Chapter 8: Assessment Techniques & Safety in Clinical Setting PDF

Chapter 8 - Assessment Techniques & Safety in the Clinical Setting (8 Questions) 1.​ Explain & demonstrate the exam techniques of inspection, palpation, percussion & auscultation. Inspection is concentrated watching that’s done 1st when you meet the patient (general survey)....

Chapter 8 - Assessment Techniques & Safety in the Clinical Setting (8 Questions) 1.​ Explain & demonstrate the exam techniques of inspection, palpation, percussion & auscultation. Inspection is concentrated watching that’s done 1st when you meet the patient (general survey). -​ Compare left and right sides of their body -​ Inspection requires good lighting, adequate exposure, and occasional use of certain instruments. Palpation applies your sense of touch to assess for the following factors: texture, temperature, moisture, organ location and size, swelling, vibration or pulsation, rigidity or spasticity, crepitation, presence of lumps, masses, and presence of tenderness or pain. -​ Start with light palpation to detect surface characteristics and to accustom the person to being touched. Percussion is tapping the patient's skin with short, sharp strokes to assess underlying structures. -​ Strokes yield an audible vibration -​ It signals the density of the structures within the body -​ The stationary hand avoids bony prominences (ribs or scapulae) -​ The striking hand aims for just behind the nail bed -​ Amplitude (or intensity) is described as a loud or soft sound -​ Pitch (or frequency) is described as the number of vibrations per second -​ Quality (timbre) is the subjective difference caused by the distinctive overtones of a sound -​ Dull is a soft sound → Resonance is a medium-loud sound → Hyperresonance is a loud sound -​ A structure with relatively more air (lungs) produces a louder, deeper, and louder sound because it vibrates freely, whereas a dense, more solid structure (liver) gives a softer, higher, shorter sound because it does not vibrate as easily. Auscultation is listening to sounds produced by the body, such as the heart, blood vessels, lungs, and abdomen. -​ The diaphragm (flat surface) is used for high pitched sounds, like breath, bowel, and normal heart sounds. -​ The bell (deep, hollow, and cuplike shape) is best for low pitched sounds such as extra heart sounds or murmurs. -​ To evaluate any body sounds, you must keep the room quiet and warm, as well as your stethoscope, wet excessive chest hair to minimize crackling sounds, and place the stethoscope directly onto the skin. 2.​ Identify common equipment utilized during physical exams. Otoscope - funnels light into the ear canal and onto the tympanic membrane Ophthalmoscope - illuminates the internal eye structures Tuning fork - used for auditory screening and assessment of vibratory sensation Percussion or reflex hammer - used to test deep tendon reflexes (DTRs) Doppler - uses ultrasonic waves to detect and amplify difficult-to-hear sound (fetal heart tones) Penlight - provides focused light source for inspection 3.​ Describe standard precautions. Standard precautions are applied to all patients, regardless of suspected or confirmed infection status, and in any setting in which healthcare is delivered. -​ Hand hygiene -​ Use of gloves, gown, make, eye protection, or face shield -​ Respiratory hygiene/cough etiquette 4.​ Identify hand hygiene principles. Most important step to decrease the risk of microorganism transmission! -​ Before and after every physical patient encounter -​ After contact with blood, body fluids, secretions, and excretions -​ After contact with any equipment contaminated with body fluids -​ After removing gloves -​ Alcohol-based hand sanitizer is to be rubbed for 20-30 seconds 5.​ Recognize the different types of Personal Protective Equipment (PPE) that is used for transmission-based precautions. Transmission-based precautions are additional precautions that are used with infectious agents. There are 3 types of transmission-based precautions: -​ Contact: spread by direct contact (C. diff) → Gown & gloves -​ Droplet: spread by close respiratory contact (influenza or pertussis) → Basic surgical mask in addition to standard precautions -​ Airborne: spread by airborne agents (tuberculosis) → Gown, respirator (N95), eye protection, and gloves 6.​ Describe what occurs during a physical exam. -​ Begin the examination by touching the patients hands, checking skin color, nail beds, and metacarpophalangeal joints. This eases the patient into being touched during the exam. -​ You may need to ask the patient to change positions during the exam as you assess different parts of the body systems. -​ Use additional drapes to maintain the patients privacy and prevent chilling. -​ Throughout the examination, occasionally offer some brief teaching about the patient's body.  -​ At the end of the exam, summarize your findings, share the necessary information, and thank the person. Let them know if there are any follow-up needs or next steps, or if anything is scheduled afterwards. 7.​ Identify different developmental considerations that may need to occur during a physical exam. Infant -​ Position: Flat on a padded exam table or held by their caregiver -​ Best done 1 or 2 hours after feeds so they’re not too drowsy or hungry -​ Nude -​ You should warm your hands before examining -​ Use brightly colored toys to help with distraction -​ Listen to their heart, lungs, and abdomen first Toddler -​ They’re more difficult to exam because they fear invasive procedures and dislike being restrained. -​ Use their caregiver to help with position changes, or complete the exam on the caregivers lap. -​ They’ll have a security object, such as a blanket or teddy bear. -​ Begin by greeting the caregiver and gather objective data during the history interview with them. -​ Have the caregiver undress the child one part at a time. -​ Make the assessment a game for the toddler and start with non threatening areas first. -​ Offer the child choices if possible. -​ Inform the child of what you’re going to do. Use the caregiver to demonstrate procedures. Preschool -​ Start with noninvasive tasks, such as the head, eyes, ears, and nose. Examine the throat last. -​ They retake on tasks independently, plan the tasks, and see them through. -​ Preschoolers are often cooperative, helpful, and easy to involve. -​ They may see illness as punishment and fear body injury from invasive procedures. -​ Preschoolers may be held or sit on the exam table. -​ Use short and simple explanations. -​ They’re willing to undress but wait until the end for the genital examination to remove underpants. -​ Offer choices when possible, or not at all. -​ Explain the steps in the examination process. -​ Let them play with equipment to reduce their fears. -​ Don’t rush the child. -​ Give feedback and reassurance during the examination. School Age -​ Usually cooperative because they desire approval from caregivers and teachers. -​ They should sit or lay on the table. -​ An older school age child may not want their caregiver present. -​ They should use a gown but keep their underpants on. -​ Break the ice with small talk about their interests. -​ Show them how to use equipment. -​ Comment on how their body works since they’re interested in learning more. -​ Progress the school age child with a head-to-toe assessment. Adolescent -​ At this age, adolescents need to feel satisfied and comfortable with themselves. They value their peers' values and want to be accepted. -​ They should be sitting on the table but with their street clothes on. -​ Do the examination without the presence of their caregiver. -​ Give feedback to ensure their body is healthy and working the way it should. -​ Communicate with care. Focus on teaching adolescents how to promote their health and well-being. -​ Perform the head-to-toe assessment. Examine genitalia last and quickly. Aging Adult -​ Aging adults have tasks that are directed in developing the meaning of life and one’s own existence, and to adjust to changes in physical strength and health. -​ They should be examined on the table. Older, more frail, adults may need to be supine. -​ Arrange the sequence to allow as few position changes as possible. -​ Match the pace of the aging adult, slowly and carefully. -​ Use physical touch because other senses may be diminished (they can’t see or hear as well). -​ Be aware that aging years contain more life stress. -​ Use the head-to-toe approach. Sick Patient -​ Adapt your assessment to the person’s comfort level, such as positioning if they’re in distress. -​ You may initially collect a mini database on areas appropriate to the body before completing a full assessment.