Type of assessment

INTRODUCTION OF - Asses peripheral perfusion of

THE NURSING toes- pulse, tightness of the cast-
look at the hair if its lost
PROCESS - Capillary blanch test- pinching
the nails- blood should be back
in 2-3 secs ( if not it means
you’re dehydrated)
Health assessment - Bipedal pules (compare both legs
-plan of care that identifies specific pulse)
needs of clients - Take and monitor vital signs
-how these needs will be addressed by
the health care organization, or skilled Client 5: Has minimal fluid intake
nursing facility Type of assessment
-plan of care that identifies specific - Assess tissue/ skin turgor
needs of clients (pulling of skin)
-how these needs will be addressed by - Monitor intake and output
the health care organization, or skilled - Take and monitor vital signs
nursing facility. The Nurse in the Late 1800’s to early
1900s
Examples of Nursing Assessments Weber and Kelly Dillon
Nurses relied on
Client 1 : Complains of abdominal natural senses,
pain observed for the
Type of assessment changes: Color,
- Inspect, percuss (drum), palpate temperature,
(touch and feel), and auscultate muscled strength,
(listen) the abdomen use of limns, body
- Take and monitor the vital signs output, nutrition,
(Pulse rate, cardiac rate, and hydration
temperature, blood pressure, status
Palpation used to
respiratory rate, pain)
measure pulse
rate and quality,
Client 2: Admitted due to head injury plus locate
Type of assessment fundus of the
- Asses the level of consciousness puerperal woman
- Assess the pupillary reaction to (pregnant)
light accommodation Independent
- Take and monitor the vital signs nursing practices
Client 3: Prescribed a cardiotonic (inspection,
drug palpation [GI],
- Asses the apical pulse(Heart) and auscultation,
compare with baseline data – BP- testing CN VII,
compare it to the patients data and examination
before he/she arrived of school children
in school systems)
Client 4: Cast applied on lower leg
 Is 8 months
pregnant. TPR
Weber and Kelly Dillon 99.4, 80, 20. Ht
Routine client Observation 5’4”. Wt 116 1/4.
and home notes only. Role Urine to lab”
inspection by is a skilled
public health observer. The nurse in the 1970’s
nurse
Weber and Kelly Dillon
Case finding, “Patient admitted
Primary health Records
prevention of to ward in a
services and intravenous and
communicable wheelchair.
conducting blood therapy.
diseases, routine Stated that he is
health histories Includes
assessment skills unable to walk
with physical and observation and
in poor inner-city due to pinched
psychological information on
areas (Frontier nerves of right
assessments past illness and
Nursing Service, foot. Patient is
diet. Nurse role
and Red cross) crying says he is
now includes
homesick.
observation,
Condition of skin
interview,
is good. Made as
performing
comfortable as
procedures( venip
possible”
uncture) and,
The Nurse in the 1930s monitoring
Autonomous in
The Nurse in the 1950s making
Webber and Kelly Dillon comprehensive
Pre-employment Nurse’s notes initial assessment
health and trace the past which become the
physical and present bases for plans of
examinations for history of an care
major companies illness as well as
(Occupational observations.
health nursing)
The nurses role Nurse in the 1900s- Present
has expanded to
include
Weber and kelly
interviewing skills
Expanded from acute care setting
that asses past
and the community, into
and current
baccalaureate and graduate
health status
education (holistic assessment)
“25-year old
Because of budget cuts, nurse
female admitted
documentation of health care
ambulatory. Past
providers was used to justify health
history ulcerative
services
colitis. Now in
because of Creation of critical pathways or
abdominal protocols in the care of patients
cramps and Advanced practices nurses as
vomiting x4days. clinical nurse specialists and nurse
practitioner in the hospital and
community setting respectively
Rise of health maintenance
organization(HMO’s) and preferred
provider organization (PPO’s)
Home Health Nursing- Independent
nursing diagnosis, referrals, and
collaborative care as needed
-Median salary $78,983

