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an overview on gathering objective data; basic concepts in gathering objective data
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COLLECTION OF OBJECTIVE DATA
Maria Carmela L .Domocmat, RN, MSN
Objective data
• Data directly observed by the examiner
Maria Carmela L .Domocmat, RN, MSN
Objective data
• Data include:– physical characteristics (skin color, posture)– body functions (HR, RR)– appearance (dress, hygiene)– appearance (dress, hygiene)– behavior (mood, affect)– measurement
• (BP, Temp, Ht, Wt)
– results of laboratory testing • (platelet count, CXR)
Maria Carmela L .Domocmat, RN, MSN
Requires basic knowledge in:
1. Types of and operation needed for the particular examination
2. Preparation of the setting, oneself, and the client for the PAthe client for the PA– Setting– Self– Client
Maria Carmela L .Domocmat, RN, MSN
3. Performance of the four assessment techniques: IPPA
Maria Carmela L .Domocmat, RN, MSN
Equipments for Physical Assessment
• Assessment document forms• Coin or key• Cotton ball• Cover card (for eye assessment)• Cover card (for eye assessment)• Gloves• Goniometer• Gown for client• Lubricating jelly
Maria Carmela L .Domocmat, RN, MSN
Equipments for Physical Assessment
• Magnifying glass• Marking pencil• Mini-mental status Exam (MMSE) form• Newspaper print or rosenbaum pocket • Newspaper print or rosenbaum pocket
screener• Notepad and pencil• Ophthalmoscope• Otoscope
Maria Carmela L .Domocmat, RN, MSN
Equipments for Physical Assessment
• Paper clip• Penlight• Pillows (two small pillows)• Platform scale with height attachment• Platform scale with height attachment• Reflex hammer• Ruler with centimeter markings• Skin-fold caliber• Flexible tape measure
Maria Carmela L .Domocmat, RN, MSN
Equipments for Physical Assessment
• Small cup of water to drink• Snellen chart• Stethoscope with sphygmomanometer• Substances for testing taste (e.g. salt, • Substances for testing taste (e.g. salt,
calamansi or lemon, sugar)• Substances for testing smell (e.g. soap,
coffee)• Thermometer
Maria Carmela L .Domocmat, RN, MSN
Equipments for Physical Assessment
• Tongue depressor• Tuning fork• Vaginal speculum• Watch with second hand• Watch with second hand
Maria Carmela L .Domocmat, RN, MSN
Equipments Used
Maria Carmela L .Domocmat, RN, MSN
Goniometer
SkinfoldCaliper
Wood’s lampWood’s lamp
Doppler UltrasonicStethoscope
Transilluminator
Maria Carmela L .Domocmat, RN, MSN
OphthalmoscopeOtoscope
Maria Carmela L .Domocmat, RN, MSN
Snellen’sChart
Maria Carmela L .Domocmat, RN, MSN
Rosenbaum Chart
Maria Carmela L .Domocmat, RN, MSN
Physical assessment forms
Maria Carmela L .Domocmat, RN, MSN
FOUR ASSESSMENT TECHNIQUES: IPPA
Maria Carmela L .Domocmat, RN, MSN
Inspection
Maria Carmela L .Domocmat, RN, MSN
Maria Carmela L .Domocmat, RN, MSN
Inspection
• Involves using the sense of vision, smell,
and hearing to observe and detect any
normal or abnormal findings.normal or abnormal findings.
Maria Carmela L .Domocmat, RN, MSN
Maria Carmela L .Domocmat, RN, MSN
Inspection
• Precedes the PPA because the latter
techniques can potentially alter the
appearance of what is being inspectedappearance of what is being inspected
Maria Carmela L .Domocmat, RN, MSN
• Note the following:
– Color, patterns, symmetry, size, location,
consistency, movement, behavior, odors, or consistency, movement, behavior, odors, or
sounds
Maria Carmela L .Domocmat, RN, MSN
PALPATION
Maria Carmela L .Domocmat, RN, MSN
Palpation
• Involves using parts of the hand to touch and feel for the following characteristics:
• Texture – rough or smooth• Temperature – warm or cold• Temperature – warm or cold• Moisture – dry or wet• Mobility –fixed, movable, still, vibrating• Consistency – soft, hard, fluid-filled• Size – small, medium, large• Shape –well defined, irregular• Degree of tenderness
Maria Carmela L .Domocmat, RN, MSN
Palpation
Maria Carmela L .Domocmat, RN, MSN
Parts of hands used
– Fingerpads – fine discriminations, pulses, texture, size, consistency, shape, crepitus
– ulnar/palmar surface – vibrations, thrills, fremitusfremitus
– dorsal surface -temperature
Maria Carmela L .Domocmat, RN, MSN
• Crepitus is a symptom characterized by a crackling or grating feeling or sound under the skin, around the lungs or in the joints. In soft tissues, crepitus is often due to gas, most often air, that has abnormally penetrated and infiltrated an area (for example, in the soft tissues beneath the skin).
• In a joint, crepitus can indicate cartilage wear in the joint space. The • In a joint, crepitus can indicate cartilage wear in the joint space. The term "crepitus" is derived from the Latin, meaning "a crackling sound or rattle." Typically, crepitus is a grinding noise coupled with a sensation in the affected joint. Crepitus can occur with or without pain.
