Techniques of Physical Assessment Mrs.Mahdia Kony 4/15/2017

Inspection Always begin with inspection Inspection is the most frequently used assessment technique, but its value is often overlooked. With inspection, you use not only your sense of sight but also your senses of hearing and smell to inspect your patient critically. Do not rush the process; take your time and really look at your patient. Mrs.Mahdia Kony 4/15/2017

Inspection Be sure you have adequate lighting. Be systematic, working from head to toe and noting key landmarks and normal findings. Use your patient as a comparative when possible. Ask yourself, “Does it look the same on the left side as the right?” Look for surface characteristics such as color, size, and shape. Mrs.Mahdia Kony 4/15/2017

Inspection Look for gross abnormalities or signs of distress. Do you notice any unusual odors or hear any unusual sounds that warrant further investigation? Always view your findings in light of the patient’s growth and developmental stage and cultural background, which may influence your interpretation. Mrs.Mahdia Kony 4/15/2017

Types of inspection Direct inspection: involves directly looking at your patient. Indirect inspection: involves using equipment to enhance visualization. E.g. oto/ ophthalmoscope allows better visualization of the ears and eyes. Mrs.Mahdia Kony 4/15/2017

Palpation During palpation, you are using your sense of touch to collect data. Palpation is used to assess every system. It usually follows inspection, but both techniques are often performed simultaneously. . Mrs.Mahdia Kony 4/15/2017

Uses of palpation To assess surface characteristics, such as texture consistency, and Temperature To assess for masses, organs, pulsations, muscle rigidity, and chest excursion. To differentiate areas of tenderness from areas of pain Mrs.Mahdia Kony 4/15/2017

Parts of the hand that is used n palpation Mrs.Mahdia Kony 4/15/2017

The dorsal aspect of the hand is best for assessing temperature changes Mrs.Mahdia Kony 4/15/2017

The ball of the hand on the palm and ulnar surface is best for detecting vibration Mrs.Mahdia Kony 4/15/2017

The finger pads and tips are the most discriminating for detecting fine sensations, such as pulsations. Mrs.Mahdia Kony 4/15/2017

Types of Palpation Light palpation is applying very gentle pressure with the tips and pads of your fingers to a body area and then gently moving them over the area, pressing about 1⁄2 inch. Light palpation is best for assessing surface characteristics, such as: Temperature Texture Mobility Shape ,and size. Assessing pulses Areas of edema Areas of tenderness. Closing your eyes while palpating may help you concentrate better on what you are feeling. Mrs.Mahdia Kony 4/15/2017

Types of Palpation Deep palpation is applying harder pressure with your fingertips or pads over an area to a depth greater than 1⁄2 inch. Deep palpation can be single-handed or bimanual Mrs.Mahdia Kony 4/15/2017

When using the bimanual technique, feel with your dominant hand When using the bimanual technique, feel with your dominant hand. You can place your other hand on top to help control your movements or to stabilize an organ with one hand while you palpate it with the other Mrs.Mahdia Kony 4/15/2017

Uses of deep palpation To assess organ size Detect masses Assess areas of tenderness. Mrs.Mahdia Kony 4/15/2017

Rebound tenderness To assess for rebound tenderness, press down firmly with your dominant hand and then lift it up quickly. An increase in the patient’s pain when you release the pressure signals rebound tenderness. Mrs.Mahdia Kony 4/15/2017

Ballottement Ballottement is a palpation technique used to assess a partially free-floating object. Deep palpation is applied in one area, causing the partially attached object to become palpable in another area. It is frequently used to assess the fetus during pregnancy. It is also used to assess for fluid in the supra patellar pouch, which, if present, results in a floating kneecap that bounces back on your finger when tapped. Mrs.Mahdia Kony 4/15/2017

Percussion Percussion is used to assess density of underlying structures, areas of tenderness, and deep tendon reflexes (DTRs). Striking a body surface with quick, light blows and eliciting vibrations and sounds. The sound determines the density of the underlying tissue and whether it is solid tissue or filled with air or fluid. Mrs.Mahdia Kony 4/15/2017

Mrs.Mahdia Kony 4/15/2017

Factors influence the sound produced during percussion: The thickness of the surface being percussed: The more tissue you have to percuss through, the duller the sound. Your technique. Percussion is a skill that usually requires practice to perfect. You also need to develop skill at identifying and differentiating the percussion sounds. Mrs.Mahdia Kony 4/15/2017

Types of Percussion Direct or immediate percussion is directly tapping your hand or fingertip over a body surface to elicit a sound or to assess for an area of tenderness. It is also used to assess for sinus tenderness. Indirect or mediate percussion: place your nondominant hand over a body surface, pressing firmly with your middle finger. Mrs.Mahdia Kony 4/15/2017

