Assessment Techniques and the Clinical Setting

Assessment Techniques and the Clinical Setting Chapter 8

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 • Specula: vaginal, nasal • Penlight

Cultivating Your Senses (cont.) • Palpation • Purpose • Use different parts of the hands • Light vs. deep palpation

Texture Temperature Moisture Organ location and size Swelling Vibration or pulsation Rigidity or spasticity Crepitation Presence of lumps or masses Presence of tenderness or pain Palpation SpecificsCharacteristics Assessed by Palpation

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

Cultivating Your Senses • Percussion • Purpose • Indirect percussion • Stationary hand • Striking hand • Characteristics of percussion notes • Resonant • Hyperresonant • Tympany • Dull • Flat

Cultivating Your Senses (cont.)

Cultivating Your Senses (cont.) • Auscultation • Fit and quality of stethoscope • Diaphragm and bell endpieces • Eliminate confusing artifacts

Setting • Examination room • Examination table

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

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

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

Approach to the Clinical Setting • General approach • Patient’s emotional state • Examiner’s emotional state

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

Your physical examination of the patient should begin on the hands because • They are easy to reach from any position. • They reveal a great deal about the patient. • They will always be clean and dry. • They are a place people are accustomed to being touched by strangers.

Which of the following characteristics is not evaluated via palpation? • Temperature • Resilience • Density • Crepitation

Assessment Techniques and the Clinical Setting