Learning Objectives Name the four fundamental physical assessment techniques Describe how to perform each of the techniques Identify the components of Equipment used in physical examination Describe how to assess each of the major organ systems. Define common physical assessment terms Interpret common physical assessment abbreviations.
Physical Assessment Information 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.
A physical examination PE is an evaluation of the body and its functions using inspection, palpation, percussion, and auscultation.
All pharmacists need a basic understanding of physical assessment skills. WHY ?
understand the meaning of specific physical assessment findings documented by other health care professionals
Pharmacists in some clinical settings (e.g., ambulatory care clinics) routinely assess patient response to medication regimens themselves using a variety of physical assessment skills
grow as pharmacists assume more direct patient care responsibilities.
Physical Assessment Sequence 1Vital signs 2. Appearance and behavior 3. Skin 4. Head 5. Eyes 6. Ears 7. Nose 8. Mouth 9. 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
Review 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
Assessment Sequencing Head – to - Toe Assessment Most comprehensive Used to obtain baseline information to identify changes in patient status ◦ organized - everything assessed from head progressing down to toes- combines Body Systems Assessment ◦ one system at a time ◦ Cardiac: heart sounds, pulses, capillary refill, B/P ◦ Respiratory: breath sounds, rate and depth, skin color ◦ organized per body systems i.e. lung assessment, abdominal assess, cardiovascular, neuro system ◦ best used for focused physical assessment
Performing 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
Assessment techniques The PA consists of detailed patient evaluation that consist of four fundamental techniques (IPPA). 15 InspectionPalpation Percussion Auscultation
Assessment Techniques Inspection - critical observation Take time to “observe” with eyes, ears, nose Use good lighting Look at color, shape, symmetry, position Odors from skin, breath, wound Inspection is done alone and in combination with other assessment techniques
Assessment Techniques Palpation ◦ Using hands to fell areas that cannot be seen ◦ light and deep touch ◦ Back of hand to assess skin temperature ◦ Fingers to assess texture, moisture, areas of tenderness ◦ Assess size, shape, and consistency of lesions ◦ Organ size and location ◦ Rigidity or spasticity ◦ Crepitation & Vibration ◦ Position & Size ◦ Presence of lumps or masses ◦ Tenderness, or pain
Assessment Techniques Percussion Sounds produced by striking body surface Produces 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
Assessment techniques - Cont. Percussion Direct – tapping the body directly with the distal end of a finger ◦ sinus tenderness Indirect- tapping a finger placed on the body, only the finger being struck touches the body ◦ lung percussion Blunt percussion-organ tenderness 19
Assessment Techniques Auscultation listening to sounds produced by the body Direct auscultation – sounds are audible without stethoscope Indirect auscultation – uses stethoscope Describe sound characteristics (frequency, pitch intensity, duration, quality) Flat diaphragm picks up high-pitched respiratory sounds best Bell picks up low pitched sounds such as heart murmurs