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Techniques of Physical Examination | Part One

Techniques of Physical Examination

Inspection: the act of visually evaluation the patient
Palpation: the process by which the examiner feels the texture, size, consistency and location
Percussion: gently striking or tapping a part of the body to evaluate the size, borders and consistency of internal organs – and to discover the presence of fluid in body cavities
Auscultation: listening for sounds within the body to evaluate the condition of the heart, lungs, pleura, intestines, or other organs, or to detect fetal heart sounds. Most commonly with a stethoscope

Vital Signs: typically pulse, respirations and blood pressure. Temperature also, but not in the field.

Vital signs:

  • Evaluate as a set. One will not provide info by itself
  • No one value is normal for everyone. Normal varies largely, also by age
  • Vital signs need continued monitoring, every 5-10 minutes, 15 for stable patients
  • Height and weight needed to calculate drug doses, estimate will do

Equipment:

  • Stethoscope
  • Blood pressure cuff
  • Fingerstick glucose meter
  • Cardiac monitor – ECGs and oscilloscope readings, recording devices, alarm to set to alert you to variations
  • Pulse oximeter – sends infrared beam of light through finger to figure O2 sats
  • Capnometer – measures end tidal CO2

Evaluation of Mental Status: one of the best indicators of a person’s condition, based on a combination of factors:

  • Appearance and behavior: Level of Consciousness (LOC) use AVPU
  • Terms used to describe LOC: Normal, Drowsy, Obtundation, Stupor, Coma Dress, grooming, personal hygiene: observe and record
  • Facial expression and affect: “affect” is outward manifestations of emotions. A “flat affect” means emotionally unresponsive
  • Posture and Motor Behavior: Purposeful or Non-purposeful
    • Decerebrate: arms extended internally rotated, feet extended forced plantar = serious nervous system pathology
    • Decorticate: Arms flexed at elbow/wrists, legs may be flexed = serious nervous system pathology
    • Opisthotonic: Acute arching of back, head bent on neck, heels bent back on legs severe muscle spasms seizure, tetanus
    • Rigidity, Tremor, Motor Tics
    • Ataxic: unable to coordinate movements
  • Speech and language: Quantity, Rate, Loudness, Fluency
    • Aphasia: brain injury makes patient unable to speak/speak clearly
    • Dysphonia: difficulty speaking, could be brain injury or laryngitis
    • Dysarthria: impaired speech due to tongue or other muscles, mental function normal
  • Mood: may be indication of underlying illness either physical or psychiatric
  • Orientation: Time, place, person, events A & O x3 = Alert and Oriented x3 (also known as CAOx4)

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