1. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Assessment Techniques and the Clinical Setting Health Assessment Across the Lifespan NRS 102

2. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 8: Assessment Techniques and the Clinical Setting Slide 8-2 Cultivating Your Senses  Inspection  Do not rush  Compare patient’s right side with left side  Use good lighting  Obtain adequate exposure (of the patient)  Will include instruments in many body systems Otoscope/ophthalmoscope Otoscope/ophthalmoscope Specula: vaginal, nasal Specula: vaginal, nasal Penlight Penlight

3. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 8: Assessment Techniques and the Clinical Setting Slide 8-3 Cultivating Your Senses (cont.)  Palpation  Purpose  Use different parts of the hands  Light vs. deep palpation

4. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 8: Assessment Techniques and the Clinical Setting Slide 8-4 Palpation Specifics Characteristics Assessed by Palpation Texture Texture Temperature Temperature Moisture Moisture Organ location and size Organ location and size Swelling Swelling Vibration or pulsation Vibration or pulsation Rigidity or spasticity Rigidity or spasticity Crepitation Crepitation Presence of lumps or masses Presence of lumps or masses Presence of tenderness or pain Presence of tenderness or pain

5. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 8: Assessment Techniques and the Clinical Setting Slide 8-5 Palpation Specifics (cont.) Uses for particular parts of the hand  Fingertips—best for fine tactile discrimination, as of skin texture, swelling, pulsation, and determining presence of lumps  A grasping action of the fingers and thumb—to detect the position, shape, and consistency of an organ or mass  The dorsa (backs) of hands and fingers—best for determining temperature because the skin here is thinner than on the palms  Base of fingers (metacarpophalangeal joints) or ulnar surface of the hand—best for vibration

6. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 8: Assessment Techniques and the Clinical Setting Slide 8-6 Cultivating Your Senses  Percussion  Purpose  Indirect percussion Stationary hand Stationary hand Striking hand Striking hand  Characteristics of percussion notes Resonant Resonant Hyperresonant Hyperresonant Tympany Tympany Dull Dull Flat Flat

7. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 8: Assessment Techniques and the Clinical Setting Slide 8-7 Cultivating Your Senses (cont.)

8. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 8: Assessment Techniques and the Clinical Setting Slide 8-8  Auscultation  Fit and quality of stethoscope  Diaphragm and bell endpieces  Eliminate confusing artifacts Cultivating Your Senses (cont.)

9. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 8: Assessment Techniques and the Clinical Setting Slide 8-9 Setting  Examination room  Examination table

10. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 8: Assessment Techniques and the Clinical Setting Slide 8-10 Equipment  Platform scale with height attachment  Skinfold calipers  Sphygmomanometer  Stethoscope with diaphragm and bell  Thermometer  Pulse oximeter (in hospital setting)  Flashlight or penlight  Otoscope/ophthalmoscope  Tuning fork  Nasal speculum  Tongue depressor

11. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 8: Assessment Techniques and the Clinical Setting Slide 8-11 Equipment (cont.)  Pocket vision screener  Skin-marking pen  Flexible tape measure and ruler  Reflex hammer  Sharp object (split tongue blade)  Cotton balls  Bivalve vaginal speculum  Clean gloves  Materials for cytologic study  Lubricant  Fecal occult blood test materials

12. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 8: Assessment Techniques and the Clinical Setting Slide 8-12 A Safer Environment  Clean the equipment  Clean vs. used area for handling equipment  Nosocomial infections  Handwashing or alcohol-based hand rub  Wear gloves  Standard precautions  Transmission-based precautions

13. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 8: Assessment Techniques and the Clinical Setting Slide 8-13 Approach to the Clinical Setting  General approach  Patient’s emotional state  Examiner’s emotional state

14. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 8: Assessment Techniques and the Clinical Setting Slide 8-14 Approach to the Clinical Setting (cont.)  Hands on  Measurement and vital signs  Begin with person’s hands  Concentrate on one step at a time  Examination sequence  Brief health teaching  When findings are complicated  Summarize findings for person

15. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 8: Assessment Techniques and the Clinical Setting Slide 8-15 Your physical examination of the patient should begin on the hands because A.They are easy to reach from any position. B.They reveal a great deal about the patient. C.They will always be clean and dry. D.They are a place people are accustomed to being touched by strangers.

16. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 8: Assessment Techniques and the Clinical Setting Slide 8-16 Which of the following characteristics is not evaluated via palpation? A.Temperature B.Resilience C.Density D.Crepitation