1. Overview of Physical Assessment Chapter 13 PNU 145 Bethann Davis RNC/NP MSN

2. Learning Objectives List the four purposes of a physical assessment. Name and define four assessment techniques. Inspection Percussion Palpation Auscultation

3. Learning Objectives (cont) Identify a head-to-toe approach to physical assessment. Define Accommodation Capillary refill Edema

4. Learning Objectives (cont) Describe the sequence of a lung assessment. Define Adventitious sounds Crackles Gurgles Wheezes Describe appropriate way to assess the abdomen.

5. Overview of Assessment Purposes 1. Evaluate current physical condition 2. Detect early health problems 3. Establish a baseline 4. Evaluate client’s responses to interventions

6. Overview of Assessment Assessment techniques Inspection Percussion Palpation Auscultation

7. Overview of Assessment Inspection: Systematic observation

8. Overview of Assessment Percussion: striking one object against another to produce vibration and sounds – usually fingers are used

9. Overview of Assessment Palpation: light touch using hands and fingers

10. Overview of Assessment Auscultation: listening to sounds - with a stethoscope

11. Overview of Assessment General areas of assessment head & neck chest extremities abdomen genitalia anus/rectum

12. Overview of Assessment “Head-to-toe” Assessment Ht/Wt vital signs

13. Overview of Assessment Mental status assessment Determine if client alert & oriented Does client remember what you say to them

14. Overview of Assessment Neurological Assessment level of consciousness (LOC) alert lethargic

15. Overview of Assessment level of consciousness (cont) stuporous comatose

16. Overview of Assessment Orientation document: alert & oriented x’s 3 person, place, time

17. Overview of Assessment Pupil response size equality response to light accommodation

18. Overview of Assessment Lung assessment inspect: palpate:

19. Overview of Assessment Lung assessment (cont) percuss: auscultate:

20. Overview of Assessment Abnormal lung sounds Crackles (rales): high pitched popping sounds heard primarily during inspiration Gurgles (rhonchi): low pitched continuous bubbling sounds heard during expiration.

21. Overview of Assessment Wheezing: whistling or squeaking sounds, during inspiration or expiration may be heard without a stethoscope

22. Overview of Assessment Extremities assessment: Muscle strength Motor Responses Hand grasps, feet pushes Equal, unequal, strong, weak

23. Overview of Assessment Extremities assessment (cont) Nails capillary refill

24. Overview of Assessment Extremities assessment (cont) Edema: pitting dependent

25. Overview of Assessment Extremities assessment (cont) Sensory responses: touch, pinch skin deep response – pinch mid chest or achillis tendon

26. Overview of Assessment Abdominal Assessment 4 quadrants: RUQ, RLQ, LLQ, LUQ Inspect: auscultate:

27. Overview of Assessment Abdominal Assessment (cont) palpation: percussion:

28. Overview of Assessment Abdominal Assessment (cont) Abdominal girth: measure abdomen, same site, same time of day

29. Overview of Assessment Genitalia, anal, rectal assessments

30. General Considerations Make sure client has glasses/hearing aid in place if needed Explain everything you are going to do. Make sure client understands your terminology.

31. General Considerations When positioning client, be aware of any physical limitations. Set a time limit with your client for the examination.