Maria Carmela L .Domocmat, RN, MSN
Type of palpation
Maria Carmela L .Domocmat, RN, MSN
Light palpation
• very little or no pressure (less than 1 cm)
• feel the structure using a circular motioncircular motion
• use: feel pulses, tenderness, surface skin texture, temperature, moisture
Maria Carmela L .Domocmat, RN, MSN
Maria Carmela L .Domocmat, RN, MSN
Moderate palpation
• Depress the skin surface 1 to 2 cm• size, consistency, mobility
Maria Carmela L .Domocmat, RN, MSN
Deep palpation
• Place dominant hand on the skin surface and nondominant hand on top of the dominant hand to apply pressure (2.5-5 cm or 1 to 2 inches)cm or 1 to 2 inches)
Maria Carmela L .Domocmat, RN, MSN
• Feel very deep organs or structures that are covered with thick muscles
Maria Carmela L .Domocmat, RN, MSN
Bimanual palpation
• Use two hands, placing one on each side of the body part (uterus, breasts, spleen) being palpated
• One hand apply pressure, other hand feel • One hand apply pressure, other hand feel structure
• size, shape, consistency, mobility
Maria Carmela L .Domocmat, RN, MSN
Maria Carmela L .Domocmat, RN, MSN
Maria Carmela L .Domocmat, RN, MSN
Percussion
Maria Carmela L .Domocmat, RN, MSN
Percussion
• Involves tapping the body parts to produce sound waves
• The sound waves or vibrations enable the examiner to assess the underlying examiner to assess the underlying structures.
Maria Carmela L .Domocmat, RN, MSN
Percussion
• Uses:– Determining location, size, and shape– Determining density– Detecting abnormal masses– Detecting abnormal masses– Eliciting pain– Eliciting reflexes
Maria Carmela L .Domocmat, RN, MSN
Types of Percussion
• Direct• Blunt• Indirect
Maria Carmela L .Domocmat, RN, MSN
Percussion
Maria Carmela L .Domocmat, RN, MSN
Percussion Sounds
• Resonance• Hyperresonance• Dullness• Flatness• Tympany
Maria Carmela L .Domocmat, RN, MSN
Percussion Sounds
• Resonance:– heard over part air and part solid – normal lung– loud intensity, low pitch, long (length), hollow – loud intensity, low pitch, long (length), hollow
(quality)
Maria Carmela L .Domocmat, RN, MSN
Percussion
• Dullness: over more solid organs (diaphragm, liver)– Medium ,medium, moderate, thudlike
• Flatness : over very dense tissue (muscle, bones, sternum, thigh)– Soft, high, short, flat
Maria Carmela L .Domocmat, RN, MSN
• Tympany: heard over air– Puffed out cheek, gastric bubble– Loud, high, moderate, drumlike
• Hyper resonance: heard over mostly air– Lung with emphysema– Very loud, low, long, booming
Maria Carmela L .Domocmat, RN, MSN
AUSCULTATION
Maria Carmela L .Domocmat, RN, MSN
Auscultation
• Listening to sounds produced by the body (heart, lungs, blood vessels, abdomen)
• Stethoscope: does not magnify sound but does block out extraneous room soundsdoes block out extraneous room sounds
Maria Carmela L .Domocmat, RN, MSN
Auscultation
• Classifications– Intensity: loud, soft– Pitch : high, low– Duration: length– Quality: musical,
crackling, raspy
Maria Carmela L .Domocmat, RN, MSN
Maria Carmela L .Domocmat, RN, MSN
Auscultation
• Diaphragm: high-pitched sound– Normal heart sounds, breath sounds, bowel
sounds– Hold the diaphragm firmly against the – Hold the diaphragm firmly against the
person’s skin –– firm enough to leave a slight ring afterward
Maria Carmela L .Domocmat, RN, MSN
Auscultation
• Bell: low-pitched sounds – abnormal heart sounds and bruit (abnormal
loud, blowing, or murmuring sounds)– FHT– FHT– Hold lightly against the person’s skin – just
enough that it forms a perfect seal; any harder causes the skin to act as a diaphragm, obliterating the low-pitched sounds
Maria Carmela L .Domocmat, RN, MSN
Factors to consider
• Eliminate any confusing artifacts
Maria Carmela L .Domocmat, RN, MSN
Eliminate any confusing artifacts
• Room must be quiet• Keep examination room warm• Clean the stethoscope endpiece with an
alcohol wipe. Then warm it by rubbing it in alcohol wipe. Then warm it by rubbing it in your palm: this avoids the “chandelier sign” elicited when placing a cold endpiece on a warm chest
Maria Carmela L .Domocmat, RN, MSN
Eliminate any confusing artifacts
• Wet the hair before auscultating the hairy chest: The friction on the endpiece from a man’s hairy chest causes a crackling sound that mimic an abnormal breath sound that mimic an abnormal breath sound called crackles.
• Never listen through a gown: reach under a gown to listen, but take care that no clothing rubs on the stethoscope
Maria Carmela L .Domocmat, RN, MSN
Factors to consider
• Eliminate any confusing artifacts• Listen selectively: only one thing at a time. • As you listen, ask yourself:
– What am I actually hearing?– What am I actually hearing?– What should I be hearing at this spot?
Maria Carmela L .Domocmat, RN, MSN
Let’s practice
Maria Carmela L .Domocmat, RN, MSN