2- General Survey, Assessment Techniques, Measurement-1.pdf

Health Assessment Lecture 2 Assessment Techniques & Safety in the Clinical Setting General Survey Measurement 1 I- Assessment Techniques & safety in the Clinical Setting 2 ...

Health Assessment Lecture 2 Assessment Techniques & Safety in the Clinical Setting General Survey Measurement 1 I- Assessment Techniques & safety in the Clinical Setting 2  Assessment Techniques Health History: Subjective Data (symptoms) Physical Examination: Objective Data (signs) The physical examination requires that the examiner develop technical skills (tools to gather the data) and a knowledge base. You will use your senses: sight, smell, touch and hearing to gather data. The skills requisite for the physical examination are: Inspection, Palpation, Percussion, and Auscultation. 3  Assessment Techniques A) Inspection Is defined as a concentrated watching. It is close, careful scrutiny, first of the individual as a whole and then of each body system. Begins the moment you first meet the person and develop a general survey. Is the first technique used in physical examination (PE) Requires good lightening, adequate exposure, and occasional use of instruments (e.g. otoscope, penlight) Requires comparison between the right & left sides of the body. The two sides are nearly symmetric. 4 5  Assessment Techniques B) Palpation Palpation applies sense of touch to assess: Texture, temperature, moisture, organ location and size, swelling, vibration or pulsation, rigidity or spasticity, presence of lumps or masses, and presence of tenderness or pain. 6  Assessment techniques- Palpation ❖Different parts of the hand are used to assess different factors: ▪ Fingertips: skin texture, swelling, pulsation, lumps. ▪ Dorsal (back) of hand: temp ▪ Grasping action of fingers and thumb: position, shape, and consistency of an organ ▪ Base of fingers (metacarpophalngeal joints) or ulnar surface of the hand: Vibration 7  Assessment Techniques- Palpation Use slow motion and check for symmetry Use calm gentle approach Keep fingernails short Wash & warm your hands Identify any tender area and palpate it last Stop palpating if the patient complain from pain – Start with light palpation to gain trust and to detect surface characteristics, then perform deeper palpation. 8  Assessment Techniques- Palpation – With deep palpation use an intermittent palpation rather than a long one. Use relaxation techniques (e.g., deep breathing, imagery). Avoid any situation in which deep palpation could cause internal injury or pain. Bimanual palpation requires the use of both hand to capture an organ such as the uterus and kidney. 9  Assessment Techniques C) Percussion Is tapping the persons skin with short, sharp strokes to assess underlying structures. The strokes producing palpable vibrations & sound waves. Determines location, size, shape of organs, & density of the underlying organ. May elicit pain & tenderness when the assessed area is inflamed (e.g., Sinusitis) Detects density of underlying structure , i.e., fluid-filled, air- filled, or solid tissue. May detect an abnormal masses when they are not deeper than 5 cm. 10  Assessment Techniques- Percussion ❑ Two types: – Direct Percussion: the striking hand contacts the skin. (e.g., assessing sinuses) Indirect Percussion: involves both hands. The striking hand contacts the stationary hand which is fixed in the person’s skin In the indirect method, one finger (middle) acts as ‘hammer’ while the finger (middle) of other hand acts as striking surface. 11  How to percuss? May elicit pain & tenderness when the assessed area is inflamed (e.g., Sinusitis) 12 Direct Percussion - Indirect Percussion 13  Assessment Techniques- Percussion ▪ Percussion Sounds: Resonance- Over normal lungs Hyper-resonance- Abnormal in adult, over lungs with increased amount of air: COPD lung, & emphysema. Tympany- over air-filled bowel; stomach, intestine- (musical or drum-like) Dullness- over liver or spleen (dense area) Flatness- muscle & bone (no air is present, very dense, over thigh muscle, bone or tumor). 14  Percussion sound depends on: The nature of underlying structure Thickness of body wall Correctness of the technique 15  Assessment Techniques D) Auscultation Is listening to sounds produced by the body, such as heart, lung, abdomen. Sounds: – Audible: Heard with unassisted ears – Auscultatory: Heard with stethoscope e.g., ‘audible’ wheezes can be heard just by standing next to person; ‘auscultatory’ wheezes can only be heard with a stethoscope. 16  Assessment Techniques- Auscultation ▪ Stethoscope block external sounds and does not magnify the sound. When using the stethoscope: Place it on bare skin, not over clothing Have a quiet environment Use the diaphragm and the bell of the stethoscope correctly. Diaphragm: for high pitched sounds such as breath, bowel, & normal heart sounds. Bell: is for soft low pitched sounds such as abnormal heart sounds or murmurs. 17 The Clinical Setting 18  The examination room should be: Warm & comfortable Quiet & Private Good lighting Bedside stand or table for equipment Position the examination table so that both sides of the person are easily accessible. 