Physical Exams and Technique Powerpoint presentation lesson

Physical Exams and Technique PPT.ppt

1. Copyright © 2015 by Mosby, an imprint of Elsevier Inc.Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
EXAM TECHNIQUES AND EQUIPMENT
Jarvis/NSD 01/2018

2. Copyright © 2015 by Mosby, an imprint of Elsevier Inc.Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
PRECAUTIONS TO PREVENT INFECTION
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3. Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
STANDARD PRECAUTIONS
•Used for the care of all
patients regardless of their
presumed infection status
in any setting in which
health care is delivered
•Persons of all ages and
backgrounds may be
sources of infections
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4. Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
STANDARD PRECAUTIONS (CONT.)
•These precautions are based
on the principle that all of the
following may contain
transmissible infectious
agents:
•Blood
•Body fluids
•Secretions
•Excretions (except sweat)
•Nonintactskin
•Mucous membranes
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5. Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
STANDARD PRECAUTIONS (CONT.)
•Hand hygiene
•Personal protective equipment:
•Gloves
•Gown
•Mask
•Eye protection or face shield, depending on the anticipated
exposure
•Respiratory hygiene/cough etiquette
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STANDARD PRECAUTIONS (CONT.)
•Safe injection practices
•Use of masks for insertion of catheters or injection of
material into spinal or epidural spaces via lumbar
puncture
•Handling of equipment or items likely to have been
contaminated with infectious body fluids in a manner
to prevent transmission of infectious agents
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7. Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
TRANSMISSION-BASED PRECAUTIONS
•A second tier of precautions
designed for the care of
specified patients known or
suspected to be infected by
epidemiologically important
pathogens
•Applies to pathogens spread
by:
•Air
•Droplet
•Dry skin
•Contaminated surfaces
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PATIENT POSITIONS AND DRAPING
•Seated
•Supine
•Prone
•Dorsal recumbent
•Lateral recumbent
•Lithotomy
•Sims
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9. Copyright © 2015 by Mosby, an imprint of Elsevier Inc.Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
EXAMINATION TECHNIQUE
Inspection
Palpation
Percussion
Auscultation
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10. Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
INSPECTION
•Process of observation beginning
with the initial meeting of the
patient and continuing through
the history and physical
examination
•Guidelines
•Adequate lighting –daylight or
artificial
•Unhurried and careful inspection
•Expose what you want to inspect
•Validation of findings with patient
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11. Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
PALPATION
•Use of hands and fingers to
gather information through
the sense of touch
•Guidelines
•Keep fingernails short.
•Have warm hands.
•Be gentle in approach.
•Use correct palpation depth.
•Use appropriate hand surface.
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HAND AREAS
•Palmar surface of the fingers
and finger pads
•Position, texture, size, consistency,
fluid, crepitus, form of a mass, or
structure
•Ulnar surfaces of hand and
fingers
•Vibration
•Dorsal surface of hand
•Temperature
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13. Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
PERCUSSION
•One object striking against
another produces vibrations and
sound waves.
•Tapping finger causes vibrations
by impact on underlying tissues.
•Sound waves arise from
vibrations and produce
percussion tones (resonance).
•Tone is related to density of
underlying tissue.
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PERCUSSION TONES
•Tympany―loud, high, drumlike
•Gastric bubble
•Hyperresonance―very loud, low, booming
•Emphysematous lungs
•Resonance―loud, low, hollow
•Healthy lung tissue
•Dullness―soft, moderate, thudlike
•Over liver
•Flatness―soft, high, dull
•Over muscle
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PERCUSSION TECHNIQUES
•Immediate (direct)―Finger strikes directly against
body
•Mediate (indirect)―Middle finger of dominant hand is
hammer; middle finger of nondominant hand is
placed on body and struck
•Fist―Nondominant hand is placed on body and struck
with fist of dominant hand
•Most commonly used to elicit tenderness arising from the liver,
gallbladder, or kidneys
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AUSCULTATION
•Listening to sounds produced by
body
•Guidelines
•Perform last in examination sequence.
•Except with the abdominal
examination
•Stethoscope is placed on naked skin.
•Listen for presence/characteristics of
sound.
•Listen to one sound at a time.
•Take time to identify characteristics of
sound.
•Do not anticipate next sound.
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17. Copyright © 2015 by Mosby, an imprint of Elsevier Inc.Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
MEASUREMENT OF HEIGHT AND WEIGHT
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MEASUREMENT OF HEIGHT AND WEIGHT
•Adult
•Standing platform scale with height attachment
•Electronic scale
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MEASUREMENT OF HEIGHT AND
WEIGHT (CONT.)
•Infant
•Weight on platform scale sitting or lying
•Height on measuring device with rigid headboard and movable
footboard or measuring pads
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MEASUREMENT OF HEIGHT
AND WEIGHT (CONT.)
•Child (when able to stand)
•Stadiometer: stature-measuring
device
•Movable headpiece attached
to a rigid measurement bar
and platform
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21. Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
THERMOMETER
•Electronic temperature measurement
•Sensing probe can be used for oral, rectal, or axillary
temperatures
•Tympanic thermometers
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22. Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
STETHOSCOPE
•Required for
amplification in
auscultation
•Four types
•Acoustic
•Magnetic
•Electronic
•Stereophonic
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23. Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
STEREOPHONIC STETHOSCOPE
•Differentiate
between right and
