Chapter 8: Assessment Techniques and the Clinical Setting

*Physical examination requires you to develop technical skills and a knowledge base.   -technical skills are the tools to gather data.    -knowledge base: you need to know what to look for.

*Skills are performed one at a time, in this order:    -Inspection    -Palpation    -Percussion    -Auscultation 

        Inspection*************************

*Inspection is concentrated watching.    -first of the as a whole and then of each body system. *Begins the moment you first meet someone and develop a general survey.*Requires good lighting and adequate exposure.

        Palpation**********************

*Palpation follows and often confirm points you noted during inspection. *Touch assess:     -texture     -temperature     -moisture     -organ location and size     -swelling     -vibration/pulsation     -rigidity/spasticity     -crepitation      -presence of lumps/masses     -presence of tenderness/pain

*Fingertips: best for fine tactile discrimination, as of skin texture, swelling, pulsation, and determining presence of lumps.*Fingers and thumb: to detect the position, shape, and consistency of an organ or mass.* Dorsa (backs) of hands and fingers: best for determining temperature because the skin here is thinner than on the palm.*Base of fingers or ulnar surface of the hand: best for vibrations

How 

How 

How to Palpate:

How to Palpate:

How to Palpate:*Slow and systematic.*Warm hands by kneading them together.   -start with light palpation to detect surface characteristics and to accustom the person to being touched.    -Perform deeper palpation. Your sense of touch becomes blunted with heavy or continuous pressure so PRN. Deep palpation is needed for abdominal contents and intermittent pressure is better than prolonged. 

    Percussion********************

*Percussion is tapping the person's skin with short, sharp strokes to assess underlying structures. *Strokes yield a palpable vibration and a characteristic sound that depicts the location, size, and density of the underlying organ.*Uses:    -Mapping out location and size of an organ by exploring where the percussion note changes between the borders of an organ and its neighbors.    -Signaling the density (air, fluid, or solid) of a structure by a characteristic note.    -Detecting an abnormal mass if it is fairly superficial-percussion vibrations penetrate 5 cm...deeper mass won't be detected.     -Eliciting a deep tendon reflex using the percussion hammer.

The Stattionaru H

The Stationary Hand:*Hyper

The Stationary Hand:*Hyperextend the middle finger and place its distal portion firmly against the person's skin. Avoid ribs and scapulae. *Always lift the rest of the stationary hand up off the skin!!The Striking Hand:*Use the middle finger of your dominant hand as the striking finger. *Action is all in the wrist, must be relaxed.*Aim finger just behind the nail bed.*Flex the finger so that its tip, and not the finger bed, makes contact. RIGHT ANGLES!*Percuss 2 times in this location.     -Lift finger off quickly, then move to another location. 

Production of Sound *Amplitude (intensity): a loud or soft note. Loudness depends on the force of the blow and the structure's ability to vibrate.*Pitch (or frequency): the number of vibrations per second. More rapid vibrations produce a high-pitchedtone, slow vibrations produce a low-pitched sound.*Quality: (timbre)*Duration**Structure with more air produces a louder, deeper, and longer sound bc it vibrates freely.**Denser, more solid structures gives a softer, higher, shoer sound 

methods  Direct, sometimes called immediate, the striking hand directly contacts body wall  Indirect, or mediate, using both hands, the striking hand contacts stationary hand fixed on person’s 

2 Methods  *Direct, sometimes called immediate, the striking hand directly contacts body wall  *Indirect, or mediate, using both hands, the striking hand contacts stationary hand fixed on person’s 

Percussion Sounds  *Resonant: lung  *Tympani: Air filled organs (stomach, bowel)  *Dull: Dense organs (liver)  *Flat: Dense-no air, (bone, heavy muscle) 

     Auscultation*************************

*Auscultation is listening to sounds produce by the body, such as the heart and blood vessels and the lungs and abdomen.*Use diaphragm for high-pitch sounds...breath, bowel, and normal heart sounds. Press firmly.*Use bell for soft, low-pitch sounds...blood. Press very lightly. *Never listen through a gown!

New Page