Chapter 8 - Assessment Techniques & Safety in the Clinical Setting
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Questions and Answers

Which examination technique involves tapping the patient's skin with short, sharp strokes?

  • Auscultation
  • Percussion (correct)
  • Palpation
  • Inspection

When performing palpation, it is best to begin with deep palpation to quickly identify any masses or tenderness.

False (B)

What part of the stethoscope is best used for listening to low-pitched sounds like extra heart sounds?

The bell

______ is concentrated watching that's done 1st when you meet the patient.

<p>Inspection</p> Signup and view all the answers

Match the following terms with their descriptions:

<p>Amplitude = Intensity of sound Pitch = Number of vibrations per second Quality = Subjective difference caused by overtones Resonance = Medium-loud sound</p> Signup and view all the answers

What is the primary purpose of comparing the left and right sides of a patient’s body during inspection?

<p>To evaluate for symmetry and any abnormalities (D)</p> Signup and view all the answers

When performing auscultation, a noisy room can enhance the quality of the exam by providing a diverse range of sounds.

<p>False (B)</p> Signup and view all the answers

Which of the following factors is NOT generally assessed using palpation?

<p>Color (C)</p> Signup and view all the answers

Which of the following instruments uses ultrasonic waves to detect difficult-to-hear sounds?

<p>Doppler (A)</p> Signup and view all the answers

Standard precautions are only applied when the patient has a confirmed infection.

<p>False (B)</p> Signup and view all the answers

What is the most important step to decrease the risk of microorganism transmission?

<p>hand hygiene</p> Signup and view all the answers

For airborne precautions, in addition to standard precautions, a gown, gloves, and a _________ are required.

<p>respirator (N95)</p> Signup and view all the answers

Match the following age groups to the appropriate examination considerations:

<p>Infant = Exam done 1-2 hours after feeds, uses brightly colored toys for distraction Toddler = Use caregiver to help with position changes, make the assessment a game Preschool = Start with noninvasive tasks, explain steps in process, give feedback School Age = Usually cooperative because they desire approval from caregivers and teachers, head-to-toe assessment Aging Adult = Sequence should allow as few position changes as possible, use physical touch</p> Signup and view all the answers

Which of the following best describes how to begin a physical examination with a patient?

<p>Touch the patient's hands to check skin color and metacarpophalangeal joints. (D)</p> Signup and view all the answers

A penlight is used to funnel light into the ear canal.

<p>False (B)</p> Signup and view all the answers

You should rub an alcohol-based hand sanitizer for how many seconds for effective hand hygiene?

<p>20-30 seconds</p> Signup and view all the answers

For droplet precautions, in addition to standard precautions, a _________ is required.

<p>basic surgical mask</p> Signup and view all the answers

Which of the following is NOT a generally accepted time for hand hygiene?

<p>Before eating lunch. (A)</p> Signup and view all the answers

It is generally acceptable to have a school-age child remain in their street clothes during an exam.

<p>False (B)</p> Signup and view all the answers

What are the three types of transmission-based precautions?

<p>contact, droplet, airborne</p> Signup and view all the answers

A _____ is used to test deep tendon reflexes.

<p>percussion or reflex hammer</p> Signup and view all the answers

Match the following PPE to the appropriate transmission-based precaution:

<p>Gown and gloves = Contact Basic surgical mask = Droplet Gown, respirator (N95), eye protection, and gloves = Airborne</p> Signup and view all the answers

For an adolescent, the physical exam should be performed:

<p>With their street clothes on. (D)</p> Signup and view all the answers

Flashcards

Inspection

Visual examination of the body, checking both sides for symmetry and abnormalities.

Palpation

Using your sense of touch to assess texture, temperature, moisture, and more.

Percussion

Tapping on the body with short, sharp strokes to assess underlying structures. Different sounds indicate different densities.

Auscultation

Listening to sounds produced by the body, like the heart, lungs, and abdomen.

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Diaphragm of the stethoscope

The flat surface of the stethoscope used for high-pitched sounds.

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Bell of the stethoscope

The deep, cuplike shape of the stethoscope used for low-pitched sounds.

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Stationary hand during percussion

The stationary hand during percussion, positioned away from bony prominences.

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Striking hand

The striking hand used for percussion; aims for just behind the nail bed.

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What is an ophthalmoscope?

A medical instrument used to illuminate the internal structures of the eye. It has a light source and a viewing lens that allows the examiner to see the retina, optic nerve, and other structures.

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What is an otoscope?

A medical instrument used to examine the ear canal and tympanic membrane. It has a light source and a magnifying lens that allows the examiner to see the ear canal and eardrum.

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What is a percussion hammer?

A tool used to assess deep tendon reflexes (DTRs) by tapping on tendons to elicit a reflex response. It is also known as a reflex hammer.

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What is a Doppler?

A device that uses ultrasonic waves to detect and amplify faint sounds, often used to listen to fetal heart tones.

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What is a tuning fork?

A device used to assess auditory screening and vibratory sensation by producing a specific frequency sound.

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What are standard precautions?

These precautions are applied to all patients regardless of their suspected or confirmed infection status. They aim to prevent the spread of infection.

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What is hand hygiene?

The most important step to decrease the risk of microorganism transmission. It involves cleaning hands before and after patient contact, after contact with body fluids, and after contact with contaminated equipment.

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What are transmission-based precautions?

These are additional precautions used for patients with specific infectious agents. They include contact, droplet, and airborne precautions.

