1 / 25

** Assessment Technique& General Survey

** Assessment Technique& General Survey. Introduction. P/E requires that examiner develop technical skills & a knowledge base.

Jims
Download Presentation

** Assessment Technique& General Survey

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. ** Assessment Technique& General Survey

  2. Introduction • P/E requires that examiner develop technical skills & a knowledge base. • “we see only what we know”. to recognize a significant finding, you need to know what to look for. You will use your senses to gather data during P/E, these skills are: inspection, palpation, percussion& auscultation in this order. • start with v/s measurement, wash your hands

  3. ·        Inspection: • is concentrated watching, first as a whole & then of each body system. It always comes first. Train your self not to rush .Compare the right & left sides of the body, requires good lighting, adequate exposure & occasional use of certain instruments.

  4. Inspection

  5. Palpation: • applies your sense of touch to assess these factors: texture, temperature, moisture, organ location& size, as well as any swelling, vibration or pulsation, presence of lumps or masses & presence of tenderness or pain.

  6. palpation

  7. different parts of the hands are best suited for assessing different factors: • 1-     Fingertips: for fine tactile discrimination, as of skin texture, swelling, pulsation, lumps. • 2-     A grasping action of the fingers & thumb- to detect the position of an organ or mass • 3-     The dorsa(backs) of hands & fingers- best for determining temperature • 4-     Base of fingers- best for vibration.

  8. Technique should be slow & systematic. use a calm, gentle approach. warm your hands by kneading them together or holding them under warm water. Identify any tender areas & palpate them last.

  9. - Start with • 1- light palpation to detect surface characteristics & to accustom the person to being touched. • 2- Then deeper palpation, intermittent pressure is better than one long continuous palpation. • 3- Bimanual palpation requires the use of both of your hands to envelop certain body parts or organs- such as kidneys.

  10. ·        Percussion: • its tapping the person’s skin with short, sharp strokes to assess underlying structures. The strokes gives a palpable vibration & density of the underlying organ. Percussion has the following uses:

  11. Percussion:cont • 1- mapping out the location & size of organ • 2- signaling the density(air, fluid or solid) of a structure by a characteristic note. • 3- detecting an abnormal mass superficial(5 cm deep) • 4- eliciting pain if the underlying structure is inflamed • 5- Eliciting a deep tendon reflex using the percussion hammer.

  12. Hyperextend the middle finger & place its distal portion firmly against the person’s skin. Lift the rest of the stationary hand up off the person’s skin, the resting hand will dampen off the produced vibrations. ·       the stationary hand:

  13. ·        the striking hand: • use the middle finger of your dominant hand as the striking finger, with your upper arm & shoulder steady. Action is all in the wrist, spread your fingers wish your wrist & bounce your middle finger off the stationary one. Aim for behind the nail bed or at the distal interpharyngeal joint, its tip not the finger pad, makes contact, percuss 2 times, the force of the blow determines the loudness of the note, the thickness of the person’s body wall will be a factor.

  14. ·        Production of the sound: • - all sounds results from vibration of some structure, percussion notes is differentiated by (component of percussion): • amplitude(or intensity, aloud or soft sound) • pitch(or frequency, no of vibrations/sec) • quality(subjective difference due to a sound’s distinctive overtones) • duration(length of time the note lingers).

  15. ·       Auscultation: • - its listening to sounds produced by the body as heart& lung, through a stethoscope , doesn’t magnify sound but does block out extraneous room sounds. The fit & quality of the stethoscope are important.

  16. stethoscope • a stethoscope with 2 end pieces a diaphragm & bell . Diaphragm its flat edge best for high-pitched sounds-breath, bowel& normal heart, hold the diaphragm firmly against skin. The bell best for soft, low-pitched sounds as murmurs hold it lightly against skin.

  17. You must eliminate any confusing artifact: • 1. Any extra room noise • 2. Warm room (shivering draw out the involuntary muscle contractions). • 3. Warm stethoscope by rubbing it in your palm • 4. Friction on the end piece from male’s hairy chest causes a crackling sound that mimics abnormal breath so wet the hair before auscultation • 5. Never listen through a gown • 6. Avoid your own artifact as breathing on the tubing or the thumb from bumping the tubing together.

  18. ·        setting: • -  Warm comfortable, quite, private & well lit, natural lighting. • - Position the examination table so both sides of person are easily accessible, a suitable height.

  19. 1- scale with height attachment 2-  skin fold caliper 3-  sphygmomanometer 4-   stethoscope with bell & diaphragm 5-  thermometer 6-  penlight 7-  otoscope / ophthalmoscope 8-  turning fork 9-     nasal speculum 10-tongue depressor 11-vision screen 12-tape measurement& ruler 13-reflex hammer 14-cotton ball 15-vaginal speculum 16- gloves 17- Lubricant ·        Equipment:

  20. General Survey: • It’s a study of the whole person, covering the health state & any physical characteristic.

  21. · Physical Appearance: • - age( does he appear his stated age) • - sex(sexual development appropriate for gender& age) • -  level of consciousness(alert, oriented) • - skin color( even, varying with genetic background, no lesions) • - facial features(symmetric with movement)

  22. ·       Body structure: • stature(height appropriate with age) • nutrition(weight appropriate with height &body build) • symmetry (body parts look equal bilaterally) • posture(stands comfortably as appropriate for age • Position (sits comfortably in a chair or in the bed, arm relaxed at sides. • Body build, contour(arm span equal height)

  23. ·       Mobility: • Gait(base is wide as the shoulder width, walk smooth& well balanced • Range of motion: full mobility for each joint, with accurate smooth coordinated no involuntary movement.

  24. ·       Behavior: Facial expression: maintain eye contact, expressions appropriate to situation. Mood & affect: comfortable &cooperative with the examiner Speech: articulation is clear & understandable, fluently, appropriate to culture& education Dress & personal hygiene: appropriate to climate, fits the body, appropriate to culture& age. Clean, hair brushed& groomed.

  25. Thank you

More Related