huda al-owairdy clinical pharmacy dept.. physical assessment skills
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Learning Objectives
Name the four fundamental physical assessment techniques
Describe how to perform each of the techniques
Identify the components of Equipment used in physical examination
Describe how to assess each of the major organ systems.
Define common physical assessment terms
Interpret common physical assessment abbreviations.
Physical Assessment
Information obtained from the physical examination along with data obtained during a patient medication history interview and laboratory data are used to assess patient response to drug and nondrug therapy.
A physical examination
PE is an evaluation of the body and its functions using inspection, palpation, percussion, and auscultation.
understand the meaning of specific physical assessment findings documented by other health care professionals
Pharmacists in some clinical settings
(e.g., ambulatory care clinics)
routinely assess patient response to medication regimens themselves using a variety of physical assessment skills
Physical Assessment Sequence
1Vital signs
2. Appearance and behavior
3. Skin
4. Head
5. Eyes
6. Ears
7. Nose
8. Mouth
9. Neck
10. Breasts
11. Chest and lungs
12. Heart
13. Abdomen
14. Extremities
15. Back and spine
16. Nervous system
17. Mental status
18. Genitalia and rectum
Review PA abbreviation table 4-1
HEENT : Head, eyes, ears, nose, and throat
WNL: Within normal limits
WDWN: Well-developed, well-nourished
VS : Vital signs
HR: Heart rate
Assessment Sequencing Head – to - Toe Assessment
• Most comprehensive• Used to obtain baseline information to identify changes
in patient status◦ organized - everything assessed from head progressing
down to toes- combines Body Systems Assessment
◦ one system at a time◦ Cardiac: heart sounds, pulses, capillary refill, B/P◦ Respiratory: breath sounds, rate and depth, skin color◦ organized per body systems i.e. lung assessment,
abdominal assess, cardiovascular, neuro system◦ best used for focused physical assessment
Performing Physical Exam(ROS and PE)
Review of Symptoms
▫ Observation and Interview
▫ Head to toe verbal review of all relevant symptoms
▫ Gather subjective information from patient
• Physical Exam
▫ Inspection, palpation, percussion, auscultation
▫ Physical assessment of all relevant body systems
▫ Gather objective information yourself
Assessment techniquesThe PA consists of detailed patient evaluation that consist of four fundamental techniques (IPPA).
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Assessment Techniques
Inspection - critical observation
Take time to “observe” with eyes, ears, nose
Use good lighting
Look at color, shape, symmetry, position
Odors from skin, breath, wound Inspection is done alone and in combination with other assessment techniques
Assessment Techniques
Palpation ◦Using hands to fell areas that cannot be seen◦ light and deep touch◦ Back of hand to assess skin temperature◦ Fingers to assess texture, moisture, areas of
tenderness◦ Assess size, shape, and consistency of lesions◦ Organ size and location◦ Rigidity or spasticity◦ Crepitation & Vibration◦ Position & Size◦ Presence of lumps or masses◦ Tenderness, or pain
Assessment Techniques
Percussion
Sounds produced by striking body surface
Produces different notes depending on underlying mass (dull, resonant, flat, tympani)
Used to determine size and shape of underlying structures by establishing their borders and indicates if tissue is air-filled, fluid-filled, or solid
Assessment techniques - Cont.Percussion
Direct – tapping the body directly with the distal end of a finger◦ sinus tenderness
Indirect- tapping a finger placed on the body, only the finger being struck touches the body◦ lung percussion
Blunt percussion-organ tenderness 19
Assessment Techniques
Auscultation listening to sounds produced by the body
Direct auscultation – sounds are audible without stethoscopeIndirect auscultation – uses stethoscope
Describe sound characteristics (frequency, pitch intensity, duration, quality)
Flat diaphragm picks up high-pitched respiratory sounds bestBell picks up low pitched sounds such as heart murmurs
Assessment techniques - Cont.Auscultation
Instrument: stethoscope (to skin)
Diaphragm –high pitched sounds
HeartLungsAbdomen
Bell – low pitched soundsBlood vessels
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