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5 objective data


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

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5 objective data

  1. 1. COLLECTION OF OBJECTIVE DATAMaria Carmela L .Domocmat, RN, MSN
  2. 2. Objective data• Data directly observed by the examinerMaria Carmela L .Domocmat, RN, MSN
  3. 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. 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. 5. 3. Performance of the four assessment techniques: IPPAMaria Carmela L .Domocmat, RN, MSN
  6. 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. 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. 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. 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. 10. Equipments for Physical Assessment• Tongue depressor• Tuning fork• Vaginal speculum• Watch with second handMaria Carmela L .Domocmat, RN, MSN
  11. 11. Equipments UsedMaria Carmela L .Domocmat, RN, MSN
  12. 12. Skinfold Caliper Goniometer Wood’s lamp Doppler Ultrasonic Transilluminator StethoscopeMaria Carmela L .Domocmat, RN, MSN
  13. 13. Ophthalmoscope OtoscopeMaria Carmela L .Domocmat, RN, MSN
  14. 14. Snellen’s ChartMaria Carmela L .Domocmat, RN, MSN
  15. 15. Rosenbaum ChartMaria Carmela L .Domocmat, RN, MSN
  16. 16. Physical assessment formsMaria Carmela L .Domocmat, RN, MSN
  17. 17. FOUR ASSESSMENT TECHNIQUES: IPPAMaria Carmela L .Domocmat, RN, MSN
  18. 18. InspectionMaria Carmela L .Domocmat, RN, MSN
  19. 19. Maria Carmela L .Domocmat, RN, MSN
  20. 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. 21. Maria Carmela L .Domocmat, RN, MSN
  22. 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. 23. • Note the following: – Color, patterns, symmetry, size, location, consistency, movement, behavior, odors, or soundsMaria Carmela L .Domocmat, RN, MSN
  24. 24. PALPATIONMaria Carmela L .Domocmat, RN, MSN
  25. 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. 26. PalpationMaria Carmela L .Domocmat, RN, MSN
  27. 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. 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. 29. Type of palpationMaria Carmela L .Domocmat, RN, MSN
  30. 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. 31. Maria Carmela L .Domocmat, RN, MSN
  32. 32. Moderate palpation• Depress the skin surface 1 to 2 cm• size, consistency, mobilityMaria Carmela L .Domocmat, RN, MSN
  33. 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. 34. • Feel very deep organs or structures that are covered with thick musclesMaria Carmela L .Domocmat, RN, MSN
  35. 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. 36. Maria Carmela L .Domocmat, RN, MSN
  37. 37. Maria Carmela L .Domocmat, RN, MSN
  38. 38. PercussionMaria Carmela L .Domocmat, RN, MSN
  39. 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. 40. Percussion• Uses: – Determining location, size, and shape – Determining density – Detecting abnormal masses – Eliciting pain – Eliciting reflexesMaria Carmela L .Domocmat, RN, MSN
  41. 41. Types of Percussion• Direct• Blunt• IndirectMaria Carmela L .Domocmat, RN, MSN
  42. 42. PercussionMaria Carmela L .Domocmat, RN, MSN
  43. 43. Percussion Sounds• Resonance• Hyperresonance• Dullness• Flatness• TympanyMaria Carmela L .Domocmat, RN, MSN
  44. 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. 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. 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. 47. AUSCULTATIONMaria Carmela L .Domocmat, RN, MSN
  48. 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. 49. Auscultation• Classifications – Intensity: loud, soft – Pitch : high, low – Duration: length – Quality: musical, crackling, raspyMaria Carmela L .Domocmat, RN, MSN
  50. 50. Maria Carmela L .Domocmat, RN, MSN
  51. 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. 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. 53. Factors to consider• Eliminate any confusing artifactsMaria Carmela L .Domocmat, RN, MSN
  54. 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. 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. 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. 57. Let’s practiceMaria Carmela L .Domocmat, RN, MSN