gathering objective data

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

1. COLLECTION OF OBJECTIVE
DATA
Maria Carmela L .Domocmat, RN, MSN

2. Objective data
• Data directly observed by the examiner
Maria Carmela L .Domocmat, RN, MSN

3. Objective data
• Data include:
–physical characteristics (skin color, posture)
–body functions (HR, RR)
–
appearance (dress, hygiene)
–
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. Requires basic knowledge in:
1. Types of and operation needed for the
particular examination
2. Preparation of the setting, oneself, and
the client for the PA the client for the PA
–Setting
–Self
–Client
Maria Carmela L .Domocmat, RN, MSN

5. 3. Performance of the four assessment
techniques: IPPA
Maria Carmela L .Domocmat, RN, MSN

6. Equipments for Physical
Assessment
• Assessment document forms
• Coin or key
• Cotton ball
•
Cover card (for eye assessment)
•
Cover card (for eye assessment)
• Gloves
• Goniometer
• Gown for client
• Lubricating jelly
Maria Carmela L .Domocmat, RN, MSN

7. Equipments for Physical
Assessment
• Magnifying glass
• Marking pencil
• Mini-mental status Exam (MMSE) form
•
Newspaper print or rosenbaum pocket
•
Newspaper print or rosenbaum pocket screener
• Notepad and pencil
• Ophthalmoscope
• Otoscope
Maria Carmela L .Domocmat, RN, MSN

8. Equipments for Physical
Assessment
• Paper clip
• Penlight
• Pillows (two small pillows)
•
Platform scale with height attachment
•
Platform scale with height attachment
• Reflex hammer
• Ruler with centimeter markings
• Skin-fold caliber
• Flexible tape measure
Maria Carmela L .Domocmat, RN, MSN

9. Equipments for Physical
Assessment
• Small cup of water to drink
• Snellen chart
• Stethoscope with sphygmomanometer
•
Substances for testing taste (e.g. salt,
•
Substances for testing taste (e.g. salt, calamansi or lemon, sugar)
• Substances for testing smell (e.g. soap,
coffee)
• Thermometer
Maria Carmela L .Domocmat, RN, MSN

10. Equipments for Physical
Assessment
• Tongue depressor
• Tuning fork
• Vaginal speculum
•
Watch with second hand
•
Watch with second hand
Maria Carmela L .Domocmat, RN, MSN

11. Equipments Used
Maria Carmela L .Domocmat, RN, MSN

12. Goniometer
Skinfold
Caliper
Wood’s lamp Wood’s lamp
Doppler Ultrasonic
Stethoscope
Transilluminator
Maria Carmela L .Domocmat, RN, MSN

13. Ophthalmoscope
Otoscope
Maria Carmela L .Domocmat, RN, MSN

14. Snellen’s
Chart
Maria Carmela L .Domocmat, RN, MSN

15. Rosenbaum
Chart
Maria Carmela L .Domocmat, RN, MSN

16. Physical assessment forms
Maria Carmela L .Domocmat, RN, MSN

17. FOUR ASSESSMENT
TECHNIQUES: IPPA
Maria Carmela L .Domocmat, RN, MSN

18. Inspection
Maria Carmela L .Domocmat, RN, MSN

19. Maria Carmela L .Domocmat, RN, MSN

20. Inspection
• Involves using the sense of vision, smell,
and hearing to observe and detect any
normal or abnormal findings. normal or abnormal findings.
Maria Carmela L .Domocmat, RN, MSN

21. Maria Carmela L .Domocmat, RN, MSN

22. Inspection
• Precedes the PPA because the latter
techniques can potentially alter the
appearance of what is being inspected appearance of what is being inspected
Maria Carmela L .Domocmat, RN, MSN

23. • Note the following:
–Color, patterns, symmetry, size, location,
consistency, movement, behavior, odors, or consistency, movement, behavior, odors, or sounds
Maria Carmela L .Domocmat, RN, MSN

24. PALPATION
Maria Carmela L .Domocmat, RN, MSN

25. Palpation
• Involves using parts of the hand to touch
and feel for the following characteristics:
• Texture –rough or smooth
•
Temperature
–
warm or cold
•
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 tenderness
Maria Carmela L .Domocmat, RN, MSN

