Health Assessment Exam Two HEALTH 2058

Health Assessment Exam Two Chapter 8 Physical exam requires you to develop technical skills and a knowledge base. Technical skills are the tools to gather date. We use our senses  smell, hearing, touch, sight Inspection, Palpation, Percussion, Auscultation UNLESS you are examining the abdomen THEN it is Inspection, Auscultation, Percussion, Palpation Inspection • Concentrated watching • Begins the moment we first meet someone • Inspection requires good lighting, adequate exposure, and occasional use of certain instruments Palpation • Allows our sense of touch to assess the following factors: texture, temperature, moisture, organ location and size, any swelling, vibration or pulsation, rigidity or spasticity, crepitation, presence of lumps or masses, and presence of tenderness or pain • Different parts of hands are best suited for assessing different factors • Fingertips o Best for fine tactile discrimination, as of skin texture, swelling, pulsation, and determining presence of lumps • Grasping action of the fingers and thumb o Detect the position, shape, and consistency of an organ or mass • Dorsa (back of hands and fingers) o Determining temperature because the skin is thinner than on the palms • Base of fingers o Best for vibration • Technique should be slow and systematic, calm, and gentle • Make sure are hands are warm • Start with light palpation and go deep when needed, not deep where we are causing pain or injury to patient Percussion • Tapping the persons skin with short, sharp stroked to assess underlying structures • Strokes yield audible vibration and a characteristic sound that depicts the location, size, and density of the underlying organ • Mapping out the 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; the percussion vibrations penetrate about 5 cm deep – deeper mass would give no change in percussion • Eliciting a deep tendon reflex using the percussion hammer • Stationary Hand o Hyperextend the middle finger and place its distal joint and tip firmly against the person’s skin o Lift rest of the stationary hand up off the person’s skin • The striking hand o Use the middle finger of your dominant hand as the striking finger AMPLITUDE PITCH QUALITY DURATION SAMPLE LOCATION Resonant Medium-Loud Low Clear, hollow Moderate Over normal lung tissue Hyper resonant Louder Lower Booming Longer Normal over child’s lung, Abnormal in the adult, over lungs with increased amount of air as in emphysema Tympany Loud High Musical and drum like (like a kettledrum) Sustained longest Over air-filled viscus (stomach, intestine) Dull Soft High Muffled thud Short Relatively dense organ as liver or spleen Flat Very soft High A dead stop of sound, absolute dullness Very short When no air is present, over thigh muscles or bone or over tumor Auscultation • Listening to sounds produces by the body, such as the heart and blood vessels and the lungs and abdomen • Stethoscope  Diaphragm and bell • Diaphragm  Used most often, its flat edge is best for high-pitches sounds – breath, bowel, and normal heart sounds • Bell  Deep, hollow, cuplike shape. Best for soft, low-pitches sounds such as extra heart sounds or murmers Setting • Warm and comfortable, quiet, private and well lit • Stop any distracting noises such as humming machinery, radio or television, or talking that could make it difficult to hear body sounds Equipment ..,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,CONTINUED………………………………………………….