27/03/2013

What skills are necessary?

Physical •
•
Communication
Empathy

Examinations Skills •
•
Inspection
Palpation

A lecture for NURS1004 Physical •

•
Percussion
Auscultation
Dimensions of Being Human • Olfaction
By
• Documentation
Ailsa n’ha Winifreyda

Communication Empathy
Empathy Sympathy
Definition: Understanding what someone else is Acknowledging a person's
• Be professional in looks and manner feeling because you have experienced it emotional hardships and
yourself or can put yourself in their shoes. providing comfort and
• Interactional Skills assurance.
• Listening – undivided attention to what the person is saying Nursing: Relating with your patient because you Comforting your patient or
have been in a similar situation or their family
• Attending i.e. giving full attention to verbal and non verbal experience
messages Scope: Personal, It can be one to many in some From either one to another
circumstances person or one to many (or
• Paraphrasing – rewording person’s answer to show you one to a group).
understood the person’s information Relationship: Personal Friends, family and
• Leading – encouraging information from a person community (the experience
of others)
• Questioning – appropriately and when necessary Example: I know it's not easy to lose some weight When people try to make
• Reflecting – actually repeating information to show that you have because I have faced the same problems changes like this (e.g. lose
myself some weight) at first it
heard it seems difficult
• Summarizing – showing the person that you have heard all of the
http://www.diffen.com/difference/Empathy_vs_Sympathy
information

Sequencing of assessment Inspection

• Inspection – done continuously • Inspection: concentrated watching; close, careful scrutiny
• Do not rush
• Palpation • Compare patient’s right side with left side
• Use good lighting
• Percussion • Daylight is excellent for the integument
• Auscultation • May need specially angled lights
• Obtain adequate exposure (of the person)
• EXCEPT with GIT when palpation is done • Will include instruments in many body systems
LAST • Otoscope/ophthalmoscope
• Specula: vaginal, nasal
• Olfaction done continuously • Penlight

1
 27/03/2013

Nine principles to facilitate accurate

inspection of body parts
• Keep the patient informed.
• The patient should be relaxed and positioned comfortably.
• Use good lighting and additional light.
• Position and expose body parts.
• Be aware of normal physical characteristics related to age, culture
and gender.
• Always pay attention to the patient, watching all movements and
non-verbal cues.
• Inspect each area for size, shape, colour, symmetry, position and
abnormalities.
• Compare each area inspected with the same area on the opposite
side of the body.
• Do not hurry inspection – be thorough and pay attention to detail.
Palpation
• Palpation: using the sense of touch to assess texture,
temperature, moisture, organ location and size, as well as any
swelling, vibration or pulsation, rigidity or spasticity,
crepitation, presence of lumps or masses, and presence of
tenderness or pain
• Use different parts of the hands
• Fingertips—best for fine, tactile discrimination
• A grasping action of the fingers and thumb—to detect the
position, shape, and consistency of an organ or mass
• The dorsa (back) of hands and fingers—best for determining
temperature because the skin here is thinner than on the palms
• Base of fingers or ulnar surface of the hand—best for detecting
vibration

Palpation
• Light vs. deep palpation
• Light palpation is done to detect surface characteristics.
• Deep palpation is done to assess deeper structures, and should
use intermittent pressure rather than one long continuous
palpation. Not done in class
• Bimanual palpation uses both hands to envelop or capture
certain body parts or organs for more precise delimitation. Not
done in class

Characteristics Assessed by Palpation

• Texture
• Temperature
• Moisture
• Organ location and size
• Swelling
• Vibration or pulsation
• Rigidity or spasticity
• Crepitation
• Presence of lumps or masses
• Presence of tenderness or pain

2
 27/03/2013

Percussion Percussion
• Tapping the person’s • Requires considerable skill and can help to confirm other
skin with short, sharp assessment findings
strokes to assess • Percussion helps verify abnormalities assessed through
underlying structures. palpation and auscultation
• The strokes yield a • Evaluates the size, borders and consistency of body
palpable vibration and organs and to discover fluid in body cavities.
a characteristic sound
• Types of percussion.
that indicates the
• Direct: Striking the body surface directly with one or two fingers.
location, size, and
• Indirect: The tip of the middle finger of the examiner’s dominant
density of the
hand (called the plexor) strikes the base of the examiner’s distal
underlying organ. joint of the pleximeter

Direct Percussion vs. Indirect Percussion Indirect Percussion

• Direct percussion involves the striking hand directly contacting
the body wall.
• Indirect percussion is used more often, and uses both hands.
• A hand is placed over the area, the stationary hand, and remains
fixed, while the striking hand contacts the stationary hand to
produce a sound.

Percussion Sounds Auscultation

• Listening to sounds produced by the body, such as the heart,
blood vessels, lungs, and abdomen, usually using a
stethoscope
• A diaphragm is best used for high-pitched sounds—breath,
bowel, and normal heart sounds.
• A bell is best used for soft, low-pitched sounds, such as extra
heart sounds or murmurs.
• A stethoscope does NOT amplify sounds
• It focusses the sound

3
 27/03/2013

Auscultation Characteristics of sounds

• Involves listening to sounds produced by the body
• Learn normal sounds first before identifying abnormal sounds
or variations
• Requires a good stethoscope
• Requires concentration and practice
• Requires a quiet ambience
• Frequency: Number of oscillations generated per second by a
vibrating object. The higher the frequency, the higher the
pitch of a sound.
• Loudness: The amplitude of a sound wave. Auscultated sounds
are described as loud or soft.
• Quality: Sounds of similar frequency and loudness from
different sources. Terms such as blowing or gurgling describe
the quality of sound.
• Duration: The length of time that sound vibrations last. The
duration of sound is short, medium or long.

Olfaction Documentation
• Used to identify the nature and source of body odours • If you don’t write the information down, then it can be
• Helps to detect abnormalities assumed you didn’t either ask the question or assess that part
of the person i.e.
• Used in conjunction with other assessments • Person says that she has no history of heart problems in her
family
• Person’s anterior chest auscultated over all areas – no
adventitious sounds heard
• Write
• Subjective data first
• Then write Objective data
• Then Write list of person’s:
• Actual problems
• Potential problem’s
• Strengths