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What are four physical assessment techniques?
- Inspection
- Palpation
- Percussion
- Auscultation
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What is inspection and what do you do?
- observation
- 1) general observation of the whole body, then specific body systems
- 2) assess symmetry (compare both sides)
- 3) use your senses (visual, smell, hearing)
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What is palpation and what do you do?
- touch
- hands- fingertips (most sensitive to fine tactile discrimination)
- - skin texture, swelling, pulses and lumps or masses
- - metacarpo-phalangeol joints (MCP) or ulnar surface of hands (assess vibration)
- Use light palpation (1 cm) followed by deeper palpation
- Bimanual
(use of both hands to capture organ)- e.g. pelvic exam-uterus
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What is percussion?
yielding a palpable vibration
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Percussion reflects: (3)
- 1) location and size of organ
- 2) density (air, fluid, solid mass)
- 3) superficial masses (less than or equal to 5 cm)
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Percussion helps elicit ________.
pain (if inflammation is present)
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What are the two types of percussion?
- 1. Direct (strike body directly) e.g. percuss sinuses in an adult
- 2. Indirect (2 handed technique)- strike finger ay DIP joint
- -Resonant (normal lungs)
- - Hyperresonant (hyperinflated alveoli)-r/t COPD
- - Tympany (air filled organ) -intestine and stomach
- - Dull (dense organ)- liver, consolidated lung, full bladder
- - Flat- muscle, bone, tumor
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How would you directly and indirectly percuss the costoverterbral angle tenderness (CVAT)?
- Direct: use fist (ulnar surface) to percuss directly over the CVA
- Indirect
: Examiner places his/her hand over the patient's CVA and then provides moderate force when striking his or her hand
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How do you percuss deep tendon reflexes (DTR)
use a reflex hammer
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What is auscultation?
listening with stethoscope
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What is the diaphragm used for?
high pitched sounds- breath sounds, bowel sounds, normal heart sounds
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What is the bell used when auscultating?
low pitched/soft sounds-rest bell gently on the skin to hear extra heart sounds and murmurs
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