Health Care - Physical Assessment PDF

Field of pharmacy sciences Bachelor of pharmacy Phram-D program (Clinical Pharmacy) Pharmacy Skills and patient counselling (PPP303) Fall semester 2024-2025 Date : 1 / 10 /2024...

Field of pharmacy sciences Bachelor of pharmacy Phram-D program (Clinical Pharmacy) Pharmacy Skills and patient counselling (PPP303) Fall semester 2024-2025 Date : 1 / 10 /2024 Dr : Dr/ Azza Mansy Associate professor of clinical pharmacy and head of clinical pharmacy department AlMenofia University  Clinical skills for Pharmacy practice Interpreting physical assessment terms Dr/Azza Mansy  Diagnostic work-up Pt Histories Physical investigations examination Laboratory radiological Pathological  Indications of diagnostic approaches Provide important information regarding: 1- Diagnosis of specific diseases 2- Progression and regression of disease 3- Response to drug therapy 4- Ability of patients to metabolize and eliminate specific therapeutic agents  Clinical Tools of patient assessment To assess pt response (therapeutic efficacy/toxicity) to a management action, pharmacist use: 1- information obtained from pt interview (essentially needed for subjective indicators) 2- results of pt physical examination (essentially needed for objective indicators) 3- results of investigations (confirm/aid diagnosis & guide intervention) Techniques of physical inspection assessment I percussion P Palpation P Auscultation A  Techniques of physical assessment 1- Inspection Definition: visual surveillance e.g. inspecting color of eye sclera seeking an evidence of jaundice 2- Percussion Definition: a technique of tapping body surfaces to determine density of a specific area of the body by listening to produced sound (notes) Hand finger names  Techniques of physical assessment 2- Percussion- cont. Procedure: either; 1- direct: tap body surface directly with distal end of a finger 2- indirect: tap a finger placed on the body: middle finger of examiner's left hand (pleximeter) is firmly applied to body so as to displace any air between it and body while middle or index of examiner right hand (plexor) strikes on middle phalanx of pleximeter.  Only the pleximeter of left hand should touch the body  Techniques of physical assessment 3- Palpation Definition: Using hands to feel body parts that cannot be seen OR detect painful areas e.g. locating spleen tip (normally not palpable) to diagnose splenomegaly 4- Auscultation Definition: listening either directly with ears or indirectly with the aid of a stethoscope to sounds that arise spontaneously from the body e.g. Breath , heart & bowel sounds  Equipment used in physical assessment Equipment Purpose Image Flashlight 1- Assessment of pupillary reflexes (torch) (normally both pupils constrict in response to light stimulus & redilate after its removal) 2- Inspection of orophyrnax & skin Ophthalmo- Fundscopic examination scope Otoscope Assess external ears & tympanic membrane  Equipment used in physical assessment Equipment Purpose Image Tongue Inspection of orophyrnax depressor Watch with Assess heart and respiratory rate second hand Thermometer Obtain body temperature  Equipment used in physical assessment Equipment Purpose Image Stethoscope Auscultate cardiovascular, pulmonary & abdominal system sphygmoma Obtain BP nometer Reflex Assess neurological function by hammer measuring deep tendon reflexes to detect abnormalities in central or peripheral nervous system.  Equipment used in physical assessment Equipment Purpose Image tuning fork 1- Assess neurological function 2- Assess hearing Snellen Assess visual acuity eye chart  Physical examination of skin & nails Techniques: inspection & palpation Examined aspects: 1- Color: pallor (poor peripheral circulation), cyanosis (poor O2 saturation), redness (CO poisoning, fever, sunburn, mild thermal burns), yellowness (jaundice) 2- Hydration: dry (normal), moist (hypoglycemia, heart attack, viral gastroentritis), excessively dry (dehydration) 3- temperature: warm (fever, sunburn), cold (hypothermia as in early shock)  Physical examination of skin & nails Examined aspects- cont.: 4- thickness: thick (e.g. eczema) , thin (e.g. corticosteroids use, aging) 5- presence of lesions: location, type, color, shape, size, grouping & pattern  E.g. of skin lesions Lesion Description Significance Image name Petechiae small (1cm) SC Trauma, hemophilia, bleed spot betamethasone use  E.g. of skin lesions Lesion Description Significance Image name Vesicle a small (180) bet. nail base & bed may indicate heart disease as bacterial endocarditis or lung disease as COPD/ lung cancer/complicated TB 2- Cyanosis: COPD, acute severe asthmatic attack, severe pneumonia  Physical examination of skin & nails 3- Koilonychia: thinning & spooning of nails associated with iron deficiency anemia 4- Onycholysis: separation of nails from nail beds associated