what you saw during inspection
  ie. does this hurt when I touch it? does it move?

Question 5

What should you do during palpation? (6)

Answer 5

• slow and systemic
• light palpation generally used
• deep palpation has risks
• intermittent pressure (skin trigger, temp)
• can use circular motions, not tugging on skin
• bimanual palpation

Question 6

Where should you use palpation on the body? (5)

Answer 6

• parts of hand
  1. fingertips
  2. grasping
  3. Back (dorsa) of hands and fingers
  4. Base of fingers (metacarpophalangeal joints) or ulnar surface

Question 7

Where should you palpate on the hands when trying to test temperature? Why?

Answer 7

• back of hands and fingers
• skin is thinner than on the palms

Question 8

Where should you palpate for vibration?

Answer 8

• base of fingers or ulnar surface of hand

Question 9

When palpating, what characteristics should you look for? (4)

Answer 9

1. Texture, temo, moisture (diaphoresis)
2. Swelling, thickness (increased density), lumps or masses
3. Tenderness or pain
4. Vibration or pulsation

Question 10

What is percussion? (3)

Answer 10

• tapping skin with short, sharp strokes to assess underlying structures
• direct or indirect
• produces vibrations (sounds)
  basically trying to understand density

Question 11

What should the sounds when percussing sound like? (2)

Answer 11

1. dull and flat over dense underlying organs like liver, or fluid
2. Resonant, hyper-resonant, tympanic over more hollow or air-filled cavities (lungs, stomach)

Question 12

Why do we use percussion? (3)

Answer 12

• to elicit pain
• pain over kidney or sinus for ex
• not used daily in practice, replaced by diagnostics

Question 13

What is auscultation?

Answer 13

• hearing sounds produced by heart, blood vessels, lungs, and abdomen channeled through a stethoscope

Question 14

What are the characteristics of a stethoscope?

Answer 14

1. Diaphragm (high pitch) and bell (low pitch) end pieces
2. Pressure sensitive diaphragm (high and low)
3. Earpieces (firm v silicone)
4. length of tubing, multiple tubes

Question 15

Some times we hear sounds that confuse us when auscultating. What factors play a role in this? (6)

Answer 15

1. room noise
2. Friction from hair crackles
3. they need to control breathing for other sounds
4. our own breathing or bumping tubing/end piece
5. clean stethoscope and warm end-piece
6. Keep patient warm to prevent shivering

Question 16

Should you auscultate through a gown, sheet, or dressing material?

Answer 16

• no

Question 17

What is data verification?

Answer 17

• nurse confirming and correlating their assessment findings

Question 18

What is an example of a nurse doing data verification?

Answer 18

• a nurse takes a patient’s radial pule. they count 40 bpm. What should the nurse do next?
• use diff piece of equipment

Question 19

Why are laboratory values important? (6)

Answer 19

• provide key info about homeostasis
• measures indices like electrolyte level, organ function, clotting, etc.
• important piece of evidence to our clinical judgment
• What do these results mean for our patient?
• nurses are responsible for checking lab values prior to patient care and report abnormal findings to HCP
• blood, urine, sputum samples