Time Weber and Dillon School Nursing-needs of communities

period Kelly and monitor growth and health of
Late Focused Skilled children
1800s natural observer.
to senses on Hospice nursing- assess the need of
early observable
terminally ill clients and their families
1900s changes,
1930s PHNS do
home Acute care nursing- biglaan and short
inspection, term; extensive focused assessments
case finding,
prevention of Forensic nursing- extensive focused
communicabl assessments (reversed process)- what is
e diseases in the cause of the injury/death
inner city
areas thru Critical care outreach nursing-
FNS and RC. enhance assessment skills to safely
1950s Pre- Traced past asses clients outside the structured
employment and current intensive care environment
examinations history as an
(OHN) interviewer.
Ambulatory care nursing- outpatient;
19870 Primary Begins
assess and screen clients to determine
s health performing
service, procedures need for referrals, should be critical on
assessments (venipunctur the patient.
(physical and e) and
psychological monitoring
), formulates vital signs. How can we tell the age of a
plans of care. contusion?
1990s Baccalaureat Holistic
to e and health RED-BLUE-GREEN-YELLOW-ORANGE
presen graduate assessment.
t programs. Includes Red-Oxyhemoglobin- 0-2 days
Rise of biophysical, Blue-Deoxyhemoglobin- 2-5 days
advanced nursing
Green- Biliverdin – 5-7 days
nursing practice. Rise
Yellow- Bilirubin 7- 10 days
practices and of HMOS
HMOs psychosocial, Orange-Hemosiderin- 10-14 days
andPPOS. and cultural
aspects.