19 20  The Equipment Platform scale with height attachment Skinfold calipers Sphygmomanometer, Stethoscope, thermometer Penlight Otoscope / Opthalmoscope Tuning fork Tongue depressor Vision screener 21  The Equipment Flexible tape measure Reflex hummer Sharp object Cotton balls Clean cloves Pulse oximeter Nasal speculum 22  A safer Environment Monitor the cleanliness of your equipments Wash your hands to decrease risk of microorganism transition – Before and after every physical patient encounter – After contact with blood, body fluids, secretions, and excretions – After contact with any contaminated with body fluids – After removing gloves Wear gloves when the potential exists for contact with any body fluids (e.g., blood, open skin lesion, mucous membrane, body fluids) 23  II. General Survey- Objective Data Is a study of the whole person, covering the general health state & any obvious physical characteristics. Is an introduction for the PE Gives an overall impression of the person ▪ Consists of Four main components : 1. Physical Appearance 2. Body Structure 3. Mobility 4. Behavior 24 1. Physical Appearance: – Age: person appears his or her stated age. – Sex: sexual development is appropriate for gender and age. – Level of Consciousness: alert, oriented, attends to questions & responds appropriately. -Abnormal Findings: confused, drowsy, lethargic – Skin Color: color tone is even, skin intact -Abnormal Findings: pallor, cyanosis, jaundice – Facial Features: are symmetric with movement 25  II.General Survey 2. Body Structure – Stature: the height appears within normal range for age -Abnormalities: Gigantism, Dwarfism – Nutrition: weight appears within normal range for height & body build -Abnormalities: simple obesity, truncal obesity – Symmetry: body parts look equal bilaterally -Abnormalities: Unilateral atrophy or hypertrophy – Posture: stand comfortably erect -Abnormalities: rigid spine & neck, moves as one unit – Position: sit comfortably in a chair or bed -Abnormalities: tripod- leaning forward 26  II.General Survey 3. Mobility ▪ Gait: foot placement is accurate, Walk is smooth, even, balanced, symmetric arm swing are present. ▪ Range of Motion: full mobility for each joint, movement is smooth, coordinated, deliberate, no involuntary movement. - Abnormalities: limited joint range of motion, paralysis, jerky movement, uncoordinated, tremors. 27  II.General Survey A standing person with A, good trunk alignment The swing and stance phases of a normal gait 28  II. General Survey 4. Behavior ▪ Facial Expression: maintains eye contact, expression are appropriate to the situation. -Abnormalities: Smiling when anxious, depressed, sad, distressed, angry. ▪ Mood and Affect: comfortable & cooperative -Abnormalities: hostile, crying, suspicious ▪ Speech: Articulation (ability to form words) ▪ Dress: appropriate to the climate, clean & fit ▪ Personal Hygiene: clean, hair is groomed & brushed. 29 30 III-Measurement 31  III-Measurement Weight – Remove shoes & heavy outer clothes before standing on the scale. – Measure at the same time of the day & the same type of clothing when repeated measures are required. – Compare recent weight with the previous ones – A weight gain usually reflects overabundant caloric intake, unhealthy eating habits 32  Weight Measures. ◼Percent Ideal Body Weight (%IBW): 90% to 110% can be interpreted as normal. – Steps to Calculate the %IBW: Step 1: Calculate the IBW: Step 2: Calculate the %IBW:  Weight Measures. Mild malnutrition 85% to 95% of ideal body weight; Moderate malnutrition 75% to 84% of ideal body weight severe malnutrition 120% of ideal body weight 34  III-Measurement Height – Use a wall-mounted device or the measuring pole on the balance scale. – The person should be shoeless – Standing straight & looking forward – Feet, shoulder & buttocks should be in contact with hard surfaces. 35 III-Measurement 36  III-Measurement Body Mass Index (BMI) A practical marker of optimal healthy weight for height and an indicator of obesity or malnutrition BMI = BMI= weight in kilograms Height (in meters)2 Underweight < 18.5 kg/m2 Normal weight 18.5 to 24.9 kg/m2 Overweight 25 to 29.9 kg/m2 Obesity (class 1) 30 to 34.9 kg/m2 Obesity (class 2) 35 to 39.9 kg/m2 Extreme obesity (class 3) ≥40 kg/m2 37  III-Measurement Height – Use a wall-mounted device or the measuring pole on the balance scale. – The person should be shoeless – Standing straight & looking forward – Feet, shoulder & buttocks should be in contact with hard surfaces. 38  III-Measurement Waist Circumference Excess abdominal fat is an important independent risk factor for disease. If most of the weight is carried around the waist instead of around the hips, the person is at higher risk for heart disease and type 2 diabetes. – A waist circumference (WC) ≥35 inches (88.9 cm) in women and ≥40 inches (101.6cm) in men increases the risk for type 2 diabetes, dyslipidemia, hypertension, and cardiovascular disease in people with a BMI between 25 and 35. 39