Overview of Physical Assessment Chapter 13 PNU 145

Overview of Physical Assessment Chapter 13 PNU 145 Bethann Davis RNC/NP MSN

Learning Objectives • List the four purposes of a physical assessment. • Name and define four assessment techniques. Inspection Percussion Palpation Auscultation

Learning Objectives (cont) • Identify a head-to-toe approach to physical assessment. • Define Accommodation Capillary refill Edema

Learning Objectives (cont) • Describe the sequence of a lung assessment. • Define Adventitious sounds Crackles Gurgles Wheezes • Describe appropriate way to assess the abdomen.

Overview of Assessment Purposes 1. Evaluate current physical condition 2. Detect early health problems 3. Establish a baseline 4. Evaluate client’s responses to interventions

Overview of Assessment • Assessment techniques • Inspection • Percussion • Palpation • Auscultation

Overview of Assessment • Inspection: Systematic observation

Overview of Assessment • Percussion: striking one object against another to produce vibration and sounds – usually fingers are used

Overview of Assessment • Palpation: light touch using hands and fingers

Overview of Assessment • Auscultation: listening to sounds - with a stethoscope

Overview of Assessment • General areas of assessment head & neck chest extremities abdomen genitalia anus/rectum

Overview of Assessment • “Head-to-toe” Assessment Ht/Wt vital signs

Overview of Assessment • Mental status assessment • Determine if client alert & oriented • Does client remember what you say to them

Overview of Assessment • Neurological Assessment level of consciousness (LOC) alert lethargic

Overview of Assessment level of consciousness (cont) stuporous comatose

Overview of Assessment • Orientation document: alert & oriented x’s 3 person, place, time

Overview of Assessment • Pupil response size equality response to light accommodation

Overview of Assessment • Lung assessment inspect: palpate:

Overview of Assessment • Lung assessment (cont) percuss: auscultate:

Overview of Assessment • Abnormal lung sounds • Crackles (rales): high pitched popping sounds heard primarily during inspiration Gurgles (rhonchi): low pitched continuous bubbling sounds heard during expiration.

Overview of Assessment • Wheezing: whistling or squeaking sounds, during inspiration or expiration may be heard without a stethoscope

Overview of Assessment • Extremities assessment: Muscle strength Motor Responses • Hand grasps, feet pushes Equal, unequal, strong, weak

Overview of Assessment • Extremities assessment (cont) Nails capillary refill

Overview of Assessment • Extremities assessment (cont) Edema: pitting dependent

Overview of Assessment • Extremities assessment (cont) Sensory responses: touch, pinch skin deep response – pinch mid chest or achillis tendon

Overview of Assessment • Abdominal Assessment 4 quadrants: RUQ, RLQ, LUQ Inspect: auscultate:

Overview of Assessment • Abdominal Assessment (cont) palpation: percussion:

Overview of Assessment • Abdominal Assessment (cont) Abdominal girth: measure abdomen, same site, same time of day

Overview of Assessment • Genitalia, anal, rectal assessments

General Considerations Make sure client has glasses/hearing aid in place if needed Explain everything you are going to do. Make sure client understands your terminology.

General Considerations When positioning client, be aware of any physical limitations. Set a time limit with your client for the examination.