Rapid Expansion in the Nurse Role’ Skills of assessment


Cognitive skills
-considered to be a thinking process
-needed for critical and creative
thinking, and clinical decision making
-theoretical knowledge base enables
you to holistically asses patients,
differentiate normal from abnormal, as
well as identify and prioritize actual and
potential problems
-reflective and reasonable thinking
-not just doing, but asking “why”
-involves inquiry, interpretation,
analysis, and synthesis
Types of assessment
According to weber
1.Initial comprehensive
-total or complete assessment
-other members of the health team may
also participate (Hospital->physician,
pt, dietitian)
-collection of data
- Subjective- (client’s perception of his
condition) immersible
- Objective- (physical examination)
measurable
2. Ongoing or partial
- Occurs after comprehensive database
is established
- Mini-overview of body systems and
health patterns
- Functions as follow-up on the health
status
- Problems initially detected are
reassessed to determine changes
(deterioration/improvement)
- Brief assessment to detect new
problems
- Usually done by another nurse or
health professional
- Can be done in hospital, community,
or at home
- Frequency is determined by acuity of
client
Acute-fast Chronic-long-term
Focused or problem-oriented
-does not replace comprehensive
assessment
-done after database is established (Old
patient Old case, Old patient New case)’
- Thorough assessment of a particular
problem
- Does not cover areas not related to
the complaint
Emergency
- Very rapid assessment during life-
threatening situation (choking, cardiac
arrest, drowning)
- Immediate assessment to provide
prompt
- Major and only concern is determine
status of client’s life-sustaining
physical functions
Steps of the health assessment
The steps are
1. Collection of subjective data- What
happened to you?
2. Collection of Objective data- Data
that are seen by sense- BP is high
due to pain
3. Validation of data – check the data
4. Documentation of data
Client Preparation
- Review the clients medical record if
available
- Keep an open mind and avoid
premature judgments (dec. accuracy of
data collection)
- Use tome to educate self about
diagnosis and tests performed
- Self-awareness (reflect on own
feelings) regarding encounter with the
client
- Prepare all materials needed
- Review the client’s medical record
- Familiarize biographical data (age,
sex, religion, educational level, and
occupation)
- Provide background of chronic
diseases and clues how the present
illness impacts ADLs
- Awareness of past and current
health status guides interactions with
client
- Info can also be procured from
other members of health team, and
significant others
- Keep an open mind and avoid
premature judgment (decreases
accuracy of data)
- Do not assume a 30-year-old female
client, an RN, knows everything about
hospital routine and medical care
- Nor assume a 60-year-old male client
with MD needs client teaching
regarding diet.
- Do validate information and be
prepared to collect additional data
-Use time to educate self about
diagnosis and tests performed
-unfamiliar medical diagnosis
-special blood tests (abnormal results)
- Consult available resources
(laboratory manual, textbook, or
electronic reference)
- Self-awareness (reflect on own
feelings) regarding first encounter
with client
-Case: 22-year-old drug addiction, but
you do not drink, smoke, take illegal
drugs, or drink caffeine
- avoid biases, judgment, and
projecting those judgements (be
objective and open
- Other cases: STDs, amputation,
paralysis, HIV/AIDS, abortion, sexual
preferences, PWDs who are cognitively
challenged
Prepare all materials needed
- equipment (stethoscope,
thermometer, etc)
- interview tools/
Data collection-process of gathering
information about a client’s health
status
Database- all the information (pooled)
about the client
Collecting subjective data
- Sensation or symptoms (pain, hunger)
-things that are seen on the patient
that patient can only tell
-feelings
-perceptions
-desires
-beliefs and ideas
-values
-personal information elicited and
verified only by the client himself
Major areas:
Biographical information (Name, age,
religion, occupation, etc)
History of Present health concern
(physical symptoms related to each
body part)
Personal and Family Health history
Health and Lifestyle practice (risky,
nutrition, activity, relationships,
cultural beliefs, practices, family
structure and function, community
environment)
Collecting objective data
Objective
Directly observed by the examiner
- Physical characteristics (skin color,
posture)
- Body functions (hear rate, respiratory
rate)
 - Appearance (dress and hygiene) Examples I have a RR- 16
- Behavior (mood, affect) headache bpm or
-Measurements (BP, height, weight, cpm
temperature) It frightens BP
-Laboratory test results (complete me 180/100
blood count, x-ray findings) mmHg
- Obtained by general observation and I am not X-ray film
hungry reveals
PE techniques (inspect, auscultate,
fractured
palpate, percuss)
pelvis
- Taken from EMHR (another source),
through the entries of the other health
Validation of data
care professionals
- Can also from patient’s family
-Crucial part
members
-Occurs along with collection of data
-Ensures the assessment process is
FACTOR SUBJECTIVE OBJECTIVE not ended prematurely (all relevant
DESCRIPTIO Data elicited Data directly/
data is collected)
N and verified indirectly
by the client observed
through Do all data require validation
measurement
RESOURCES Client Observations -No, do validate instead:
and PE by the - Discrepancies-> gaps in the
nurse or other information
professionals - Subjective vs. Objective data (Happy
Client record Documentation vs. cancer)
of assessment - What client says at different times
made (History of childbirth
Other health Observations
professionals by client’s Methods of validation
Family of -Recheck own data (repeat assessment)
significant -Clarify data by asking additional
others
questions
- Verify data with another health
METHOD Client Observation and
professional
USED interview PE
- Go through the database established
SKILLS Interview and Inspection
NEEDED therapeutic - Consider areas you may overlooked”
communication
skills Sources of data
Caring ability Palpation - Primary -the client/patient
and empathy - unless too ill, young, or unable to
Listening skills Percussion communicate clearly
Ausculation - Emphasis on subjective data only he
can provide
-Secondary- all sources other than the Neautral No direction or
client pressure from
-Support system- (family, members, nurse
friends, caregivers) Leading Direct the client’s
-Client records- (medical, records lab answer
results, therapy records)
-Health care professionals Observation of method
-Literature- nursing and other -Gathering data using the use of sense
professional journals - Vision ( body size, skin color and
lessions
DATA COLLECTION METHODS - Smell (Body and breath odors
- Hearing (Lungs and heart sounds)
1. INTERVIEW - Touch (skin temperature and
2. OBSERVATION moisture)
3. PHYSICAL ASSESMENT
4. MEDICAL RECORDS REVIEW Physical Assessment Method
- Inspection -> careful and critical
Interview method observation
-Planned and purposeful conversation - Auscultation-> listening through a
Directive stethoscope
- highly structured and elicits - Palpation -> touching and feeling
specific information - Percussion -> touching and tapping –
- nurse establish purpose of and making sounds
controls interview (close-ended
questions Who invented the stethoscope?
Non-Directive
- client controls the purpose, subject Rene Laennec (1816)
matter and pace
- builds rapport (open-ended Organization of data
questions, empathy) - Use of written or computerized format
that organizes the assessment data
The interview questions systematically
Types Description Organized according to different models
Closed/Closed- Limits the -Nursing conceptual models (Gordon’s
ended response that can functional health pattern’s Orem’s self-
be given- care model, Roy’s adaptation model)
When,Where, -Wellness models
Who what -Non-nursing models (Body system
Do (Did,does) model, Maslow’s hierarchy of needs,
Is (was, are) developmental theories)
Sometimes
How What Models do we use?
Opend/Open Invites clients to -Maslow’s Hierarchy of needs
ended explore thougts
or feelings
(elaborate,clarify,
or illustrate)
 Patient Positioning for Physical
Assessment

