PA Week 1.docx - Physical Assessment Week 1 Chapter 9 Professional Responsibilities Provide a safe and comfortable environment o Take into consideration

PA Week 1.docx - Physical Assessment Week 1 Chapter 9...

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Physical Assessment Week 1 Chapter 9 Professional Responsibilities - Provide a safe and comfortable environment o Take into consideration: Personal and culture preferences Elderly Obese patients Disabilities - Identify cues presented by patient o Bits of information that hint at the possibility of a health problem - Apply critical thinking o Cues + Data collection NEXT interpret findings Standard precautions - Hand Hygiene o Scrub and rinse hands with soap for 40–60 seconds When hands visibly soiled After using restroom After removing gloves Before and after contact with medical equipment o Nonsterile examination gloves - HAI (healthcare associated infections) Medical Equipment - Light disinfectant for surfaces that touch patient's intact skin but not open sores or mucous membranes - High-level disinfectant for contact with non-intact skin or mucous membranes - Sterile if entering bloodstream or normally sterile areas - Dirty instruments in biohazard can General Survey - Body structure - HT/WT - BMI - Are they able to change positions? - Facial Expressions - Signs/symptoms of pain - Grooming/Hygiene - Are they dress appropriately? - Are there any odors?
- Do they use any devices? - Are there any lines? - Any dressings? - What is the client’s mood or affect? Inspection - ALWAYS First! (begins with first contact) - Observing (general then in detail) o Color o Shape o Contour o Symmetry o Movement o Drainage Palpation - Utilizing sense of touch - Characteristics o Size o Shape o Location o Mobility o Position o Vibrations o Temperature o Texture o Moisture o Tenderness o Edema - What is the dorsal surface of the hand most sensitive to? o Temperature - What are the fingertips most sensitive to? o Pulsations - What is the palmer surface of the finger and hand most sensitive to? o vibration Palpation - Light palpation: o Always first o Use finger pads, 1 cm deep assessing for surface characteristics, pulse of tender location - Moderate palpation: o Use palmar surface, 1-2 cm deep o Assessing for other structures: depth, size, shape, consistency, & mobility of organs
- Deep palpation: o Dominant hand on skin, non-dominant on top, 2-4 cm deep o Assessing for organs that lie deep or obese patients o Do not use with patient with rigidity r/t inflammatory process Percussion - Strikes through body part with object producing a measurable sound o Used to determine the size and shape of organs and masses o Direct : tapping with fingertips (infant thorax, adult sinuses) o Blunt : closed fist of dominant hand (Gallbladder, Liver, Kidneys) o Indirect : tapping finger of non-dominant hand (use tip of finger, motion is from wrist) Percussion Sounds - Tympany o Loud, high pitched, drum-like Organ filled with air (gastric bubble over the stomach or over air-filled intestines) - Resonance o Loud, low pitched, hollow tone (Normal finding over the Lungs) - Hyperresonance o Loud, low pitched, booming, longer duration (Air trapped in the lungs (COPD)) - Dullness o Medium pitched, thud-like, short duration (Solid organs, bowel full of stool) - Flatness o High pitched tone, very soft, very short duration (Muscle or bone)

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