Chapter Three Approach to the Physical Assessment

Types of Physical Assessment Complete Observations Vitals signs General appearance Behavior Head to toe assessment of all structures and body systems. Focused General Survey Vitals signs and measurements Assessment of the specific body structure or system.

Tools of the Physical Assessment Tools we use every day Tools you might need Your senses are first and foremost the most important tools you have. Stethoscope Thermometer Doppler Sphygmomanometer Pen light Ophthalmoscope Otoscope Tuning fork Tape measure Pens Scale Tongue blade

Four techniques of physical assessment 1. Inspection The process of being with your patient. Look at your patient. Be present with them. Did you notice a strange odor from their breath? Inspect with your eyes nose and ears. Work from head to toe or system to system. Always use a systematic approach. Use of direct inspection is critical for all patients

2. Palpation Palpation can be just light touch in which you are looking for texture, temperature, consistency (eg: a hot area, a tense muscle, or a pulse.) Palpation can be deep in which you are feeling for a organ structure such as the border of the liver. (Deep Palpation is > ½ inch in depth) **Note the abdomen should never be palpated before auscultation

3. Percussion Striking a body surface with a quick light blow in order to elicit vibrations or sounds. Direct percussion can be used to test for areas of pain (eg pain caused by renal calculus.) It can be used to determine the density of a body structure, as well as the size and shape. It is further used to detect deep tendon reflexes (DTRs) Two factors influence the sound produced by percussion: The thickness of the surface (the more tissue you percuss through—the duller the sound) Your technique

4. Auscultation Direct auscultation is done with out a stethoscope Using your sense of hearing to obtain physical data. Direct auscultation is done with out a stethoscope Indirect auscultation is using a stethoscope or doppler to hear sounds not heard with the naked hear. Tips A Stethoscope is one of the most used tools in nursing. Use a good quality stethoscope. If your stethoscope is cheap the quality of your auscultation may be poor. Using cheap tools is not an excuse for missing something in court.

Using a Stethoscope Never listen through clothes Try and listen in a quiet environment Use light pressure for low pitch sounds and firm pressure for high pitch sounds Learn to block out unwanted sounds and focus on sounds you are trying to hear. eg heart tones that are mixed in with Respirations

Approach to the Physical Assessment… Should be systematic whether head to toe or system by system Be cognitive of any special needs your patient might have. Understand the different positions needed for different exams on pg 75 in text.

Components of the Physical Exam General Survey First impressions. Learn to listen you your Gut feelings. Use all of your senses. Ask yourself… Are there signs of distress? This is the time to look listen and smell. Body type and posture Speech Grooming and Hygiene Signs of mental health problems? Look for cultural or developmental considerations.

Vital Signs Respiration Pulse Blood pressure Temperature Pain scale