Types of Percussion Indirect or mediate percussion: Place your nondominant hand over a body surface, pressing firmly with your middle finger. Then place your dominant hand over it. Flexing the wrist of your dominant hand, tap the middle finger of your nondominant hand with the middle finger of your dominant hand. Do not rest your entire hand on the body surface because this dampens the sound. Keep only your middle finger on the body surface, and hyperextend it as you percuss. Tap lightly and quickly, removing your top finger after each tap. Mrs.Mahdia Kony 4/15/2017

Types of Percussion Using a percussion hammer: To test reflexes is also a type of indirect percussion. Instead of your finger, you use the hammer to tap a body surface. The purpose of this type of percussion is to elicit DTRs. Mrs.Mahdia Kony 4/15/2017

Types of Percussion Fist or blunt percussion: Is used to assess for organ tenderness It may be direct or indirect. a) Direct fist percussion involves striking a body surface with the ulnar surface of your fist. b) Indirect fist percussion involves placing your nondominant hand over the body surface and then striking that hand with the ulnar surface of your other fist. Mrs.Mahdia Kony 4/15/2017

Auscultation Auscultation involves using your sense of hearing You will listen to heart sounds, lung sounds, bowel sounds,and vascular sounds. Direct auscultation is listening for sounds without a stethoscope, example is respiratory congestion in a patient who requires suctioning Indirect auscultation with a stethoscope. Your ability to hear is affected by the quality of the stethoscope. Mrs.Mahdia Kony 4/15/2017

Auscultation Auscultation is also a skill that requires practice. You need to know normal sounds before you can begin to identify abnormal sounds. Characteristics of sound: Pitch may be high, medium, or low. Intensity can range from soft to loud Duration may be short or long Quality describes the sound. Was it harsh, blowing Mrs.Mahdia Kony 4/15/2017

Auscultation Tips ■ Always have earpieces pointing forward to seal the ear canal. Warm your stethoscope. ■ Work on the patient’s right side. ■ Never listen through clothes. ■ Make sure that the environment is quiet. ■ If hair is a problem, wet it to minimize artifact. ■ Use light pressure to detect low-pitched sounds ■ Use firm pressure to detect high-pitched sounds. ■ Close your eyes to help you focus. ■ Learn to become a selective listener. Mrs.Mahdia Kony 4/15/2017

Positions for Physical Assessment Supine: AREAS ASSESSED: ■ Anterior chest for respiratory, cardiac, and breast exams (should be supine for breast exam). ■ Pulses and extremities. ADVANTAGES/ DISADVANTAGES: If patient has trouble breathing in supine position, use semi-Fowler’s position . Mrs.Mahdia Kony 4/15/2017

Sitting AREAS ASSESSED: ■ Head and neck. ■ Anterior and posterior chest for respiratory, cardiac, and breast exams. ■ Vital signs and upper extremities. ADVANTAGES/ DISADVANTAGES: Provides good visualization. Allows full lung expansion for respiratory assessment. Patients with weakness or paralysis may have difficulty assuming position and need assistance Mrs.Mahdia Kony 4/15/2017

Dorsal recumbent AREAS ASSESSED: ■ Abdomen: Basically supine position with knees slightly flexed to relax abdominal muscles. ■ Female pelvic area if patient is unable to assume lithotomy or Sims’ position. ■ Lithotomy position for female pelvic and rectal areas essentially same as dorsal recumbent but legs and feet in stirrups. ADVANTAGES/ DISADVANTAGES: ■ If patient has abdominal pain, flexing knees is usually more comfortable. ■ Older patients may have difficulty assuming lithotomy position. Mrs.Mahdia Kony 4/15/2017

Prone AREAS ASSESSED: ADVANTAGES/ DISADVANTAGES: ■ Musculoskeletal system. ADVANTAGES/ DISADVANTAGES: ■ Difficult position for many patients, especially those with respiratory disease. Mrs.Mahdia Kony 4/15/2017

Left Lateral Recumbent AREAS ASSESSED: ■ Chest: Best for cardiac auscultation, particularly of S3, S4, and some murmurs. ADVANTAGES/ DISADVANTAGES: ■ Patients with respiratory problems may have trouble assuming this position. Mrs.Mahdia Kony 4/15/2017

Knee-chest ADVANTAGES/ DISADVANTAGES: AREAS ASSESSED: ■ Male rectal and prostate areas: Best position for these exams. ADVANTAGES/ DISADVANTAGES: ■ This position and its alternative (bending over a table) are very difficult and embarrassing for most patients. Mrs.Mahdia Kony 4/15/2017

Standing AREAS ASSESSED: ■ Spine and joints (ROM): Best for these musculoskeletal areas; used for both neurological exam and to assess gait and cerebellar function. ADVANTAGES/ DISADVANTAGES: ■ Patients who are weak, disabled, or paralyzed may need assistance or may not be able to assume this position. Mrs.Mahdia Kony 4/15/2017