PATIENT ANALYSIS AND TEACHING TOOL 5 Percussion is performed next to elicit any tenderness and produce sound in various systems (Jensen, 2019). The vibrations produced by the nurse tapping their fingers on the specific body area create percussive tones that are conducted into the body. When assessing the musculoskeletal system, tones heard over bones will be quiet or flat. Louder tones are heard over areas filled with air or fluid, such as the gastrointestinal, HEENT, and respiratory systems (Jensen, 2019). Auscultation is performed to observe sounds of movement from organs and tissues (Jensen, 2019). This form of assessment is used to assess the respiratory, gastrointestinal, and cardiovascular systems. Appropriateness of Data Collection Techniques According to Campbell and Lynn, the physical examination should be completed in an orderly fashion, requiring the patient to change position as few times as possible (1990). Meaning, each form of assessment should be completed in a “head-to-toe” manner, rather than completing each assessment individually. The assessment should begin with an inspection of the patient’s general appearance, muscle mass, movement, and breathing pattern (Campbell & Lynn, 1990). The HEENT system is examined next. This would involve inspection of the face, as well as inspection and palpation of the scalp. Next, the eyes should be inspected, including visual acuity and eye movements. The outer ear should be inspected as well as the inner ear using an otoscope, at this time an exam to test auditory acuity should be completed as well (Campbell & Lynn, 1990). The nares and mouth require inspection as well to determine any abnormality. Finally, inspection and palpation of the neck must be performed in order to identify any swelling, tracheal deviation, bruits, or lymphadenopathy (Campbell & Lynn, 1990).
PATIENT ANALYSIS AND TEACHING TOOL 6 The anterior and posterior torso will be assessed next. This involved inspection of the chest and spine; palpation of the PMI, for tactile fremitus, and chest expansion; auscultation of heart and lung sounds; and percussion of lung fields (Campbell & Lynn, 1990). At this point, it would be appropriate to assess motor strength, deep tendon reflexes, distal pulses and sensation of the upper extremities (Campbell & Lynn, 1990). An abdominal assessment is completed by inspecting for any abnormality. Next, auscultation of bowel sounds and abdominal arteries arteries is performed, followed by percussion and palpation of the abdomen to determine organ size and identify any abnormalities (Campbell & Lynn, 1990). The lower extremities will be examined last, inspecting potential peripheral edema, gait, motor strength, range of motion, deep tendon reflexes, and sensation; palpating peripheral pulses; and auscultating arteries (Campbell & Lynn, 1990).
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