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Introduction to Physical Assessment

Introduction to Physical Assessment. Practicum I & II Health Science Technology 2011 - 2012. Introduction. Assessment begins with subjective findings, including the health history and review of systems

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Introduction to Physical Assessment

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  1. Introduction to Physical Assessment Practicum I & II Health Science Technology 2011 - 2012

  2. Introduction • Assessment begins with subjective findings, including the health history and review of systems • Once this is obtained you move to the physical assessment to obtain objective data about a patient • Physical assessment has 4 parts: • General Survey • Vital Sign Measurements • Assessment of Height and Weight • Physical Examination

  3. Thermometer Stethoscope Sphygmomanometer Visual Acuity Charts Penlight or Flashlight Measuring Tape and Pocket Ruler Marking Pencil Scale Tongue Depressor Safety Pins Cotton Balls Test tubes filled with Hot and Cold water Water – Soluble lubricant Basic Assessment Equipment

  4. Advanced Assessment Equipment • Ophthalmoscope • Nasoscope • Otoscope • Tuning Fork • Reflex Hammer • Skin Calipers • Vaginal Speculum • Goniometer • Transilluminator

  5. Physical Assessment Techniques • Inspection • Palpation • Percussion • Auscultation

  6. 1. Inspection • Critical observation or inspection is the first step in assessing a patient • Reveals more than other techniques • Approach inspection in a careful, unhurried manner • Pay close attention to details, and try to draw logical conclusions from the findings

  7. 2. Palpation • The examiner touches the body to feel pulsations and vibrations, to locate body structures, and to assess such characteristics as size, texture, warmth, mobility, and tenderness • Allows detection of a pulse, muscle rigidity, enlarged lymph nodes, skin or hair dryness, organ tenderness or breast lumps, and measurement of the chest rising and falling with each respiration

  8. Guidelines for Palpation • Warm your hands before beginning • Explain what you will do and why, and describe what the client can expect, especially in sensitive areas • Encourage the client to relax by taking several deep breaths, concentrating on inhaling and exhaling • Stop palpating immediately if the patient complains of pain

  9. 3. Percussion • Use of quick, sharp tapping of the fingers or hands against body surfaces to produce sounds, elicit tenderness, or assess reflexes • Percussing for sound – the most common percussion goal – helps locate organ borders, identify organ shape and position, and determine if an organ is solid or filled with fluid or gas

  10. Percussion • When percussing for sound, the examiner uses quick light blows to create vibrations that penetrate about 1 ½ inch to 2 inches under the skin surface • The returning sounds reflect the contents of the percussed body cavity

  11. Normal Percussion Sounds: • Resonance • Tympany • Dullness

  12. Resonance • The long, low, hollow sound heard over an intercostal space lying above healthy lung tissue

  13. Tympany • The loud, high – pitched, drumlike sound heard over a gastric air bubble or gas filled bowel

  14. Dullness • Soft, high – pitched, thudding sound normally heard over more solid organs, such as the liver and heart

  15. Abnormal Percussion Sounds • Hyperresonance – long, loud, low – pitched sound – classic sign of lung hyperinflation such as in emphysema • Flatness – Similar to dullness but shorter in duration and softer in intensity – may also be heard over pleural fluid accumulation or pleural thickening

  16. Guidelines for Percussion To enhance you percussion technique and improve results, follow these guidelines: • Keep your fingernails short, and warm your hands before starting • Have the client void before you begin • Make sure the examination room or area is quiet and distraction free

  17. Guidelines for Percussion • Remove any jewelry or other items that could clatter and interfere with the ability to hear returning sounds • Before performing percussion, briefly explain to the client what you will do and why • In an obese client, expect percussion sounds to be muffled by a thick subcutaneous fat layer

  18. 4. Auscultation • The examiner listens to body sounds – particularly those procedure by the heart, lungs, vessels, stomach, and intestines • Most auscultated sounds result from air or fluid movement • Usually performed after other assessment techniques • EXCEPT in the abdomen, auscultation is performed BEFORE percussion and palpation

  19. Approach to Physical Assessment • Begin by introducing yourself • Make sure your grooming, dress and behavior reflect a professional attitude • Before starting the assessment, briefly explain what you will do and why; include any position changes that you will ask the client to make

  20. Approach to Physical Assessment • Have all necessary equipment on hand and in working order • To help ensure accurate findings and promote client comfort, ask the client to void before you begin the assessment • Respect the client’s privacy and modesty; ask family members and other visitors to leave, close the door, and use pull drapes as appropriate

  21. Approach to Physical Assessment • Make the client as comfortable as possible by offering a pillow and making sure that the room and assessment equipment are warm • Always warn the client before performing a procedure that may cause discomfort • If possible avoid touching painful tender or painful areas until the end of the assessment

  22. Approach to Physical Assessment • Use the same communication skills you applied in the interview; politely ask the client to follow your instructions; answer any questions and express thanks for cooperation • Be sensitive, unhurried, and reassuring • Wash your hands BEFORE and AFTER the assessment in the client’s presence

