Assessment Techniques and Safety in the Clinical Setting

1. Palpation

1.1. Sense of Touch to assess the following:

1.2. Texture, temperature, moisture

1.3. Organ size and location

1.3.1. Lumps/masses

1.4. Swelling, vibrations/pulsation and crepitation(grating sound caused by bone and cartilage

1.5. Rigidity and spasticity

1.6. Pain and tenderness

2. Palpation: Different Parts of the Hand

2.1. Start with light palpation move to deep if needed

2.1.1. One hand or bi-manual

2.1.2. Depending on needed depth

2.2. Fingertips

2.2.1. Pulses, swelling, texture, lumps distinction

2.3. Thumb and Fingers

2.3.1. Position, shape, and consistency of organ/mass

2.4. Dorsa of hand

2.4.1. Temperature

2.5. Base of fingers, ulnar surface of hand

2.5.1. Vibrations

3. Percussion

3.1. Percussion technique

3.1.1. Stationary hand: Middle finger hyperextension

3.1.2. Striking hand: Striking finger

3.2. Percussion sounds

3.2.1. Normal: Resonant

3.2.1.1. Abnormal: Hyperresonant

3.2.1.1.1. Seen in emphysema

4. WARNING

4.1. Do not confuse auscultation with percussion

4.2. In percussion, we are assessing for percussion notes: resonant, hyperresonant, tympany, dull, flat(see chart for descriptions)

4.3. In auscultation we are assessing for heart and lung sounds

5. Inspection, Palpation, Percussion, Auscultation

6. Inspection

6.1. Always start here

6.2. Careful observation of each body system is always first

6.3. Starts from the very first time you meet

6.3.1. General survey

6.4. What we will need

6.4.1. Good light and exposure (but always ensure privacy).

6.4.2. Some equipment

6.4.2.1. Pen light, scopes, speculums etc may help enhance your view

7. Auscultation

7.1. Makes sounds easier to here

7.2. Must have proper fit and placement

7.3. Know the parts of the stethoscope and what they are for!

7.4. Diaphragm: High-pitch sounds

7.4.1. Lung, bowel, normal heart sounds (S1,S2)

7.5. Bell: Low pitch sounds

7.5.1. Vascular sounds and abnormal/extra heart sounds

7.6. Make sure to make environment warm

7.7. Warm stethoscope by rubbing in hands

7.8. Don’t list over very hairy areas

7.9. Never listen through a client’s gown or clothing

7.10. Avoid your own artifact

7.10.1. Never use thumb : has its own pulse!