gathering objective data

COLLECTION OF OBJECTIVE DATA

Maria Carmela L .Domocmat, RN, MSN

Objective data

• Data directly observed by the examiner

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)

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 PAthe client for the PA– Setting– Self– Client

3. Performance of the four assessment techniques: IPPA

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

• 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

• 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

• 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

• Tongue depressor• Tuning fork• Vaginal speculum• Watch with second hand• Watch with second hand

Equipments Used

Goniometer

SkinfoldCaliper

Wood’s lampWood’s lamp

Doppler UltrasonicStethoscope

Transilluminator

OphthalmoscopeOtoscope

Snellen’sChart

Rosenbaum Chart

Physical assessment forms

FOUR ASSESSMENT TECHNIQUES: IPPA

Inspection

• Involves using the sense of vision, smell,

and hearing to observe and detect any

normal or abnormal findings.normal or abnormal findings.

Inspection

• Precedes the PPA because the latter

techniques can potentially alter the

appearance of what is being inspectedappearance of what is being inspected

• Note the following:

– Color, patterns, symmetry, size, location,

consistency, movement, behavior, odors, or consistency, movement, behavior, odors, or

sounds

PALPATION

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

Palpation

Parts of hands used

– Fingerpads – fine discriminations, pulses, texture, size, consistency, shape, crepitus

– ulnar/palmar surface – vibrations, thrills, fremitusfremitus

– dorsal surface -temperature

• 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 air, 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.

Type of palpation

Light palpation

• very little or no pressure (less than 1 cm)

• feel the structure using a circular motioncircular motion

• use: feel pulses, tenderness, surface skin texture, temperature, moisture

Moderate palpation

• Depress the skin surface 1 to 2 cm• size, consistency, mobility

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)

• Feel very deep organs or structures that are covered with thick muscles

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

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.

Percussion

• Uses:– Determining location, size, and shape– Determining density– Detecting abnormal masses– Detecting abnormal masses– Eliciting pain– Eliciting reflexes

Types of Percussion

• Direct• Blunt• Indirect

Percussion

Percussion Sounds

• Resonance• Hyperresonance• Dullness• Flatness• Tympany

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)

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

• 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

AUSCULTATION

Auscultation

• Listening to sounds produced by the body (heart, lungs, blood vessels, abdomen)

• Stethoscope: does not magnify sound but does block out extraneous room soundsdoes block out extraneous room sounds

Auscultation

• Classifications– Intensity: loud, soft– Pitch : high, low– Duration: length– Quality: musical,

crackling, raspy

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

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

Factors to consider

• Eliminate any confusing artifacts

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

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

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?

Let’s practice

gathering objective data

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