gathering objective data
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an overview on gathering objective data; basic concepts in gathering objective data

an overview on gathering objective data; basic concepts in gathering objective data

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  • 1. COLLECTION OF OBJECTIVE DATAMaria Carmela L .Domocmat, RN, MSN
  • 2. Objective data• Data directly observed by the examinerMaria Carmela L .Domocmat, RN, MSN
  • 3. Objective data• Data include: – physical characteristics (skin color, posture) – body functions (HR, RR) – appearance (dress, hygiene) – behavior (mood, affect) – measurement • (BP, Temp, Ht, Wt) – results of laboratory testing • (platelet count, CXR)Maria Carmela L .Domocmat, RN, MSN
  • 4. Requires basic knowledge in:1. Types of and operation needed for the particular examination2. Preparation of the setting, oneself, and the client for the PA – Setting – Self – ClientMaria Carmela L .Domocmat, RN, MSN
  • 5. 3. Performance of the four assessment techniques: IPPAMaria Carmela L .Domocmat, RN, MSN
  • 6. Equipments for Physical Assessment• Assessment document forms• Coin or key• Cotton ball• Cover card (for eye assessment)• Gloves• Goniometer• Gown for client• Lubricating jellyMaria Carmela L .Domocmat, RN, MSN
  • 7. Equipments for Physical Assessment• Magnifying glass• Marking pencil• Mini-mental status Exam (MMSE) form• Newspaper print or rosenbaum pocket screener• Notepad and pencil• Ophthalmoscope• OtoscopeMaria Carmela L .Domocmat, RN, MSN
  • 8. Equipments for Physical Assessment• Paper clip• Penlight• Pillows (two small pillows)• Platform scale with height attachment• Reflex hammer• Ruler with centimeter markings• Skin-fold caliber• Flexible tape measureMaria Carmela L .Domocmat, RN, MSN
  • 9. Equipments for Physical Assessment• Small cup of water to drink• Snellen chart• Stethoscope with sphygmomanometer• Substances for testing taste (e.g. salt, calamansi or lemon, sugar)• Substances for testing smell (e.g. soap, coffee)• ThermometerMaria Carmela L .Domocmat, RN, MSN
  • 10. Equipments for Physical Assessment• Tongue depressor• Tuning fork• Vaginal speculum• Watch with second handMaria Carmela L .Domocmat, RN, MSN
  • 11. Equipments UsedMaria Carmela L .Domocmat, RN, MSN
  • 12. Skinfold Caliper Goniometer Wood’s lamp Doppler Ultrasonic Transilluminator StethoscopeMaria Carmela L .Domocmat, RN, MSN
  • 13. Ophthalmoscope OtoscopeMaria Carmela L .Domocmat, RN, MSN
  • 14. Snellen’s ChartMaria Carmela L .Domocmat, RN, MSN
  • 15. Rosenbaum ChartMaria Carmela L .Domocmat, RN, MSN
  • 16. Physical assessment formsMaria Carmela L .Domocmat, RN, MSN
  • 17. FOUR ASSESSMENT TECHNIQUES: IPPAMaria Carmela L .Domocmat, RN, MSN
  • 18. InspectionMaria Carmela L .Domocmat, RN, MSN
  • 19. Maria Carmela L .Domocmat, RN, MSN
  • 20. Inspection• Involves using the sense of vision, smell, and hearing to observe and detect any normal or abnormal findings.Maria Carmela L .Domocmat, RN, MSN
  • 21. Maria Carmela L .Domocmat, RN, MSN
  • 22. Inspection• Precedes the PPA because the latter techniques can potentially alter the appearance of what is being inspectedMaria Carmela L .Domocmat, RN, MSN
  • 23. • Note the following: – Color, patterns, symmetry, size, location, consistency, movement, behavior, odors, or soundsMaria Carmela L .Domocmat, RN, MSN
  • 24. PALPATIONMaria Carmela L .Domocmat, RN, MSN
  • 25. Palpation• Involves using parts of the hand to touch and feel for the following characteristics: • Texture – rough or smooth • Temperature – warm or cold • Moisture – dry or wet • Mobility –fixed, movable, still, vibrating • Consistency – soft, hard, fluid-filled • Size – small, medium, large • Shape –well defined, irregular • Degree of tendernessMaria Carmela L .Domocmat, RN, MSN
  • 26. PalpationMaria Carmela L .Domocmat, RN, MSN
  • 27. Parts of hands used – Fingerpads – fine discriminations, pulses, texture, size, consistency, shape, crepitus – ulnar/palmar surface – vibrations, thrills, fremitus – dorsal surface -temperatureMaria Carmela L .Domocmat, RN, MSN
  • 28. • Crepitus is a symptom characterized by a crackling or grating feeling or sound under the skin, around the lungs or in the joints. In soft tissues, crepitus is often due to gas, most often air, that has abnormally penetrated and infiltrated an area (for example, in the soft tissues beneath the skin).• In a joint, crepitus can indicate cartilage wear in the joint space. The term "crepitus" is derived from the Latin, meaning "a crackling sound or rattle." Typically, crepitus is a grinding noise coupled with a sensation in the affected joint. Crepitus can occur with or without pain.Maria Carmela L .Domocmat, RN, MSN
