Chapter 8: Assessment Techniques and the Clinical Setting

To prevent the spread of infection, you should?

1. Observe infection control measures 2. Maintain a clean field. For example, clean your stethoscope endpiece with an alcohol wipe before and after every patient contact. Also designate "clean" versus "used" areas for equipment.

Physical examination requires the sequential use of what four assessment techniques?

inspection, palpation, percussion, and auscultation.

what is the single most important step to decrease microorganism transmission?

Thorough handwashing or using an alcohol-based hand rub.

True or False Use Standard Precautions for all patients

True

What are the 4 components of a percussion sound

Each percussion sound has four components. Amplitude is the sound's intensity, which may be loud or soft. Pitch describes the number of vibrations per second and may be high-pitched or low-pitched. Quality (or timbre) is the subjective difference due to a sound's distinctive overtones. Duration is the length of time the note lingers.

Describe the Inspection assessment technique?

Inspection is close, careful observation of the patient as a whole and then of each body system. When conducting an inspection, use the patient's body as the control and compare the right and left sides of the body to determine symmetry.

Describe the Palpitation assessment technique?

Palpation is the use of touch to assess texture, temperature, moisture, and organ location and size. This technique also helps identify swelling, vibrations, pulsations, rigidity or spasticity, crepitation, lumps or masses, and tenderness or pain.

How do you Adjust the examination based on the patient's developmental needs?

Pay special attention to a child's position and preparation. Consider the child's developmental stage when determining the examination sequence. Use a less threatening approach, and encourage a parent to be present for an infant, toddler, or preschooler. For an older child, be sure to maintain privacy. For an aging adult, adjust the position and preparation as needed. And pace the examination to match the older adult's pace, which may be slowed. When examining a patient in distress, you may need to collect a mini-database and then complete the assessment after the initial distress is resolved.

How do you perform a percussion?

Place your interphalangeal joint firmly on the patient's skin with the rest of your hand lifted off the skin. Then use the middle finger of your dominant hand to strike the stationary finger at a right angle. Deliver two short, sharp taps, using a quick wrist action.

How should you prepare an examination room in a clinical setting?

The examination room should be warm, comfortable, quiet, private, and well lit. Before beginning the examination, ensure that all your equipment is within easy reach and laid out in an organized fashion.

What are the commonly auscultated areas?

The heart, blood vessels, lungs, and abdomen

Deep palpation assesses what?

an organ or mass deeper in a body cavity.

When should you perform hygiene?

before and after physical contact with each patient, after contact with body fluids or contaminated equipment, and after removing gloves.

How do you ensure accurate auscultation?

eliminate confusing artifacts, for example, by making sure the room is quiet and warm and not listening through clothing.

What should you do During the examination?

explain each step and how the patient can cooperate. Proceed systematically and offer brief teaching, as appropriate.

What do you Use the stethoscope's diaphragm for?

for high-pitched sounds, such as breath, bowel, and normal heart sounds.

When should you Use transmission-based precautions?

for patients with documented or suspected transmissible infections.

What do you Use the stethoscope's bell for?

for soft, low-pitched sounds, such as extra heart sounds or murmurs.

what does the Inspection assessment technique require?

inspection requires good lighting, adequate exposure, and at times, the use of special instruments, such as an otoscope or penlight.

What is Percussion assessment technique?

is tapping the patient's skin with short, sharp strokes to create percussion sounds. This technique is used to assess the location, size, and density of an organ, detect an abnormal mass, or elicit a deep tendon reflex. Each percussion sound has four components. Amplitude is the sound's intensity, which may be loud or soft. Pitch describes the number of vibrations per second and may be high-pitched or low-pitched. Quality (or timbre) is the subjective difference due to a sound's distinctive overtones. Duration is the length of time the note lingers.

What is Bimanual palpation?

is the use of both hands to envelop or capture certain body parts or organs, such as the kidneys.

How do you reduce patient anxiety?

maintain a confident, considerate, and unhurried manner. Begin with familiar, nonthreatening actions, such as measuring height, weight, and vital signs. After the person puts on a patient gown, return to the room and clean your hands in his or her presence.

Light palpation evaluates what?

surface characteristics and identifies areas of tenderness.

In the palpitation assessment technique Different parts of the hands are best for assessing what different factors?

the fingertips are best for fine tactile discrimination. Grasping with the fingers and thumb is ideal for detecting position, shape, and consistency of an organ or mass. The backs of the hands and fingers are good for determining temperature. The base of the fingers or ulnar surface of the hand is best for assessing vibration. Palpation may be light, deep, or bimanual.

What is Auscultation assessment technique?

∙ Auscultation is listening to sounds made by the body, usually using a stethoscope.