Supine Position -

- Ask client to lie down with legs

Gordon’s 11 Functional Patterns together on examination table/bed
- A small pillow can be place under the
Gordon’s Typology head. Promotes comfort
Health Perception/Management - If client has trouble breathing, the
Nutrition/Metabolic head of the bed may be elevated
Elimination
Activity/Exercise -This position allows
Sleep-Rest - Allows abdominal muscles to relax
Cognitive/Perceptual - Provides easy access to peripheral
Self-Perception/Self Concept pules sites
Role/Relationship -Areas that can be assessed in this
Sexuality/Reproductive position
Coping/Stress-Tolerance - Head and neck
Value/Belief - Chest and lungs
- Breast and axillae
Documenting Data - Heart
- Record in a factual manner (do not - Abdomen
interpret) - All extremities
- Consider this nurse recording a
client’s breakfast Prone Position
-Coffee 240 ml, Juice 120 ml
-“appetite good (bad)
- Record subjective data in client’s word

- Client lies down on abdomen with

head to the side
- Used primarily to assess the Hip
Joint
- The back can also be assessed
-Position cannot be tolerated by
patients with problems in
- Cardiac System - Areas that can be assessed
- Respiratory System - Head and neck
- Chest and lungs
Sitting position - Breast and axillae
- Sit upright on side of examination - Heart
table - Abdomen
- Edge of chair or bed (Home/Office - All extremities
setting)
Sims Position
Allows evaluation of the areas
- Head and neck
- Chest and lungs
- Breast and axillae
- Heart
- Abdomen
- All extremities
- Permits full expansion of the lungs
(allows assessment of symmetry of
upper body parts)
- Alternate position- lie down with head
elevated

Dorsal Recumbent -Client lies on right or left side

-Lower arm – Behind
- Upper arm- Flexed at the shoulder
and elbow
- lower leg->slightly flexed at knew
- Upper leg ->flexed at sharper angle
and pulled forward
-Client may need assistance in this
position (elderly and with joint
problems
-Allow assessment of the
-Rectal areas
-Vaginal Are

-Lies down on examination table

-Knees bent
- Legs separated
- Leg Flat
-More comfortable for some patients
back or abdominal pain
-Do no assess
-Abdomen (muscle contraction)

Left Lateral According to Dillon
Areas assessed
- Chest best for cardiac auscultation
particularly of S3, S4 and some
murmurs
-Patients with respiratory problems
may have trouble assuming this
position
Knee-Chest
C
lient kneels on the examination table
-Weight of body supported by the chest
and knees
- A 90-degree angle must be formed
between body and hips
- Arms placed above the head which is
turned to one side
- Small pillow may be used
- Useful for examining rectum
- May be uncomfortable and
embarrassing- limit the time as much
as possible
- Some cannot tolerate the position
(elderly, cardiopulmonary problems)
Standing position
- Normal, comfortable, resting posture
- Allows assessment of
- Posture
- Balance
- Gait
Lithotomy
-Client leans on the back
- Hips at edge of the examination table
- Feet supported by stirrups
-May require assistance to get into
position
- An exposed position > embarrassment
Examination of
- Female genital
-May not be well tolerated by elderly
clients
-Keep the client well draped
-Preform the examination quickly as
possible
Standing Position
- Normal, comfortable, resting posture
- Allows assessment of
- Posture
- Balance
- Gait
-Mail
Lithotomy Position

