gathering objective data

COLLECTION OF OBJECTIVE
DATA

Maria Carmela L .Domocmat, RN, MSN

Objective data
• Data directly observed by the examiner


Objective data
• Data include:
– physical characteristics (skin color, posture)
– body functions (HR, RR)
– appearance (dress, hygiene)
– behavior (mood, affect)
– measurement
• (BP, Temp, Ht, Wt)
– results of laboratory testing
• (platelet count, CXR)

Requires basic knowledge in:
1. Types of and operation needed for the
particular examination
2. Preparation of the setting, oneself, and
the client for the PA
– Setting
– Self
– Client


3. Performance of the four assessment
techniques: IPPA


Equipments for Physical
Assessment
• Assessment document forms
• Coin or key
• Cotton ball
• Cover card (for eye assessment)
• Gloves
• Goniometer
• Gown for client
• Lubricating jelly

Assessment
• Magnifying glass
• Marking pencil
• Mini-mental status Exam (MMSE) form
• Newspaper print or rosenbaum pocket
screener
• Notepad and pencil
• Ophthalmoscope
• Otoscope

Assessment
• Paper clip
• Penlight
• Pillows (two small pillows)
• Platform scale with height attachment
• Reflex hammer
• Ruler with centimeter markings
• Skin-fold caliber
• Flexible tape measure

Assessment
• Small cup of water to drink
• Snellen chart
• Stethoscope with sphygmomanometer
• Substances for testing taste (e.g. salt,
calamansi or lemon, sugar)
• Substances for testing smell (e.g. soap,
coffee)
• Thermometer

Assessment
• Tongue depressor
• Tuning fork
• Vaginal speculum
• Watch with second hand


Equipments Used


Skinfold
Caliper

Goniometer
Wood’s lamp

Doppler Ultrasonic Transilluminator
Stethoscope


Ophthalmoscope
Otoscope

Snellen’s
Chart


Rosenbaum
Chart


Physical assessment forms


FOUR ASSESSMENT
TECHNIQUES: IPPA


Inspection


Inspection

• Involves using the sense of vision, smell,
and hearing to observe and detect any
normal or abnormal findings.


Inspection

• Precedes the PPA because the latter
techniques can potentially alter the
appearance of what is being inspected


• Note the following:
– Color, patterns, symmetry, size, location,
consistency, movement, behavior, odors, or
sounds


PALPATION


Palpation
• Involves using parts of the hand to touch
and feel for the following characteristics:
• Texture – rough or smooth
• Temperature – warm or cold
• Moisture – dry or wet
• Mobility –fixed, movable, still, vibrating
• Consistency – soft, hard, fluid-filled
• Size – small, medium, large
• Shape –well defined, irregular
• Degree of tenderness

Palpation


Parts of hands used
– Fingerpads – fine discriminations, pulses,
texture, size, consistency, shape, crepitus
– ulnar/palmar surface – vibrations, thrills,
fremitus
– dorsal surface -temperature


• Crepitus is a symptom characterized by a crackling or grating feeling
or sound under the skin, around the lungs or in the joints. In soft
tissues, crepitus is often due to gas, most often air, that has
abnormally penetrated and infiltrated an area (for example, in the
soft tissues beneath the skin).
• In a joint, crepitus can indicate cartilage wear in the joint space. The
term "crepitus" is derived from the Latin, meaning "a crackling sound
or rattle." Typically, crepitus is a grinding noise coupled with a
sensation in the affected joint. Crepitus can occur with or without
pain.


Type of palpation


Light palpation

• very little or no pressure
(less than 1 cm)
• feel the structure using a
circular motion
• use: feel pulses,
tenderness, surface skin
texture, temperature,
moisture

Moderate palpation
• Depress the skin surface 1 to 2 cm
• size, consistency, mobility


Deep palpation
• Place dominant hand on the skin surface
and nondominant hand on top of the
dominant hand to apply pressure (2.5-5
cm or 1 to 2 inches)


• Feel very deep
organs or structures
that are covered with
thick muscles


Bimanual palpation
• Use two hands, placing one on each side
of the body part (uterus, breasts, spleen)
being palpated
• One hand apply pressure, other hand feel
structure
• size, shape, consistency, mobility


Percussion


Percussion
• Involves tapping the body parts to produce
sound waves
• The sound waves or vibrations enable the
examiner to assess the underlying
structures.


Percussion
• Uses:
– Determining location, size, and shape
– Determining density
– Detecting abnormal masses
– Eliciting pain
– Eliciting reflexes


Types of Percussion
• Direct
• Blunt
• Indirect


Percussion Sounds
• Resonance
• Hyperresonance
• Dullness
• Flatness
• Tympany


Percussion Sounds
• Resonance:
– heard over part air and part solid
– normal lung
– loud intensity, low pitch, long (length), hollow
(quality)


Percussion
• Dullness: over more solid organs
(diaphragm, liver)
– Medium ,medium, moderate, thudlike

• Flatness : over very dense tissue (muscle,
bones, sternum, thigh)
– Soft, high, short, flat


• Tympany: heard over air
– Puffed out cheek, gastric bubble
– Loud, high, moderate, drumlike

• Hyper resonance: heard over mostly air
– Lung with emphysema
– Very loud, low, long, booming


AUSCULTATION


Auscultation
• Listening to sounds produced by the body
(heart, lungs, blood vessels, abdomen)
• Stethoscope: does not magnify sound but
does block out extraneous room sounds


Auscultation
• Classifications
– Intensity: loud, soft
– Pitch : high, low
– Duration: length
– Quality: musical,
crackling, raspy


Auscultation
• Diaphragm: high-pitched sound
– Normal heart sounds, breath sounds, bowel
sounds
– Hold the diaphragm firmly against the
person’s skin –
– firm enough to leave a
slight ring afterward


Auscultation
• Bell: low-pitched sounds
– abnormal heart sounds and bruit (abnormal
loud, blowing, or murmuring sounds)
– FHT
– Hold lightly against the person’s skin – just
enough that it forms a perfect seal; any harder
causes the skin to act as a diaphragm,
obliterating the low-pitched sounds


Factors to consider
• Eliminate any confusing artifacts


Eliminate any confusing artifacts
• Room must be quiet
• Keep examination room warm
• Clean the stethoscope endpiece with an
alcohol wipe. Then warm it by rubbing it in
your palm: this avoids the “chandelier
sign” elicited when placing a cold endpiece
on a warm chest


Eliminate any confusing artifacts
• Wet the hair before auscultating the hairy
chest: The friction on the endpiece from a
man’s hairy chest causes a crackling
sound that mimic an abnormal breath
sound called crackles.
• Never listen through a gown: reach under
a gown to listen, but take care that no
clothing rubs on the stethoscope


Factors to consider
• Eliminate any confusing artifacts
• Listen selectively: only one thing at a time.
• As you listen, ask yourself:
– What am I actually hearing?
– What should I be hearing at this spot?


Let’s practice


gathering objective data

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