left auscultatory
sounds
•Two-channel design
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STETHOSCOPE TECHNIQUE
•Stabilize stethoscope between the fingers
•Diaphragm use –press firmly against the skin
•Bell use –place evenly and lightly on the skin
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PULSE OXIMETER
•Measures the percentage of
hemoglobin saturated with oxygen
(oxyhemoglobin)
•Measures how much oxygen the
blood is carrying as a percentage of
the maximum it could carry
•Requires a reasonably translucent site
with a good blood flow
•Finger
•Toe
•Pinna
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26. Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
DOPPLER
•Ultrasonic stethoscopes used to
pick up sounds not heard with
stethoscope
•Detects blood flow rather than
sounds
•Common uses
•Detect systolic blood pressure
•Auscultate fetal heart activity
•Locate vessels
•Take weak pulses
•Assess vessel patency
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FETAL MONITORING EQUIPMENT
•Used to determine
fetal heart rate
•Four types
•Fetoscope
•Leff scope
•Stethoscope
•Doppler
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28. Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
OPHTHALMOSCOPE
•System of lenses
and mirrors with
light source and
apertures enables
visualization of
interior structures of
the eye.
•Lenses vary in
powers of
magnification.
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29. Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
OPHTHALMOSCOPE (CONT.)
•Magnification
ranges from –20 to
+40 and can be
dialed up or down
to compensate for
myopia or
hyperopia in both
the examiner and
patient.
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30. Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
PANOPTIC OPHTHALMOSCOPE
•Panoramic
ophthalmoscope
head uses optical
design that allows
larger field of view
•View of the fundus
is 5 times larger
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31. Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
VISUAL ACUITY CHARTS
•Snellen alphabet
•Acuity of far vision is
screened
•Graduated letters
•Smallest complete line
patient can see is recorded
•Reading recorded as
fraction (20/20 normal)
•The larger the denominator,
the poorer the vision
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32. Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
VISUAL ACUITY CHARTS (CONT.)
Tumbling E
Capital letter “E”facing
in different directions
HOTV
Wall chart composed
only of Hs, Os, Ts, and Vs
Child points to
(matches) the correct
letter on the testing
board
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33. Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
OTOSCOPE
•Illumination for viewing
external auditory canal and
tympanic membrane
•Speculum attached to
otoscope head directs
beam of light down ear
canal
•Pneumatic attachment used
to evaluate fluctuating
capacity of tympanic
membrane
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34. Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
TUNING FORK
•Tuning forks screen for auditory
function and vibratory sensation.
•Activated fork produces vibrations
that create a particular frequency
of sound wave expressed as cycles
per second (cps) or Hertz (Hz).
•Auditory evaluation estimates
hearing loss by noting which
vibrating tuning forks can be heard
(500 to 1000 Hz).
•Vibratory sense is measured by
holding vibrating fork against a
bony prominence (100 to 400 Hz).
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35. Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
TUNING FORK (CONT.)
•Activate the tuning
fork by gently
squeezing and stroking
the prongs or by
tapping them against
the knuckles of your
hand so that they ring
softly.
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36. Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
PERCUSSION (REFLEX) HAMMER
•Used to test deep tendon
reflexes (DTRs)
•Hammer held loosely
between thumb and
index finger and a tendon
is tapped to elicit a
reaction
•Finger may also be used
as percussion hammer,
especially in pediatric
examinations
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37. Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
TAPE MEASURE
•Used to determine
circumference, length, and
diameter in metric units and
inches
•Nonstretchablefor accuracy
and pliable for circumference
•Tape pulled closely without
causing depression of skin
•Serial measures obtained by
placing tape in same location
every time
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38. Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
TRANSILLUMINATOR
•Strong light source used to
distinguish whether a body cavity
contains fluid, air,
or tissue
•Guidelines
•Perform in dark room.
•Place light against area to be
observed.
•Watch for red glow through body
cavity.
•Note presence/absence of
illumination and irregularities.
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39. Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
VAGINAL SPECULUM
•Used to view vaginal canal and cervix
•Consists of two blades and a handle
•Three basic types:
•Graves―standard
•Pederson―women with small vaginal
openings
•Pediatric/virginal―children, adolescents
•Specula are available in either disposable
plastic or reusable metal.
•Operate differently
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40. Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
WOOD’S LAMP
•A light source with a
wavelength of 360 nm (black
light)
•Certain substances fluoresce
when illuminated
•Turn light on in dark room
and shine on area of skin
being evaluated
•Skin with fungi glows yellow-
green
•Used primarily to determine
presence of fungi on skin
lesions
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41. Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
CALIPERS FOR SKINFOLD
THICKNESS
•Measure the thickness
of subcutaneous tissue
at certain body points
with calibrated calipers
•Skinfold pinched up,
caliper edge is placed
at base of skinfold and
tightened to grasp
skinfold
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42. Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
MONOFILAMENT
•Test for loss of protective sensation,
particularly on plantar surface of foot
•Bends at 10 g of linear pressure –
patient has lost sensation if not felt
when bent
•Guidelines:
•Test various foot points with patient’s
eyes closed.
•Press and bend filament.
•Have patient indicate whether filament
is felt.
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