  23. Approach to Physical Assessment • Dress comfortably and minimize position changes during the assessment • Always use the same systematic approach to assessment, varying it only to accommodate the patient’s particular needs • Avoid negative reactions, such as grimaces or exclamations, to abnormal or unexpected findings and unpleasant odors or sights

  24. The General Survey • Begins with the first moments of the patient encounter • How do you perceive the patient’s apparent state of health, demeanor, and facial affect or expression, grooming, posture and gait? • Height and Weight

  25. Vital signs • These include blood pressure, heart rate, respiratory rate, and temperature

  26. Pain Assessment • Commonly under – diagnosed • Major focus of caring for patients in all health professions • Fifth Vital Sign

  27. Common Concerning Symptoms • Changes in Weight • Fatigue and Weakness • Fever, Chills, Night Sweats • Pain

  28. Changes in Weight • Result from changes in body tissue or body fluids • Good Opening questions include: • “How often do you check your weight?” • How is your current weight compared to 1 year ago? • What would you like to weigh? • Why do you think your weight has changed?

  29. Significance • Rapid changes in weight, over a few days, suggests changes in body fluids, NOT tissues.

  30. Weight Gain • Usually occurs when caloric intake exceeds caloric expenditure over time and typically appears as increased body fat • May also reflect abnormal accumulation of body fluids • Fluid retention that is mild, may not be visible

  31. Why are vital signs so important? • Indicate normal or abnormal function • Normal = homeostasis (balance) • Accuracy can mean the difference between life and death

  32. What are vital signs? • TPR and BP where: • T = body temperature (measure of body heat) • P = pulse rate (the rate at which the heart is pumping blood through the body) • R = respiratory rate (the rate at which the lungs are breathing air in and out) • BP = blood pressure (the highest and lowest amount of pressure placed on the blood vessels of the body)

  33. What is body heat (temperature)? • Heat is produced by muscle activity, food oxidation, and glands. • Heat is “lost” through respiration, perspiration, and excretion.

  34. Factors that increase body temperature: • Exercise • Digestion of food • Increase environmental temperature • Illness • Infection • Excitement • Anxiety

  35. Factors that decrease body temperature: • Sleep • Fasting • Exposure to cold • Depression • Decreased muscle activity • Certain illnesses • Mouth breathing

  36. Most common sites to measure temperature: • Mouth (Oral) • Axilla (Underarm) • Rectum • Tympanic

  37. Types of thermometers: • Glass • Electronic digital • Aural or tympanometer • Chemically treated strips

  38. Normal temperature readings: • Oral/Tympanic = 98.6° F (37° C) • Axillary = 97.6° F (36.4° C) • Rectal = 99.6° F (38° C)

  39. Pulse • The number of times the heart pumps or beats in a minute • Indicates that blood is circulating through the body • Most common sites to measure pulse – radial, antecubital (brachial), apical (stethoscope on the chest wall)

  40. When counting the pulse, you feel the pressure of blood against the artery as the heart contracts. Pulse rate varies for different ages (faster in infants)newborn = 120 – 160teenagers = 60 - 110adults = 60-100

  41. Characteristics of a pulse: • Rate – fast, slow • Rhythm – regular, steady, irregular • Arrhythmia – even or uneven intervals between pulse • Force of the beat / volume – bounding, thready or weak; normal, strong

  42. Pulse • Pulse rates below 60 or above 100 should always be reported • Pulse below 60 = Bradycardia • Pulse above 100 = Tachycardia • Athletes may have a pulse rate under 60 due to excellent fitness

  43. Factors that influence pulse rate: • Exercise (increases pulse rate) • Hemorrhage (weakens, increases) • Emotional excitement (increases) • Elevated temperature (increases) • Medication (increases or decreases) • Age (increases) • Aerobic fitness (decreases) • Depression (decreases) • Illness (increases or decreases) • Shock (increases)

  44. Pulse Points

  45. The radial pulse is the most common site for counting the pulse rate. • Adult pulse rate may range from 60-80. • The pulse oximeter is an electronic device that determines pulse and oxygen concentration in the hemoglobin of the arterial blood. • pO2 < 90% not enough oxygen in the tissues to function normally

  46. Respiration • The process of taking in oxygen and expelling carbon dioxide • Helps regulate temperature and eliminate all waste products • 1 expiration / exhalation (breathing out) + 1 inspiration / inhalation (breathing in)

  47. Respiration rate is assessed by observing the client’s chest movement upward and outward for a complete minute.Auscultation (listening with a stethoscope) is another method to assess respiratory rate.

  48. Abnormal respirations (lung sounds) include: • Dyspnea – difficulty breathing (diminished lung sound) • Apnea – stopped breathing (no lung sound) • Cheynes-Stokes – periods of labored breathing followed by apnea • Rales – bubbling or rattling sounds caused by mucus

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