- Lithotomy
- Hips at edge of the examination table
- Feet supported by stirrups
- Client leans on the back
- Hips at edge of the examination table
- Feet supported by stirrups
- May require assistance to get into this
position
- An exposed position embarrassment
- Examination of the
- Female Genitalia
- Reproductive Tracts
- Rectum
- May not be well tolerated by elderly
clients
- Keep the client well-draped
- Perform the examination as quickly
as possible
The Equipment used in Physical Otoscope
Assessment - for viewing the ear canal and the
tympanic membrane
Glove – for protection during any part
Ophthalmoscope
of the physical examination
- for viewing the red-orange reflex, and
- especially for examination of the retina
 Body fluids Cover card
 Open wounds - for testing of strabismus
 Excreta Rosenbaum pocket screener
 Contaminated items - for testing near vision
Stethoscope – for auscultation of the Tuning fork
body sounds (or lack of it) - for comparison of air and bone
Including: conduction
Tongue Depressor
 Korotkoff sounds (BP)
- for depressing the tongue, making it
 Bowel sounds
possible to view the mouth and throat
 Heartbeats (adults/Fetal)
- helps transilluminate the sinus
 Pulsations
Piece of small gauze
- for grasping the tongue in examining
Sphygmomanometer
the oral cavity
-For measuring blood pressure
Pillow
-Systolic
- for placing under the knees and head
-Diastolic
to promote relaxation of the abdominal
muscle
Thermometer
Vaginal Speculum
-For measuring body Temperature
- for inspection of the cervix through
through:
the vaginal canal
- Oral
Lubricant
- Axillary
- for reducing friction pressure, or pain
- Otic
during some examination (rectal, and
- Rectal
vaginal)
Cotton-tipped applicator
Magnifying
- for obtaining a sample of and
- for enlarging the visibility of lesions
scrapping endocervical and vaginal
tissue
Small Cup of water
Specimen Container
- For testing the shallow reflex during
- for collecting and maintaining
examination of the head and neck (or
integrity/sterility of specimens
thyroid gland)
Reflex
- for testing deep tendon reflex (and
Penlight
sensation)
- for testing pupillary constriction
(brain function)

Snellen Chart
- for measuring distance vision
Guidelines in performing the
physical assessment
Physical Assessment
- Systematic, comprehensive, and
continuous collection, validation and
communicate of client data using a
variety of methods
General Considerations
 Physical assessment is correlated
with the patient health history
o History of Present illness
o Past Medical History
o Family History
Examiner should follow a certain
sequence in doing physical assessment
Include only finding with medical
significance
-You should not include a small scar on
the foot in a case of cataract
 Finding should not only focus on
symptoms that are present but also
pertinent negative
o In a case of dengue fever,
having no abdominal
pain/tenderness or epistaxis
is significant
o In a case of stroke, having no
neurologic deficit is
significant as well
 Result should be objective, and have
no examiner variance
 Neurologic exam is always a part of
the physical exam
 When examining a patient of the
opposite sex, always have a
companion of the same sex as the
patient with you throughout the
assessment.
 Always maintain patient privacy
 Remember the patient has the right
to refuse to be examined, despite
being an essential part of the history
 Physical findings may changes from
time to time
 Begin at the patient right side, then
moving the opposite side of the
patient, or foot of the bed as needed.
(recommended)
 Advantages Right JVP more reliable
right)
Right kidney more palpable
Right before beginning the physical
assessment
Approach to patient during PA
 When possible, begin with patient at
sitting position
 Completely expose part to be
examined, but drape the rest of the
(maintains privacy)
 Conducts the examination from
head to toe (cephalocaudal)
 Conduct the examination from head
to toe (cechlocaudal)
 Compare findings on both sides
 Explain all procedures to avoid
alarming the patient, and this
encourages cooperation
 Make patient a comfortable as
possible
Preparing the client
Explanation
1. Introduce yourself
2. Tell the patient what you are
going to do and why
3. Tell the patient the
examination normally takes
some time
4. Explain what you are doing
every step of the way (as you
go along)
Consider the Age
 Neonate
 Infant
 Toffler
 School-age
 Adolescent
  Young adult o Get a report on when and
 Middle aged adult why health information is
 Older adult shared
Empty the Bladder (check for need to o Ask to be contracted
void) somewhere other than at
home
Determiner the status of the patient o Ask that information not be
shared
 Pregnant o File complaints
o Assess both woman and Self Reminders
fetus o Be responsible and accountable
o Include fundal Height and for your practice
fetal heart tone o Be a patient advovate
o Assess for normal changes o Respect patient rights
occurring in pregnancy o Assure confidentiality of
o Pay special attention to information/patient’s data
nutritional assessment
o Last trimester -> may
difficulty switching position
o Hormonal swings may
exaggerate patient response
 Disabled
o Identify the disability
o Focus on ability (functional,
mental capacity)
Preparing the equipment
o Clean
o In working order
o Readily accessible
Preparing the environment
o Make sure room is quit,
private, warm, and well-lit.
Consider positioning
Consider draping