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What is contact precaution?

This type of precaution is used for patients with infections that can be spread through direct contact. It typically requires the use of gowns and gloves.

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What is droplet precaution?

This precaution is used for patients with infections spread through close respiratory contact. It typically requires the use of a surgical mask in addition to standard precautions.

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What is airborne precaution?

This precaution is used for patients with infections spread through airborne transmission. It typically requires the use of a respirator, gown, eye protection, and gloves.

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What is Personal Protective Equipment (PPE)?

Personal Protective Equipment (PPE) includes gloves, gowns, masks, eye protection, and face shields. It helps protect healthcare workers from exposure to infectious agents.

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What is a physical exam?

A physical examination is a systematic assessment of a patient's physical health. It involves examining different body systems to identify any abnormalities or signs of illness.

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What are developmental considerations in a physical exam?

Developmental considerations are important during physical exams, as different age groups require specific approaches. For example, infants may need distraction with toys, while adolescents may prefer privacy and minimal caregiver involvement.

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What is a head-to-toe assessment?

This is a systematic approach to a physical examination that starts with examining the head, then progresses down to the toes. It ensures that all body systems are assessed.

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What is a mini database?

This is a brief initial assessment that may be performed on a patient who is acutely ill. It focuses on the most critical areas of the body based on the patient's presenting symptoms.

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Study Notes

Assessment Techniques & Safety

  • Inspection: Initial visual assessment of the patient (general survey). Compare left and right sides of the body. Requires good lighting, exposure, and possibly instruments.

Palpation

  • Palpation: Touch to assess factors like texture, temperature, moisture, organ location/size, swelling, vibration/pulsation, rigidity/spasticity, crepitation, lumps/masses, tenderness/pain.
  • Start with light palpation to ease the patient.

Percussion

  • Percussion: Tapping the skin with short, sharp strokes to assess underlying structures.
  • Sounds indicate density:
    • Dull: soft sound.
    • Resonance: medium-loud sound.
    • Hyperresonance: loud sound.
  • Airy structures (lungs) produce louder sounds; dense structures (liver) produce softer sounds.
  • Stationary hand avoids bony prominences; striking hand aims near the nail bed.

Auscultation

  • Auscultation: Listening to body sounds (heart, blood vessels, lungs, abdomen).
  • Diaphragm (flat surface): High-pitched sounds (breath, bowel, normal heart sounds).
  • Bell (cup-like shape): Low-pitched sounds (extra heart sounds, murmurs).
  • Keep room quiet, stethoscope warm, and wet excessive chest hair to minimize crackling sounds. Stethoscope should be placed directly on skin.

Equipment

  • Otoscope: Light for ear canal and tympanic membrane.
  • Ophthalmoscope: Light for internal eye structures.
  • Tuning fork: Auditory screening and vibratory sensation.
  • Percussion/reflex hammer: Deep tendon reflexes (DTRs).
  • Doppler: Amplifies difficult-to-hear sounds (fetal heart tones).
  • Penlight: Focused light source for inspection.

Standard Precautions

  • Applied to all patients, regardless of infection status.
  • Includes: hand hygiene, gloves, gowns, eye/face protection, respiratory hygiene/cough etiquette.

Hand Hygiene

  • Essential for minimizing microorganism transmission.
  • Before/after each patient encounter, after contact with body fluids/equipment, and after glove removal.
  • Alcohol-based sanitizer: rub for 20-30 seconds.

Transmission-Based Precautions

  • Additional precautions for infectious agents.
  • Contact: direct contact (e.g., C. diff). Requires gown & gloves.
  • Droplet: close respiratory contact (e.g., influenza). Requires surgical mask.
  • Airborne: airborne agents (e.g., tuberculosis). Requires gown, respirator (N95), eye protection, gloves.

Physical Exam Process

  • Start by touching the patient's hands (assessing skin color, nail beds, metacarpophalangeal joints) to ease the patient.
  • May require position changes.
  • Maintain patient privacy and prevent chilling with drapes.
  • Provide brief, relevant patient education.
  • Summarize findings, share information, and thank the patient. State next steps.

Developmental Considerations

  • Infant: Examine 1-2 hours post-feeding. Nude. Warm hands. Use toys for distraction. Heart, lungs, abdomen first.
  • Toddler: Difficult due to fear, dislike of restraint. Use caregiver for position changes. Security object. Greet caregiver. Non-threatening areas first. Offer choices. Involve caregiver.
  • Preschool: Noninvasive areas first (head, eyes, ears, nose). Throat last. Cooperative, helpful. Explain steps. Allow playing with equipment.
  • School-age: Cooperative, desiring approval. Sit/lay on table. May not need caregiver. Gown. Small talk. Equipment demonstration. Teaching about body function. Head-to-toe approach.
  • Adolescent: Comfortable with themselves and peers. Exam without caregiver. Genitalia last. Focus on teaching healthy habits. Dress clothes allowed.
  • Aging adult: Focus on meaning of life, adjust to changes. Use physical touch when appropriate. Adjust pace. Minimize position changes. Head-to-toe approach.
  • Sick patient: Adapt to comfort level, mini-assessment if needed before full assessment.

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Description

This quiz covers fundamental assessment techniques used in healthcare, including inspection, palpation, percussion, and auscultation. Understanding these techniques is crucial for evaluating patients accurately and providing effective care. Challenge your knowledge and improve your clinical skills with this assessment quiz.

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