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33 Cards in this Set

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Techniques used during physical examination
inspection, ascultation,andpercussion, palpation
Inspection :
How and why?
by looking and observing with good lighting the patient as a whole and each of their body systems; using penlight, otoscope opthalmoscope, nasal and vaginal specula to give a bigger view; looking for symmetry
How and why?
By placing the bell of a stethoscope over the patients heart, lungs, abdomen, blood vessels, we listen for normal and abnormal sounds.
by tapping the person's skin with short, sharp strokes to assess underlying structures. vibrations and characteristic sounds tells us location, size, and density of underlying organs.
How and Why?
by sense of touch. with our hands and fingertips, assessing texture, temperature, moisture, organ location and size, as well as any swelling, vibration or pulsation, rigidity or spasticity, crepitation, presence of lumps or masses and presence of tenderness or pain.
light and deep palpation
How to Percuss/
place interphalangeal joint firmly on patient's skin. Use middle finger of your dominant hand to strike the stationary finger at a right angle. Deliver 2 short taps
Components of percussion
sound's intensity. may be soft or loud
the number of vibrations per second and may be high pitched or low pitched.
subjective difference due to a sound's distinctive overtones
the length of time the note lingers
how to auscultate
use the diaphragm for high-pitched sounds, such as breath, bowel and normal heart sounds. use the Bell for soft, low-pitched sounds, such as extra heart sounds or murmurs.
Auscultation notes
make sure room is warm and quiet and you are not listening through clothing.
infection control measures
1. clean stethoscope before and after each patient contact. have clean and used areas for equipment.
2. handwashing
3. use standard precautions
ways to reduce anxiety
maintain confidence, be considerate, unhurried. 1.Begin with familiar non threatening actions: wt, ht, vital signs. 2.clean hands in his or her presence.
loud, highpitched, drumlike, sustained long, over air filled viscus like the stomach and the intestines
medium loud, low pitch, clear hollow quality, moderate duration, over normal lung tissue
a tool to inspect the ears and nose. funnels light int the ear canal and onto the tympanic membrane.
base serves both as the power source by holding a battery and as a handle.
illuminates the internal eye structures.enables us to look through the pupil to the background or fundus of the eye.used during a physical examination
infant assessment alterations
1.have warm environment, 2.use a soft crooning voice
3.use eye contact
4. smile
5.keep movements smooth and deliberate not jerky
6. use a pacifier for crying
7.use padded exam table for infant and have parent present the whole time. parent in full view of infant.
1.when baby is sleeping, listen to heart lung, and abdominal sounds first. 2.Perform least distressing steps first. 3.Ear nose and throat last. 4.use moro reflex at end of assessment. baby may cry
toddler assessment alterations
1. Have them sit on parents lap for the entire examination.
2.sit knee to knee with parent
3.have parent help position the toddler during invasive procedures, ex: temp or otoscope
4. have parent undress child one part at a time.
5. demonstrate procedures on parent
collect some objective data during history, (less stressful)
2.while focusing on parent, notice childs motor skills and gait.
3. start with non threatening areas
4. save assessing head, ears, nose, throat last
normal adult assessment
have patient sit on examination table.
a frail adult may need to be supine
Head to toe approach
soft amplitude
high pitch
muffled thud
short duration
location: relatively dense organ ex. liver and spleen
verysoft amplitude
high pitch
dead stop of a sound, absolute dullness
very short duration
dno air is present over thigh muscles, bone or tumor
nosocomial infection
hospital acquired infection
mini database
examine body areas appropriate to the problem
vital signs and normal values
temp. 37 C(98.6 F),
temp range 35.8-37.3 C (96.4-99.1 F)
pulse 60-100
Resp 10-20
BP 120/80
blood pressure stages
hypertensive I
hyperstensive II
Normal BP
< 120/80
120/80 - 139/89
stage 1
risk factors: smoking, dyslipidemia, DM, age>60yo,Gender - Men and post menopausal women
stage 2
>= 160/100
pulse pressure
systolic minus diastolic