Ethicio-Legal Consideration

Patients Right’s Include

o Asking to see and get a copy
of health records
o Having correction added to
health information
o Receive a notice informing
him how health information
is used or shared
Techniques for Physical Assessment
 Inspection
 Palpation
 Percussion
 Auscultation
Inspection – critical observation
*always first*
1. Take time to “observe” with eyes,
ears, nose (all senses)
2. Use good lighting
3. Look at color, shape, symmetry,
position
4. Observe for odors from skin, breath,
wound
5. Develop and use nursing instincts
6. Inspection is done alone and in
combination with other assessment
techniques
Inceptions
 Precedes the other techniques
(other can alter the appearance of
what is being inspected)
 Only a few body systems require use
of special equipment:
Eyes->Opthalmoscope
Ears->Otoscope
Guidelines for inspection
 Make sure room has a comfortable
temperature
 Extreme temperature can alter
normal behavior and appearance
of client’s skin
 Use good lighting (preferably
sunlight
- Fluorescent lights alter true color
of skin
- Abnormalities may be overlooked
with dim lighting
Tangential
- cast light across body
- highlight contours, elevations, and
depression (sharper)
Useful for:
- jugular venous pulse
- Thyroid gland
- Apical pulse (heart)
Perpendicular
- shadow are reduced and subtle
undulations across the surface are lost
- Diffused light
Guideline for inspection
- Look and observe before touching
- Touching or manipulation can alter
the appearance
- Completely expose body part to be
examined
- drape the areas the need to be
exposed
- Note important characteristics
- Color, patterns, size, location,
consistency, symmetry, movement,
behavior, odors, or sounds
- Compare appearance of symmetric
body parts (eyes, ears, arms, upper and
lower extremities)
- one side may be different from the
other.
Palpation
 Use parts of the hand to touch and
feel for particular characteristics
A. Texture (rough vs smooth)
B. Moisture (dry vs wet)
C. Mobility (fixed vs movable) Fine discriminations: pulses, texture,
D. Consistency (Soft vs hard vs size, consistency, shape, and crepitus
fluid-filled =FINGERPADS
E. Strength of pulse (weak vs Vibrations, Thrills, Fremitus = Ulnar or
strong) palmar surface
F. Shape (irregular vs. regular) Temperature = Dorsal surface
G. Tenderness (degree)
Which parts of the Hands to Use?
1. Finger pads – fine
discrimination (pulse, texture,
size, consistency, shape, Type of palpation
crepitus) - depends on the structure and
2. Ulnar and Palmar surfaces thickness of the overlying tissue
- vibrations/thrills/fremitus
3. Dorsal surface Types of Palpation
- temperature  Light Palpation
 Moderate Palpation
 Deep Palpation
 Bimanual Palpation

Light Palpation
 Place dominant hand slightly on
structure surface
 There is little to no depression (1cm)
 Feeling the surface through circular
motions
 Include assessing for pulse,
tenderness and skin texture, skin
temperature, and skin moisture
  On hand applies pressure while
Moderate Palpation other feels structure
 Use dominant hand to do circular  Not size, shape, consistency, ang
motions for easily palpable body mobility of the structure
organs and masses assessed
 Depression is between 1-2 cm  Used for
 Includes assessing for size, - Breast
consistency and mobility of - Uterus
structure - Spleen


Percussion
Deep Palpation  Involves tapping body parts to
 Place your dominant hand on skin produce sound waves
surface and your non-dominant Used for:
hand on top while applying pressure  Eliciting pain
 Depression between 2.5 – 5cms  Determining location, size, and
 Allows assessment if organs covered shape
by thick or large muscles  Determining density
  Determining abnormal masses
 Eliciting reflexes
 Involves tapping body parts to
produce soundwaves
Types of Percussion
1.Immediate or direct percussion
refers to tapping (percussion) done by
striking the fingers on the surface of the
chest or abdomen. (pads 2, 3, 4 or
using middle finger)
2.Indirect, mediate, or finger
percussion is striking a finger of one
hand on a finger of the
Bimanual Palpation
other hand as it is placed over an organ
 Uses both hands on one side of
each side of the body part being
palpated
  Uses flexor surface of one finer
and struck by fingers of the
other hand
 Most commonly used method of
percussion
 Sound Produced varies according
to the density of underlying
structure
 Tones classified (origin, quality,
intensity, and pitch)
3. Blunt Percussion
 Detects tenderness over organs
(deep)
 Place one hand flat on body
surface, and used your fist of
other hand to strike the back of
the flat hand
 Using a Stethoscope
Auscultation
 Requires use of a
stethoscope to listen for
sounds
 Sounds classified (intensity,
pitch, duration, and quality)
Guidelines for Auscultation
 Eliminate distracting or
competing noises from the
environment (quiet room)
 Expose the body part to be
auscultated
- drape body parts that need to
be exposed
Guidelines for Auscultation
A. Diaphragm – high-pitched
sounds (heartbeats, breath, and
bowel sounds)
B. Bell – low-pitched sounds
(abnormal heartbeats, and
bruits)
  Requires use of stethoscope to
listen for sounds
 Sounds classified (intensity,
pitch, duration, and quality)
pressure will cause the bell to
work like a diaphragm
 Avoid listening through clothing,
which may obscure or alter
sounds

