4Learning ObjectivesName the four fundamental physical assessment techniquesDescribe how to perform each of the techniquesIdentify the components of Equipment used in physical examinationDescribe how to assess each of the major organ systems.Define common physical assessment termsInterpret common physical assessment abbreviations.
5Physical AssessmentInformation obtained from the physical examination along with data obtained during a patient medication history interview and laboratory data are used to assess patient response to drug and nondrug therapy.
6A physical examination PE is an evaluation of the body and its functions using inspection, palpation, percussion, and auscultation.
7All pharmacists need a basic understanding of physical assessment skills. WHY ?
8understand the meaning of specific physical assessment findings documented by other health care professionals
9Pharmacists in some clinical settings (e.g., ambulatory care clinics)routinely assess patient response to medication regimens themselves using a variety of physical assessment skills
10grow as pharmacists assume more direct patient care responsibilities.
11Physical Assessment Sequence 1Vital signs 2. Appearance and behavior 3. Skin 4. Head 5. Eyes 6. Ears 7. Nose 8. Mouth9. Neck 10. Breasts 11. Chest and lungs 12. Heart 13. Abdomen 14. Extremities 15. Back and spine 16. Nervous system 17. Mental status 18. Genitalia and rectum
12Review PA abbreviation table 4-1 HEENT : Head, eyes, ears, nose, and throat WNL: Within normal limits WDWN: Well-developed, well- nourished VS : Vital signs HR: Heart rate
13Assessment Sequencing Head – to - Toe AssessmentMost comprehensiveUsed to obtain baseline information to identify changes in patient statusorganized - everything assessed from head progressing down to toes- combinesBody Systems Assessmentone system at a timeCardiac: heart sounds, pulses, capillary refill, B/PRespiratory: breath sounds, rate and depth, skin colororganized per body systems i.e. lung assessment, abdominal assess, cardiovascular, neuro systembest used for focused physical assessment
14Performing Physical Exam (ROS and PE) Review of Symptoms▫ Observation and Interview▫ Head to toe verbal review of all relevant symptoms▫ Gather subjective information from patient• Physical Exam▫ Inspection, palpation, percussion, auscultation▫ Physical assessment of all relevant body systems▫ Gather objective information yourself
15Assessment techniques The PA consists of detailed patient evaluation that consist of four fundamental techniques (IPPA).InspectionPalpationPercussionAuscultation
16Assessment Techniques Inspection - critical observationTake time to “observe” with eyes, ears, noseUse good lightingLook at color, shape, symmetry, positionOdors from skin, breath, woundInspection is done alone and in combination with other assessment techniques
17Assessment Techniques PalpationUsing hands to fell areas that cannot be seenlight and deep touchBack of hand to assess skin temperatureFingers to assess texture, moisture, areas of tendernessAssess size, shape, and consistency of lesionsOrgan size and locationRigidity or spasticityCrepitation & VibrationPosition & SizePresence of lumps or massesTenderness, or pain
18Assessment Techniques PercussionSounds produced by striking body surfaceProduces different notes depending on underlying mass (dull, resonant, flat, tympani)Used to determine size and shape of underlying structures by establishing their borders and indicates if tissue is air-filled, fluid-filled, or solid
19Assessment techniques - Cont. Percussion Direct – tapping the body directly with the distal end of a fingersinus tendernessIndirect- tapping a finger placed on the body, only the finger being struck touches the bodylung percussionBlunt percussion-organ tenderness
20Assessment Techniques Auscultationlistening to sounds produced by the bodyDirect auscultation – sounds are audible without stethoscopeIndirect auscultation – uses stethoscopeDescribe sound characteristics (frequency, pitch intensity, duration, quality)Flat diaphragm picks up high-pitched respiratory sounds bestBell picks up low pitched sounds such as heart murmurs