26. Palpation
Maria Carmela L .Domocmat, RN, MSN

27. Parts of hands used
–Fingerpads–fine discriminations, pulses,
texture, size, consistency, shape, crepitus
–ulnar/palmarsurface –vibrations, thrills,
fremitus fremitus
–dorsal surface -temperature
Maria Carmela L .Domocmat, RN, MSN

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 ai r, 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
•
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. Type of palpation
Maria Carmela L .Domocmat, RN, MSN

30. Light palpation
• very little or no pressure
(less than 1 cm)
• feel the structure using a
circular motion circular motion
• use: feel pulses,
tenderness, surface skin
texture, temperature,
moisture
Maria Carmela L .Domocmat, RN, MSN

31. Maria Carmela L .Domocmat, RN, MSN

32. Moderate palpation
• Depress the skin surface 1 to 2 cm
• size, consistency, mobility
Maria Carmela L .Domocmat, RN, MSN

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) cm or 1 to 2 inches)
Maria Carmela L .Domocmat, RN, MSN

34. • Feel very deep
organs or structures
that are covered with
thick muscles
Maria Carmela L .Domocmat, RN, MSN

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
•
One hand apply pressure, other hand feel structure
• size, shape, consistency, mobility
Maria Carmela L .Domocmat, RN, MSN

36. Maria Carmela L .Domocmat, RN, MSN

37. Maria Carmela L .Domocmat, RN, MSN

38. Percussion
Maria Carmela L .Domocmat, RN, MSN

39. Percussion
• Involves tapping the body parts to produce
sound waves
• The sound waves or vibrations enable the
examiner to assess the underlying examiner to assess the underlying structures.
Maria Carmela L .Domocmat, RN, MSN

40. Percussion
• Uses:
–Determining location, size, and shape
–Determining density
–
Detecting abnormal masses
–
Detecting abnormal masses
–Eliciting pain
–Eliciting reflexes Maria Carmela L .Domocmat, RN, MSN

41. Types of Percussion
• Direct
• Blunt
• Indirect
Maria Carmela L .Domocmat, RN, MSN

42. Percussion
Maria Carmela L .Domocmat, RN, MSN

43. Percussion Sounds
•Resonance
• Hyperresonance
• Dullness
• Flatness
• Tympany
Maria Carmela L .Domocmat, RN, MSN

44. Percussion Sounds
• Resonance:
–heard over part air and part solid
–normal lung
–
loud intensity, low pitch, long (length), hollow
–
loud intensity, low pitch, long (length), hollow (quality)
Maria Carmela L .Domocmat, RN, MSN

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, flat
Maria Carmela L .Domocmat, RN, MSN

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, booming
Maria Carmela L .Domocmat, RN, MSN

47. AUSCULTATION
Maria Carmela L .Domocmat, RN, MSN

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 sounds does block out extraneous room sounds
Maria Carmela L .Domocmat, RN, MSN

49. Auscultation
•Classifications
–Intensity: loud, soft
–Pitch : high, low
–Duration: length
–Quality: musical,
crackling, raspy
Maria Carmela L .Domocmat, RN, MSN

50. Maria Carmela L .Domocmat, RN, MSN

51. Auscultation
• Diaphragm: high-pitched sound
–Normal heart sounds, breath sounds, bowel
sounds
–
Hold the diaphragm firmly against the
–
Hold the diaphragm firmly against the person’s skin –
–firm enough to leave a
slight ring afterward
Maria Carmela L .Domocmat, RN, MSN

52. Auscultation
• Bell: low-pitched sounds
–abnormal heart sounds and bruit (abnormal
loud, blowing, or murmuring sounds)
–
FHT
–
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 sounds
Maria Carmela L .Domocmat, RN, MSN

53. Factors to consider
• Eliminate any confusing artifacts
Maria Carmela L .Domocmat, RN, MSN

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 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 chest
Maria Carmela L .Domocmat, RN, MSN

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 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 stethoscope
Maria Carmela L .Domocmat, RN, MSN

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 am I actually hearing?
–What should I be hearing at this spot?
Maria Carmela L .Domocmat, RN, MSN

57. Let’s practice
Maria Carmela L .Domocmat, RN, MSN