Unit 7 Health Care Skills

Chapter 20 Physical Assessment

H&P Date Demographic data Source of referral Chief complaint(s) History of present illness Past history (continued)

H&P Current health status Family history of illness Psychosocial history Review of all systems Information called baseline

Variances from Normal Discriminate normal from abnormal –Use observation skills –Ask questions –Note changes in condition –Employ strong assessment skills Report variances to supervisor

General Survey Look at patient as whole Overall impression valuable –Determines where to focus if time limited What to look for in general survey

Psychosocial Observations Part of general survey Emotional status Mental status Appearance

Question True or False: –A critical function of the health care worker is to be able to discriminate between normal and abnormal conditions and situations.

Answer True Critical function of health care worker: –Discriminate between normal and abnormal conditions and situations

Physical Assessment Skills Inspection Auscultation Palpation Percussion

Assess Systems Musculoskeletal Integumentary Circulatory Respiratory Digestive Urinary (continued)

Assess Systems Eyes Ears Nervous Endocrine Female reproductive Male reproductive

Question Which of the following is using the senses of vision, hearing, and smell for observation of patient condition? A.Auscultation B.Palpation C.Inspection

Answer C. Inspection Inspection –Using senses of vision, hearing, and smell for observation of patient condition Auscultation –Listening to sounds inside body with aid of stethoscope

Answer C. Inspection Palpation –Using hands and fingers on exterior of body to detect evidence of abnormalities in various internal body organs

Pain Evaluation Subjective information Use pain rating scale –0 to 10 0 = no pain 10 = worst pain imaginable –Wong-Baker FACES Pain Rating Scale –Oucher Scale (continued)

Pain Scale Rating

Pain Evaluation Compare levels before and after pain medications Note nonverbal cues

Activities of Daily Living (ADL) Evaluation Actions done on regular basis to meet physical needs Inability to perform ADLs –Assistance needed as long as unable to do so

Vital Signs (VS) Temperature Pulse Respiration Blood pressure

Temperature Normal range essential to homeostasis Afebrile and febrile Intermittent fever Continuous fever Night sweats

Thermometer Routes Oral Axillary Rectal Aural Temporal artery

Question Which of the following would be an ADL (activity of daily living)? A.Doing laundry B.Gardening C.Playing piano

Answer A. Doing laundry Doing laundry is ADL –Action done on regular basis to meet physical needs Gardening and playing piano are not actions required to meet physical needs

Pulse Pulse points Rate Rhythm –Regular rhythm –Irregular rhythm Regular irregular rhythm Irregular irregular rhythm (continued)

Pulse Pulse volume Radial pulse Stethoscope Apical pulse Bradycardia (continued)

Pulse Tachycardia Pulse rates vary with age Apical-radial pulse deficit

Respiration Process of moving air through lungs Inhalation (inspiration) Exhalation (expiration) Eupnea Tachypnea Bradypnea (continued)

Respiration Ensure patient is unaware of respirations being counted Rate Rhythm –Apnea –Cheyne-Stokes (continued)

Respiration Respiratory effort Respiratory rates vary with age

Question What is tachycardia? A.Abnormally high heart rate B.Abnormally high respiratory rate C.Abnormally low heart rate

Answer A. Abnormally high heart rate Tachycardia –Abnormally high heart rate Tachypnea –Abnormally high respiratory rate Bradycardia –Abnormally low heart rate

Blood Pressure (B/P) Systolic Diastolic Hypotension Hypertension Sphygmomanometer (continued)

White coat syndrome Orthostatic (postural) hypotension Blood pressure readings vary with age When not to use arm to take blood pressure Blood Pressure (BP)

Question True or False: –Orthostatic hypotension is a rapid rise in blood pressure when the patient stands.

Answer False Orthostatic hypotension –Blood pressure falls when patient stands Rather than rises

Height and Weight Height usually stable after adulthood –Except with osteoporosis Many factors affect weight (continued)

Height and Weight Types of scales: –Standing balance –Chair and wheelchair –Mechanical lift –Bed BMI