9/10/2012

1

Detailed Physical Examination

Lesson Goal

Perform detailed physical examination, understand findings, and use findings to provide appropriate patient care

Lesson Objectives

Discuss components of detailed physical exam

State areas of body evaluated during detailed physical exam

Explain what additional care should be provided while detailed physical exam is performed

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9/10/2012

2

Lesson Objectives

Distinguish between detailed physical exam performed on a trauma patient and that done on a medical patient

Explain rationale for feelings patients may experience during detailed physical exam

Introduction

Detailed physical exam Assesses individual body parts for signs of illness

or injury

Performed for:• Trauma patients with significant MOI

• Unresponsive medical patients

Conscious medical patients• Select components relative to patient complaint

Not every patient needs detailed physical exam

Overview

Techniques Expose, inspect, palpate, auscultate

Patient feelings Protect privacy, maintain professional demeanor

Process for adults is head to toe Toe-to-head for children

Begins after initial assessment is complete

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9/10/2012

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DCAPBTLS Method

Deformities

Contusions

Abrasions

Punctures

Burns

Tenderness

Lacerations

Swelling

Also: Crepitus

Distention

Equality

Function

Guarding

Masses

Assessing the Head

Scalp

Face

Eyes

Ears

Nose

Mouth

Assessing the Face

Symmetry Have patient smile and raise eyebrows

Consider airway

Consider potential for underlying brain injury

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9/10/2012

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Assessing the Eyes

Opening

Sclera

Bleeding

Bruising

Gaze

Pupils

Visual acuity

Assessing the Ears

Drainage Blood

CSF• Halo test

• Glucometer

Cover lightly

Battle’s sign

Assessing the Nose

Blood or fluid

Singed nasal hair

Drug residue

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9/10/2012

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Assessing the Mouth

Blood, fluids, vomit

Intact teeth

Consider airway compromise Dentures

Tongue lacerations or swelling

Odors

Assessing the Neck

Manual stabilization if trauma suspected Jugular vein distention Cover open wounds with occlusive dressing Accessory muscle use Swelling, foreign bodies, masses

Reassess airway frequently

Stridor during inspiration Tracheal deviation Bruising, abrasions

Assessing the Chest

Cover open wounds with occlusive dressing Seal on 3 sides

Scars

Shape/size of chest

Tenderness/crepitus

Expansion

Paradoxical movement

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9/10/2012

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Assessing the Chest

Auscultate lungs Normally clear & equal

Rales

Wheezes

Absence of sounds

Abnormal chest findings—administer O2

Assessing the Abdomen

Distention

Rigidity

Softness

Discoloration

Consider shock

Scars, colostomy bag

Guarding

Masses

Assessing the Pelvis

Bruising

Incontinence

Crepitus

Instability

Bleeding

Special considerations Urinary catheter

Crowning (pregnancy)

Priapism

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9/10/2012

7

Assessing the Extremities

Symmetry

Positioning

Mottling/cyanosis

Pulses

Movement

Sensation

Strength

Pulses

Skin color, temperature

Edema

Pain

Crepitus

Deformity

Assessing the Back

Signs of injury

Breath sounds

Reassess Vital Signs

Once detailed assessment complete, reassess VS to detect any trends

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9/10/2012

8

Skill 12-1: Detailed Examination

1. Inspect & palpate scalp

2. Inspect & palpate face

Skill 12-1: Detailed Examination

3. Look for eye injuries & pupil responses; do not palpate eye injuries

4. Look for fluid leaking out of ears

Skill 12-1: Detailed Examination

5. Check mouth for bleeding or injuries

6. Remove clothing from patient’s upper body

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9/10/2012

9

Skill 12-1: Detailed Examination

7. Inspect & palpate neck (front & back)

8. Inspect & palpate chest

Skill 12-1: Detailed Examination

9. Compare both sides of chest for abnormalities

10. Auscultate chest

Skill 12-1: Detailed Examination

11. Inspect & palpate abdomen

12. Remove clothing from patient’s lower body

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9/10/2012

10

Skill 12-1: Detailed Examination

13. Palpate pelvis

14. Inspect & palpate each upper leg

Skill 12-1: Detailed Examination

15. Inspect & palpate each lower leg

16. Assess movement & sensation in each foot

Skill 12-1: Detailed Examination

17. Assess pulses in each foot

18. Inspect & palpate each upper arm

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9/10/2012

11

Skill 12-1: Detailed Examination

19. Inspect & palpate each lower arm

20. Assess radial pulse in each arm

Skill 12-1: Detailed Examination

21. Assess movement & sensation in each hand

22. If possible, log roll patient and assess back

Skill 12-1: Detailed Examination

23. Palpate back and inspect for signs of bleeding

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company

9/10/2012

12

Other Assessment Tools

Glucometer

Pulse oximeter

Cardiac monitor

Summary

Perform detailed physical assessment selectively

DCAPBTLS

Also look for symmetry, masses, guarding

Auscultate breath sounds

Re-evaluate VS

Consider other assessment tools

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company