Module 04 Notes .docx - Module 04 Chapter 8 Assessment...

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17 Module 04: Chapter 8: Assessment Techniques & Safety in the clinical setting Health History and Physical Examination The health history described in preceding chapters provides the following: Subjective data for health assessment Objective data (the signs perceived by examiner through physical examination) Physical examination requires examiner to develop the following: Technical skills, the tools to gather data Then examiner will relate those data to his or her knowledge base and previous experience Cultivating Your Senses The examiner will use the senses—sight, smell, touch, and hearing—to gather data during physical examination Senses will be focused to assess each person’s health state Skills performed one at a time, in this order: Inspection Palpation Percussion Auscultation Inspection Close, careful scrutiny, first of individual as a whole and then of each body system Begins when you first meet person with a general survey As you proceed through examination, start assessment of each body system with inspection Inspection always comes first Inspection requires Good lighting Adequate exposure Occasional use of instruments, including otoscope, ophthalmoscope, penlight, or nasal and vaginal specula, to enlarge your view Palpation Palpation applies sense of touch to assess the following: 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 Techniques Different parts of hands are best suited for assessing different factors
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17 Fingertips: best for fine tactile discrimination of skin texture, swelling, pulsation, determining presence of lumps Fingers and thumb: detection of position, shape, and consistency of an organ or mass Dorsa of hands and fingers: best for determining temperature because skin here is thinner than on palms Base of fingers or ulnar surface of hand: best for vibration Palpation Sequence Start with light palpation to detect surface characteristics and accustom person to being touched Then perform deeper palpation when needed Intermittent pressure better than one long continuous palpation Avoid any situation in which deep palpation could cause internal injury or pain Bimanual palpation requires use of both hands to envelop or capture certain body parts or organs, such as kidneys, uterus, or adnexa, for more precise delimitation Percussion Tapping person’s skin with short, sharp strokes to assess underlying structures Percussion has following uses: Mapping location and size of organs Signaling density of a structure by a characteristic note Detecting a superficial abnormal mass Percussion vibrations penetrate about 5 cm deep Deeper mass would give no change in percussion Eliciting pain if underlying structure is inflamed
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  • Fall '16
  • Catharines Muskus
  •  Inspection,  Skin color

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