with trauma, malnutrition or thyroid disease Physical examination of ears & hearing assessment Otoscope is inserted by tipping pt head slightly to the opposite side & gently pulling auricle up (painful in case of otitis media), back & slightly outward to examine external ear & ear drum Hearing assessment: 1- Rinne’s test: Compare bone & air conduction (normally is better) by placing the end of a vibrating tuning fork on mastoid process behind ear & in front of ear canal respectively  Physical examination of ears & hearing assessment Hearing assessment- cont.: 2- Weber’s test: placing the end of a vibrating tuning fork on the center of pt forehead Normally, sound should be heard equally in both ears Hearing only/ better from one side indicate other side (unilateral) sensorineural hearing loss  Physical examination of mouth & pharynx Technique: inspection Items inspected Inspected for lips, mucosal cavity, teeth, Color, ulceration, hydration, gums, hard palate, tonsils, inflammation, lesions & exudates soft palate, top & bottom of tongue Soft palate Movement when pt says “ah” Odor of breath Alcoholic, urinous (uremia), sweetish fruity (ketoacidosis) , musty (= fetor hepaticus in severe parenchymal liver disease )  Physical examination of chest & lungs Techniques: 1- Inspection: chest is inspected during > 1 complete respiratory cycle for detection of:  Inc in anterior posterior (AP) chest diameter (Barrel chest): associated with acromegaly or diseases characterized by air trapping in lungs (COPD) or pleural space (pneumothorax)  Chest skeletal abnormalities as: Pigeon chest (Pectus carinatum): anterior displacement (protrusion) of sternum & ribs as in rickets  Use of accessory muscles as in SOB or dyspnea  Physical examination of chest & lungs Techniques- cont.: 2- Palpation:  minor role as lung is covered by ribs & therefore not palpable  for detection & defining location of masses & painful areas 3- Percussion: for detection of  displacement of air-filled tissue by fluid (e.g. pleural effusion) or its infiltration with WBCs & bacteria (e.g. pneumonia)  chronic (e.g. COPD) or acute (e.g. pneumothorax) air trapping in lung or pleural space  Physical examination of chest & lungs Techniques- cont.: 4- Auscultation:  for detection of abnormal breathing sounds that suggests certain pathology  It is done while pt breath deeply & slowly through mouth on command  Abnormal respiratory rate Abnormality name Description Significance Apnea Absence of opiates, trauma respiration bradypnea Slow RR CNS depressants, Normal depth of ↑ intracranial breathing pressure Hyperpnea e.g. ↑ depth & rate of Coma & diabetic Kussmaul’s respiration ketoacidosis breathing Tachypnea ↑ RR Sepsis, acidosis, pneumonia, pleural effusion  Abnormal respiratory rate Abnormality Description significance name Biot’s respiration groups of quick, Pons damage shallow due to stroke, inspirations meningitis or followed by opiates use periods of apnea  Percussion sounds of chest & lung Sound description Significance name Resonance Loud, low pitched Normal lung tissue hollow note Dullness/ Soft, medium- Areas of consolidation flatness pitched note (normally air filled lung parenchyma engorged with fluid or tissue)as in pleural effusion or pneumonia. Shifting Dullness note that Accumulation of free fluid dullness shift with pt within pleural cavity as shifting hydrothorax (serous fluid as in CHF), hemothorax (blood, as in major chest injuries),  Percussion sounds of chest & lung Sound name description significance Hyper- Abnormally loud, Areas of increased air resonance low pitched note volume as in COPD, pneumothorax Normal auscultation sounds of chest & lung Sound name description significance Bronchial Very loud, high pitched, Normal breath sounds breathing harsh sound heard over trachea (extrathoracic portion inspiration & expiration has much louder & are equal with a pause more harsh sound) between them Vesicular lower pitched & softer Normal breath sounds sounds sound than bronchial. heard over lung tissue Expiration is shorter with no pause between them  abnormal auscultation sounds of chest & lung Sound name description significance Egophony Altered vocal lung resonance; spoken “e- consolidation or fibrosis e-e-”is transmitted as. “a-a-a-a” Wheezes Abnormally high Airway obstruction as pitched CONTINUOUS COPD breath sound Pleural Creaking, leather like Inflamed surface of friction rub sound visceral & parietal pleura rub against one another in pleuritis  abnormal auscultation sounds of chest & lung Sound name description significance Crackles/ DISCONTINUOUS rubbing of parts one crepitation (mainly during against other during inhalation), short inhalation caused by duration, bubbling "popping open" of sounds (clicking, small airways rattling) and alveoli collapsed by fluid, exudate, or lack of aeration in pneumonia or pulmonary edema