Patient Assessment Palpation Log # 5

Palpation Tactile = Pertaining to touch Palpation = Assessment by using tactile sense Act of feeling with your hands to determine the condition of the area examined

Used For Degree of symmetry Mediasteinal/trachea position Vocal/tactile fremitus

Symmetry Normal is equal symmetry Thumb moves approximately 3 - 5 cm. Decreased ventilation of a lobe or lung will result in decreased expansion

Tracheal and Mediastinal Shift Tracheal shift to the same or opposite side of the affected area

Causes of Tracheal Shift Shift away Tension pneumothorax Pleural effusion Herniated abdominal contents Shift towards Atelectasis Consolidation Pneumonectomy/lobectomy Simple pneumothorax

2. Mediasteinal shift A shift of the mediasteinum Causes Same as tracheal

Tactile Fremitus Significance Some diseases may improve transmission, therefore… Augment intensity of vibration Others may diminish vibration, Decrease intensity of vibration Compare both sides of chest

Vocal fremitus Vibrations created by vocal cords while speaking Tactile fremitus Vibrations felt while touching chest

Abnormalities 1. Increased fremitus Any condition that increases density of the lung Consolidation Pneumonia 2. Decreased fremitus Any condition that decreases density of the lung Muscular or obeisity Increased air (emphysema)

So the Moral of the Story is… Increased density = increase fremitus Decreased density = decrease fremitus Causes Increased – Pneumonia, lung tumour, atelectasis Decreased – Pneumothorax, pleural effusion

Procedure Patient repeats “99” while chest is palpated Palpate with palms of hands Compare one side of chest to the other

Pedal Edema Why? Performed to assess heart failure What? May be evident in chronic lung disease because of hypoxic vasoconstriction Where? Occurs mainly in ankles and feet because of gravity dependent position

Pedal Edema cont. How? Performed by pressing firmly with the fingertips on and above the ankle If the edema is severe, the skin will “pit” or indent Note the severity and location of edema

Capillary Refill Why? Performed to assess cardiac output and digital perfusion status What? Normal = refill time less than 3 sec. Abnormal = refill time slow (longer than 5 sec.)

Capillary Refill cont. How? Performed by pressing firmly on the fingernail and noting the speed at which the blood flow returns

Pediatric Palpation Less influence on lungs Cardiac output evaluation Skin perfusion Skin temperature Peripheral pulses Skin turgor

Pediatric Palpation Abdomen Liver enlargement Kidneys, bladder, or bowel Abdominal distention Palpate infants gently!