** Assessment Technique& General Survey

1. ** Assessment Technique& General Survey

2. Introduction • P/E requires that examiner develop technical skills & a knowledge base. • “we see only what we know”. to recognize a significant finding, you need to know what to look for. You will use your senses to gather data during P/E, these skills are: inspection, palpation, percussion& auscultation in this order. • start with v/s measurement, wash your hands

3. ·        Inspection: • is concentrated watching, first as a whole & then of each body system. It always comes first. Train your self not to rush .Compare the right & left sides of the body, requires good lighting, adequate exposure & occasional use of certain instruments.

4. Inspection

5. Palpation: • applies your sense of touch to assess these factors: texture, temperature, moisture, organ location& size, as well as any swelling, vibration or pulsation, presence of lumps or masses & presence of tenderness or pain.

6. palpation

7. different parts of the hands are best suited for assessing different factors: • 1-     Fingertips: for fine tactile discrimination, as of skin texture, swelling, pulsation, lumps. • 2-     A grasping action of the fingers & thumb- to detect the position of an organ or mass • 3-     The dorsa(backs) of hands & fingers- best for determining temperature • 4-     Base of fingers- best for vibration.

8. Technique should be slow & systematic. use a calm, gentle approach. warm your hands by kneading them together or holding them under warm water. Identify any tender areas & palpate them last.

9. - Start with • 1- light palpation to detect surface characteristics & to accustom the person to being touched. • 2- Then deeper palpation, intermittent pressure is better than one long continuous palpation. • 3- Bimanual palpation requires the use of both of your hands to envelop certain body parts or organs- such as kidneys.

10. ·        Percussion: • its tapping the person’s skin with short, sharp strokes to assess underlying structures. The strokes gives a palpable vibration & density of the underlying organ. Percussion has the following uses:

11. Percussion:cont • 1- mapping out the location & size of organ • 2- signaling the density(air, fluid or solid) of a structure by a characteristic note. • 3- detecting an abnormal mass superficial(5 cm deep) • 4- eliciting pain if the underlying structure is inflamed • 5- Eliciting a deep tendon reflex using the percussion hammer.

12. Hyperextend the middle finger & place its distal portion firmly against the person’s skin. Lift the rest of the stationary hand up off the person’s skin, the resting hand will dampen off the produced vibrations. ·       the stationary hand:

13. ·        the striking hand: • use the middle finger of your dominant hand as the striking finger, with your upper arm & shoulder steady. Action is all in the wrist, spread your fingers wish your wrist & bounce your middle finger off the stationary one. Aim for behind the nail bed or at the distal interpharyngeal joint, its tip not the finger pad, makes contact, percuss 2 times, the force of the blow determines the loudness of the note, the thickness of the person’s body wall will be a factor.

14. ·        Production of the sound: • - all sounds results from vibration of some structure, percussion notes is differentiated by (component of percussion): • amplitude(or intensity, aloud or soft sound) • pitch(or frequency, no of vibrations/sec) • quality(subjective difference due to a sound’s distinctive overtones) • duration(length of time the note lingers).

15. ·       Auscultation: • - its listening to sounds produced by the body as heart& lung, through a stethoscope , doesn’t magnify sound but does block out extraneous room sounds. The fit & quality of the stethoscope are important.

16. stethoscope • a stethoscope with 2 end pieces a diaphragm & bell . Diaphragm its flat edge best for high-pitched sounds-breath, bowel& normal heart, hold the diaphragm firmly against skin. The bell best for soft, low-pitched sounds as murmurs hold it lightly against skin.

17. You must eliminate any confusing artifact: • 1. Any extra room noise • 2. Warm room (shivering draw out the involuntary muscle contractions). • 3. Warm stethoscope by rubbing it in your palm • 4. Friction on the end piece from male’s hairy chest causes a crackling sound that mimics abnormal breath so wet the hair before auscultation • 5. Never listen through a gown • 6. Avoid your own artifact as breathing on the tubing or the thumb from bumping the tubing together.

18. ·        setting: • -  Warm comfortable, quite, private & well lit, natural lighting. • - Position the examination table so both sides of person are easily accessible, a suitable height.

19. 1- scale with height attachment 2-  skin fold caliper 3-  sphygmomanometer 4-   stethoscope with bell & diaphragm 5-  thermometer 6-  penlight 7-  otoscope / ophthalmoscope 8-  turning fork 9-     nasal speculum 10-tongue depressor 11-vision screen 12-tape measurement& ruler 13-reflex hammer 14-cotton ball 15-vaginal speculum 16- gloves 17- Lubricant ·        Equipment:

20. General Survey: • It’s a study of the whole person, covering the health state & any physical characteristic.

21. · Physical Appearance: • - age( does he appear his stated age) • - sex(sexual development appropriate for gender& age) • -  level of consciousness(alert, oriented) • - skin color( even, varying with genetic background, no lesions) • - facial features(symmetric with movement)

22. ·       Body structure: • stature(height appropriate with age) • nutrition(weight appropriate with height &body build) • symmetry (body parts look equal bilaterally) • posture(stands comfortably as appropriate for age • Position (sits comfortably in a chair or in the bed, arm relaxed at sides. • Body build, contour(arm span equal height)

23. ·       Mobility: • Gait(base is wide as the shoulder width, walk smooth& well balanced • Range of motion: full mobility for each joint, with accurate smooth coordinated no involuntary movement.

24. ·       Behavior: Facial expression: maintain eye contact, expressions appropriate to situation. Mood & affect: comfortable &cooperative with the examiner Speech: articulation is clear & understandable, fluently, appropriate to culture& education Dress & personal hygiene: appropriate to climate, fits the body, appropriate to culture& age. Clean, hair brushed& groomed.

25. Thank you