WEEK5- Assessing a conscious patient Flashcards
what’s the primary survey for a conscious patient whose primary survey negative
primary survey negative:
history taking
assessment
observations
what does ippa stand for
inspection
palpation
percussion
ausculation
how do you inspect
from head-to-toe check for any signs relating to the presenting complaint/ system involved.
including.
skin
face
hands
gait
then inspect system area for any abnormalities
how do you palpate
feel the area for any physical abnormalities
when palpating does it cause pain to patient
feel complete area and see if its equal/ does it change throughout
if the patients in pain, begin away from pain then move closer towards the pain
how do you conduct percussion
place middle finger over the site of striking the finger.
listen for any changes in sound
listen if its hollow or not
resonance= normal sound
hyper-resonance= higher pitched/ hollow sound
dull/hypo-resonance= low pitched/dull sound
how do you auscultate
use a stethoscope to listen to various points in the area
place over multiple areas within the system and listen for presence of normal sounds/abnormal sounds
what’s the physical examination for the cardiac system
inspection: look for scars across chest, implantable devices, patches on arms, tobacco staining on hands. Look for swelling (oedema) in legs. is the skin sweating?
palpation: bilateral radial pulses, not rate, rhythm. feel at same time and note if there’s a delay.
feel for cool peripheries (indication of poor circulation)
percussion: N/A
Auscultation: not first year skill in cardiac
what’s the physical examination for the respiratory system
inspection= look at shape of chest, look for equal chest rise and fall, is there any bruising/swelling, any cyanosis, any accessory muscle use, any visible coughing
palpation: feel for chest rise and fall, is it equal/ bilaterally the same, is breathing deep/shallow, any bony abnormalities flail segments)
percussion: any hypo-resonance/hyper-resonance
auscultation: are breath sounds present throughout, same bilaterally, any breath sounds similar on front and back, any wheezes, any stridor, any crackles, any silent chest
how do you palpate for respiratory
assess expansion of lower lobes by placing hands firmly on chest wall.
extend fingers around sides of patient’s chest, place your thumbs over the sternum
thumbs should almost meet in midline, hover just off chest so can move freely
ask patient to breath, thumbs should move symmetrically apart by at least 5cm
how do you conduct percussion for respiratory system
press middle finger of left hand firmly against chest, aligned with underlying ribs over the area to be percussed.
strike the centre of the middle phalanx of left middle finger with tip of right middle finger
use a loose swinging movement of wrist and not the forearm
repeat this down at least 4 points on each side, then repeat on back
how to auscultate for respiratory system
position diaphragm of stethoscope over each relevant locations on the chest wall- ensures all lung regions have been assessed
listen to the breathing sounds during inspiration/expiration
auscultate each side, compare findings over a large number of equivalent positions to ensure that no localised abnormalities are missed
repeat on back
what’s the physical examination for the neurological/endocrine system
inspection: any eye deviation, any visual facial droop, how conscious is the patient, any visible rashes, spontaneous/involuntary movements like a tremor/seizures
palpation: N/A
percussion: N/A
auscultation: N/A
only system which dont follow ippa. instead- multiple neurological tests like craninal nerve assessment, mini mental test. sensory, motor etc
what’s the physical examination for the gastrointestinal system
inspection: any swelling, bruising, masses/hernias, scars, any grey turners/Cullens sign, yellow skin (jaundice), visible veins over abdomen
palpation: soft/rigid, any guarding, any rebound tenderness, any lumps, murphy’s sign/rosvings sign
percussion: any lower-pitched/hollow sounds, any higher pitch than the lungs, any dullness
auscultation: any bowel sounds present/absent, is there a tinkling noise present
how do you conduct palpation for gastrointestinal
examiner should begin with light palpation from the area, start furthest away from the point of pain
move systematically through the 9 regions of the abdomen
how do you conduct percussion for gastrointestinal
hyperextend the middle finger of nondominant hand and place finger firmly against your patient’s abdomen.
with end of dominant middle finger, use quick flick of wrist to strike finger on abdomen.