How to use a stethoscope (weber)

1. Place earpiece into outer ear
canal. Fit snugly but comfortably
(effective transmission)
- rubber/ Plastic tubing should
not be more than 12 inches (to
prevent diminishing of sound
2. Use diaphragm to detect high-
pitched sounds
- Diaphragm should be 1.5
inches wide (adults) and smaller
for children
3. Use bell for low-pitched sounds
-Bell should be 1 inch wide, held
lightly against body part being
auscultated

Stethoscope Do’s and Don’t’s

 Warm the diaphragm or bell of
the stethoscope before placing it
one the client skin
 Explain why you are listening for
and answer any question the
client has. This will help alleviate
anxiety
 Do not apply too much pressure
when using the bell – too much
Culture, Spirituality, and Family
- Are all systems
- Difficult to separate the three systems
-Constantly interact with each other
- Change based on their
Culture is Universal
 Cultures may vary between groups
 Humans cannot exist without it
Construct of cultural Competence

What is Culture Cultural Assessment

- From Latin, “competere” to strive
- Totality of transmitted behavioral
patterns, values, and all other products
of human work and thought
- Characteristic of a population that
guide their world view and decision-
making
- Frame of reference in interpreting and
understanding the world
- Value and norms
- All verbal and behavioral systems
that transmit meaning
Characteristics Of Culture
1. Learned
2. Shared
3. Associated with adaptation to
environment
4. Universal
 Systematic appraisal of individual
beliefs, values, and practices
Cultural Competence
 Complex integration of knowledge,
attitudes, and skills
 Enhances cross-cultural
communication
 Promotes meaningful interaction
with patients
 Enable on to provide culturally
appropriate, congruent, and relevant
health care

Culture is Learned
 Through life’s experiences and
contact with other cultural groups
 Transmitted from generation to
another
- How – Socialization Components
Culture is shared  Cultural awareness
 Norms for behavior, Values, and  Cultural skill
beliefs  Cultural knowledge
 Shared by a group to a great extent  Cultural encounters
 Cultural Desire
As the environment changes, groups
also change to improve its ability to
survive
 Hunter and gatherer phase
 Agricultural phase
 Industrial phase
 Information
Cultural Awareness
 Deliberate, cognitive process in
which the health care provider
becomes:
- Appreciative and sensitive to the
values, and beliefs, life ways, and
practices of a clients culture
Unconscious Incompetences
 Not aware that one lacks cultural
knowledge
 Not aware that cultural difference
exists
Conscious Incompetence
 Aware that one lacks knowledge
about another culture
 Aware that cultural difference exists
 Doesn’t know how to communicate
with a client from a different culture
 Consciously (actively) learning about
a clients culture
 Providing culturally relevant
interventions
 Aware of differences between
cultures
 Able to interact effectively (despite
this)
Unconscious Competence
 Able to automatically provide
culturally congruent care to client
from different cultures
 Experienced with a variety of
cultural groups
 Ability to collect relevant cultural
data regarding client’s health history
and presenting problem
 Accurately performing a physical
assessment
 Application of cultural knowledge
- Efficient in PA and collecting of
further information
Cultural Knowledge
 Process of seeking and obtaining
sound educational foundation
 Concerning the various world views
of different cultures
- Immersion Vs. Reading
Culture encounters
 Process that allows healthcare
provider to engage directly in cross-
cultural interactions
- Actual experiences – Knowledge
and awareness
Cultural Desire
Motivation
 To engage in intercultural
encounters
 To acquire cultural competence
Culture and Illness
 Biome

Cultural Skill