1. Patient Assessment
Palpation
Log # 5

2. 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

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

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

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

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

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

8. 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

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

10. 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)

11. 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

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

13. 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

14. 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

15. 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.)

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

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

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