1. Huda Al-Owairdy Clinical Pharmacy Dept.

3. Physical Assessment Skills

4. Learning Objectives
Name the four fundamental physical assessment techniques
Describe how to perform each of the techniques
Identify the components of Equipment used in physical examination
Describe how to assess each of the major organ systems.
Define common physical assessment terms
Interpret common physical assessment abbreviations.

5. Physical Assessment
Information obtained from the physical examination along with data obtained during a patient medication history interview and laboratory data are used to assess patient response to drug and nondrug therapy.

6. A physical examination
PE is an evaluation of the body and its functions using inspection, palpation, percussion, and auscultation.

7. All pharmacists need a basic understanding of physical assessment skills.
WHY ?

8. understand the meaning of specific physical assessment findings documented by other health care professionals

9. Pharmacists in some clinical settings
(e.g., ambulatory care clinics)
routinely assess patient response to medication regimens themselves using a variety of physical assessment skills

10. grow as pharmacists assume more direct patient care responsibilities.

11. Physical Assessment Sequence
1Vital signs 2. Appearance and behavior 3. Skin 4. Head 5. Eyes 6. Ears 7. Nose 8. Mouth
9. Neck 10. Breasts 11. Chest and lungs 12. Heart 13. Abdomen 14. Extremities 15. Back and spine 16. Nervous system 17. Mental status 18. Genitalia and rectum

12. Review PA abbreviation table 4-1
HEENT : Head, eyes, ears, nose, and throat WNL: Within normal limits WDWN: Well-developed, well- nourished VS : Vital signs HR: Heart rate

13. Assessment Sequencing
Head – to - Toe Assessment
Most comprehensive
Used to obtain baseline information to identify changes in patient status
organized - everything assessed from head progressing down to toes- combines
Body Systems Assessment
one system at a time
Cardiac: heart sounds, pulses, capillary refill, B/P
Respiratory: breath sounds, rate and depth, skin color
organized per body systems i.e. lung assessment, abdominal assess, cardiovascular, neuro system
best used for focused physical assessment

14. Performing Physical Exam (ROS and PE)
Review of Symptoms
▫ Observation and Interview
▫ Head to toe verbal review of all relevant symptoms
▫ Gather subjective information from patient
• Physical Exam
▫ Inspection, palpation, percussion, auscultation
▫ Physical assessment of all relevant body systems
▫ Gather objective information yourself

15. Assessment techniques The PA consists of detailed patient evaluation that consist of four fundamental techniques (IPPA).
Inspection
Palpation
Percussion
Auscultation

16. Assessment Techniques
Inspection - critical observation
Take time to “observe” with eyes, ears, nose
Use good lighting
Look at color, shape, symmetry, position
Odors from skin, breath, wound
Inspection is done alone and in combination with other assessment techniques

17. Assessment Techniques
Palpation
Using hands to fell areas that cannot be seen
light and deep touch
Back of hand to assess skin temperature
Fingers to assess texture, moisture, areas of tenderness
Assess size, shape, and consistency of lesions
Organ size and location
Rigidity or spasticity
Crepitation & Vibration
Position & Size
Presence of lumps or masses
Tenderness, or pain

18. Assessment Techniques
Percussion
Sounds produced by striking body surface
Produces different notes depending on underlying mass (dull, resonant, flat, tympani)
Used to determine size and shape of underlying structures by establishing their borders and indicates if tissue is air-filled, fluid-filled, or solid

19. Assessment techniques - Cont. Percussion
Direct – tapping the body directly with the distal end of a finger
sinus tenderness
Indirect- tapping a finger placed on the body, only the finger being struck touches the body
lung percussion
Blunt percussion-organ tenderness

20. Assessment Techniques
Auscultation
listening to sounds produced by the body
Direct auscultation – sounds are audible without stethoscope
Indirect auscultation – uses stethoscope
Describe sound characteristics (frequency, pitch intensity, duration, quality)
Flat diaphragm picks up high-pitched respiratory sounds best
Bell picks up low pitched sounds such as heart murmurs

21. Assessment techniques - Cont. Auscultation
Instrument: stethoscope (to skin)
Diaphragm –high pitched sounds
Heart
Lungs
Abdomen
Bell – low pitched sounds
Blood vessels

22. Physical Assessment Equipment
Table 4-2.

24. Stethoscope

25. Sphygmomanometer r