Nupd 400 chapter 8 assessment techniques

Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

Chapter 8

Chapter 8: Assessment Techniques and the Clinical SettingChapter 8: Assessment Techniques and the Clinical Setting

Inspection◦ Do not rush◦ Compare patient’s right side with left side◦ Use good lighting◦ Obtain adequate exposure (of the patient)◦ Will include instruments in many body systems Otoscope/ophthalmoscope Specula: vaginal, nasal Penlight

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Palpation◦ Purpose◦ Use different parts of the hands◦ Light vs. deep palpation

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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

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Fingertips—best for fine tactile discrimination, as of skin texture, swelling, pulsation, and determining presence of lumps

A grasping action of the fingers and thumb—to detect the position, shape, and consistency of an organ or mass

The dorsa (backs) of hands and fingers—best for determining temperature because the skin here is thinner than on the palms

Base of fingers (metacarpophalangeal joints) or ulnar surface of the hand—best for vibration Slide 8-5


Percussion◦ Purpose◦ Indirect percussion Stationary hand Striking hand ◦ Characteristics of percussion notes Resonant Hyperresonant Tympany Dull Flat Slide 8-6


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Auscultation◦ Fit and quality of

stethoscope◦ Diaphragm and bell

endpieces ◦ Eliminate confusing

artifacts

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Examination room Examination table

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Platform scale with height attachment Skinfold calipers Sphygmomanometer Stethoscope with diaphragm and bell Thermometer Pulse oximeter (in hospital setting) Flashlight or penlight Otoscope/ophthalmoscope Tuning fork Nasal speculum Tongue depressor

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Pocket vision screener Skin-marking pen Flexible tape measure and ruler Reflex hammer Sharp object (split tongue blade) Cotton balls Bivalve vaginal speculum Clean gloves Materials for cytological study Lubricant Fecal occult blood test materials

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Clean the equipment Clean vs. used area for handling equipment Nosocomial infections Handwashing or alcohol-based hand rub Wear gloves Standard precautions Transmission-based precautions

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General approach◦ Patient’s emotional state◦ Examiner’s emotional state

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Hands on ◦ Measurement and vital signs◦ Begin with person’s hands◦ Concentrate on one step at a time◦ Examination sequence◦ Brief health teaching ◦ When findings are complicated◦ Summarize findings for person

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A. They are easy to reach from any position.B. They reveal a great deal about the patient.C. They will always be clean and dry.D. They are a place people are accustomed

to being touched by strangers.

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A. TemperatureB. ResilienceC. DensityD. Crepitation

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Nupd 400 chapter 8 assessment techniques

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