Assessment Techniques, General

Survey and Measurement

Assessment Techniques

Inspection
Palpation
Percussion
Auscultation
 Train Your Eyes

Finished files are the result of years of

scientific study combined with the
experience of years
 INSPECTION
• Always first and continual
• Take your time
• Evaluate symmetry
• Good lighting is essential
 PALPATION
• Fingertips
• Fingers and thumb
• Dorsal surface of hand
• Ulnar surface
 PERCUSSION
Direct and Indirect
• Tympany
• Hyperresonance
• Resonance
• Dullness
• Flatness
 Common Percussion Errors
• Failure to exert firm pressure
• Failure to separate hammer finger
• Snapping from elbow or shoulder
• Striking the finger pad
AUSCULTATION
• Master your
stethoscope
• Train your ear
 A Safe Environment

• Wash your hands before and after

physical contact with each patient
•

• After inadvertent contact with blood, body

fluids, secretions, and excretions
• After contact with any equipment
contaminated with body fluids
• After removing gloves
Assemble Your Equipment
• Sphygmomanometer
• Stethoscope
• Penlight
• Otoscope
• Ophthalmoscope
• Tongue depressor
• Pocket vision screener
• Reflex hammer
 Prevent the Spread of Infection

• Use Standard Precautions

•

• Maintain clean field

• Hand hygiene
• Use gloves, gown, mask, eye protection, or
face shield
• Respiratory hygiene
 Points to remember…..
• Organize exam so that person doesn’t
have to change positions often
• Step out while patient is undressing
• Wash hands before exam, after
physical contact with patient, and
after removing gloves
• Wear gloves when in contact with body
fluids (mouth, vagina, rectum, lesions)
 Consider Developmental Needs

• Infants, Children
•

• Work fast
• Examine eye, ears,
• throat last
• Pray for sleep
• Use parent
• Elderly
•

• Adjust position
• Slow pace
 General SurveyObjective Data

• Physical appearance • Body structure

•
•

• Age – Stature
• Sex – Nutrition
• Level of consciousness – Symmetry
• Skin color – Posture
• Facial features – Position
– Body build, contour
 General Survey

• Mobility • Behavior
• •

• Gait – Facial expression

• Range of motion – Mood and affect
– Speech
– Dress
– Personal hygiene
 Measurement

• Weight
•

• Balance scale
• Height
• BMI
• Waist circumference
 Vital Signs - Temperature
•
Routes
•

•
Oral
•
Rectal
•
Tympanic
•
Instruments
•

•
Electronic thermometer
•
Tympanic membrane
thermometer
•
Technique of measurement
 Vital Signs - Pulse
•
Technique of
measurement
•
Rate 50-95
•

•
Bradycardia
•
Tachycardia
•
Rhythm
•

•
Normal sinus rhythm
•
Force
•

•
Normal 2+
 Vital Signs - Respirations

• Technique of measurement
• Normal rate for adults 10-20
• Ratio of pulse rate to respiratory rate
should be approximately 4:1
 Vital Signs – Blood Pressure

• Average varies
120/80
• Systolic pressure
• Diastolic
pressure
• Pulse pressure
• Mean arterial
pressure
 Influences on Blood Pressure
• Age
• Race
• Weight
• Emotions
• Sex
• Diurnal rhythm
• Stress
 Optimal Conditions for BP
Measurement
•
Avoid smoking or drinking caffeinated beverages
30 minutes prior to measurement
•
Ensure that the room is quiet and comfortably
warm
•
Patient should be seated quietly in a chair with
feet on the floor for at least 5 minutes
•
Patient’s arm should be FREE of clothing
•
Palpate the brachial artery
•
Position the arm so that the brachial artery is at
heart level
•
Rest the arm on a table a little above the
patient’s waist, or support the patient’s arm with
your own at his mid-chest level
 Blood Pressure Measurement
• Sphygmomanometer
• Cuff width and size
• Technique of measurement in the arm
•

• Position of person
• Palpate brachial artery
• Proper inflation and
• deflation technique
• Korotkoff’s sounds
•

• I, systolic pressure
• IV, muffling of sounds
• V, diastolic pressure
 Normal and Abnormal Findings

• Normal (adults older than 18 years)

•

• Systolic: <120 mm Hg
• Diastolic: <80 mm Hg
• If blood pressure is elevated:
•

• Repeat blood pressure after 2 minutes and verify in

the contralateral arm
• Consider “White Coat Hypertension”
•

Occurs in 10%–20% of all patients

Try to relax the patient and retake BP later in
 Orthostatic Hypotension

• Measure blood pressure and heart rate

with the patient supine; wait 3 minutes,
then have the patient stand up; now
repeat the measurements
•

• Normal: systolic BP drops slightly or remains

unchanged; diastolic BP rises slightly
• Orthostasis: systolic BP drops >20 mm Hg or
diastolic BP drops >10 mm Hg
Sample ChartingGeneral Survey, VS,
and Measurements
C.S. is a 66yo WF, WDWN. Appears younger
than stated age. Alert, oriented X 3,
cooperative, NAD. 5’3”, 120#, T 98.6, P 72, R
14, BP 110/76

R.W. is a 30yo obese WM, appeared anxious

during exam. Alert, oriented to person only,
multiple physical deformities, poor eye
contact, acute distress. 5’5”, 200#, T 98.8, P
96, R 18, BP 168/108