  • 29. Type of palpationMaria Carmela L .Domocmat, RN, MSN
  • 30. Light palpation• very little or no pressure (less than 1 cm)• feel the structure using a circular motion• use: feel pulses, tenderness, surface skin texture, temperature, moistureMaria Carmela L .Domocmat, RN, MSN
  • 31. Maria Carmela L .Domocmat, RN, MSN
  • 32. Moderate palpation• Depress the skin surface 1 to 2 cm• size, consistency, mobilityMaria Carmela L .Domocmat, RN, MSN
  • 33. Deep palpation• Place dominant hand on the skin surface and nondominant hand on top of the dominant hand to apply pressure (2.5-5 cm or 1 to 2 inches)Maria Carmela L .Domocmat, RN, MSN
  • 34. • Feel very deep organs or structures that are covered with thick musclesMaria Carmela L .Domocmat, RN, MSN
  • 35. Bimanual palpation• Use two hands, placing one on each side of the body part (uterus, breasts, spleen) being palpated• One hand apply pressure, other hand feel structure• size, shape, consistency, mobilityMaria Carmela L .Domocmat, RN, MSN
  • 36. Maria Carmela L .Domocmat, RN, MSN
  • 37. Maria Carmela L .Domocmat, RN, MSN
  • 38. PercussionMaria Carmela L .Domocmat, RN, MSN
  • 39. Percussion• Involves tapping the body parts to produce sound waves• The sound waves or vibrations enable the examiner to assess the underlying structures.Maria Carmela L .Domocmat, RN, MSN
  • 40. Percussion• Uses: – Determining location, size, and shape – Determining density – Detecting abnormal masses – Eliciting pain – Eliciting reflexesMaria Carmela L .Domocmat, RN, MSN
  • 41. Types of Percussion• Direct• Blunt• IndirectMaria Carmela L .Domocmat, RN, MSN
  • 42. PercussionMaria Carmela L .Domocmat, RN, MSN
  • 43. Percussion Sounds• Resonance• Hyperresonance• Dullness• Flatness• TympanyMaria Carmela L .Domocmat, RN, MSN
  • 44. Percussion Sounds• Resonance: – heard over part air and part solid – normal lung – loud intensity, low pitch, long (length), hollow (quality)Maria Carmela L .Domocmat, RN, MSN
  • 45. Percussion• Dullness: over more solid organs (diaphragm, liver) – Medium ,medium, moderate, thudlike• Flatness : over very dense tissue (muscle, bones, sternum, thigh) – Soft, high, short, flatMaria Carmela L .Domocmat, RN, MSN
  • 46. • Tympany: heard over air – Puffed out cheek, gastric bubble – Loud, high, moderate, drumlike• Hyper resonance: heard over mostly air – Lung with emphysema – Very loud, low, long, boomingMaria Carmela L .Domocmat, RN, MSN
  • 47. AUSCULTATIONMaria Carmela L .Domocmat, RN, MSN
  • 48. Auscultation• Listening to sounds produced by the body (heart, lungs, blood vessels, abdomen)• Stethoscope: does not magnify sound but does block out extraneous room soundsMaria Carmela L .Domocmat, RN, MSN
  • 49. Auscultation• Classifications – Intensity: loud, soft – Pitch : high, low – Duration: length – Quality: musical, crackling, raspyMaria Carmela L .Domocmat, RN, MSN
  • 50. Maria Carmela L .Domocmat, RN, MSN
  • 51. Auscultation• Diaphragm: high-pitched sound – Normal heart sounds, breath sounds, bowel sounds – Hold the diaphragm firmly against the person’s skin – – firm enough to leave a slight ring afterwardMaria Carmela L .Domocmat, RN, MSN
  • 52. Auscultation• Bell: low-pitched sounds – abnormal heart sounds and bruit (abnormal loud, blowing, or murmuring sounds) – FHT – Hold lightly against the person’s skin – just enough that it forms a perfect seal; any harder causes the skin to act as a diaphragm, obliterating the low-pitched soundsMaria Carmela L .Domocmat, RN, MSN
  • 53. Factors to consider• Eliminate any confusing artifactsMaria Carmela L .Domocmat, RN, MSN
  • 54. Eliminate any confusing artifacts• Room must be quiet• Keep examination room warm• Clean the stethoscope endpiece with an alcohol wipe. Then warm it by rubbing it in your palm: this avoids the “chandelier sign” elicited when placing a cold endpiece on a warm chestMaria Carmela L .Domocmat, RN, MSN
  • 55. Eliminate any confusing artifacts• Wet the hair before auscultating the hairy chest: The friction on the endpiece from a man’s hairy chest causes a crackling sound that mimic an abnormal breath sound called crackles.• Never listen through a gown: reach under a gown to listen, but take care that no clothing rubs on the stethoscopeMaria Carmela L .Domocmat, RN, MSN
  • 56. Factors to consider• Eliminate any confusing artifacts• Listen selectively: only one thing at a time.• As you listen, ask yourself: – What am I actually hearing? – What should I be hearing at this spot?Maria Carmela L .Domocmat, RN, MSN
  • 57. Let’s practiceMaria Carmela L .Domocmat, RN, MSN