gathering objective data
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Objective data refers to information gathered directly from observing and examining the patient, without relying on the patient's subjective report. It includes physical characteristics, body functions, appearance, behavior, and results of measurements and tests. Performing a thorough physical assessment requires inspection, palpation, percussion, and auscultation to evaluate the patient's physical status. Proper equipment and technique are needed to obtain accurate objective findings.
gathering objective data
- 1. COLLECTION OF OBJECTIVE DATA Maria Carmela L .Domocmat, RN, MSN
- 2. Objective data • Data directly observed by the examiner Maria Carmela L .Domocmat, RN, MSN
- 3. 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) Maria Carmela L .Domocmat, RN, MSN
- 4. 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 Maria Carmela L .Domocmat, RN, MSN
- 5. 3. Performance of the four assessment techniques: IPPA Maria Carmela L .Domocmat, RN, MSN
- 6. Equipments for Physical Assessment • Assessment document forms • Coin or key • Cotton ball • Cover card (for eye assessment) • Gloves • Goniometer • Gown for client • Lubricating jelly Maria Carmela L .Domocmat, RN, MSN
- 7. Equipments for Physical Assessment • Magnifying glass • Marking pencil • Mini-mental status Exam (MMSE) form • Newspaper print or rosenbaum pocket screener • Notepad and pencil • Ophthalmoscope • Otoscope Maria Carmela L .Domocmat, RN, MSN
- 8. Equipments for Physical 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 Maria Carmela L .Domocmat, RN, MSN
- 9. Equipments for Physical 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 Maria Carmela L .Domocmat, RN, MSN
- 10. Equipments for Physical Assessment • Tongue depressor • Tuning fork • Vaginal speculum • Watch with second hand Maria Carmela L .Domocmat, RN, MSN
- 11. Equipments Used Maria Carmela L .Domocmat, RN, MSN
- 12. Skinfold Caliper Goniometer Wood’s lamp Doppler Ultrasonic Transilluminator Stethoscope Maria Carmela L .Domocmat, RN, MSN
- 13. Ophthalmoscope Otoscope Maria Carmela L .Domocmat, RN, MSN
- 14. Snellen’s Chart Maria Carmela L .Domocmat, RN, MSN
- 15. Rosenbaum Chart Maria Carmela L .Domocmat, RN, MSN
- 16. Physical assessment forms Maria Carmela L .Domocmat, RN, MSN
- 17. FOUR ASSESSMENT TECHNIQUES: IPPA Maria Carmela L .Domocmat, RN, MSN
- 18. Inspection Maria Carmela L .Domocmat, RN, MSN
- 19. Maria Carmela L .Domocmat, RN, MSN
- 20. Inspection • Involves using the sense of vision, smell, and hearing to observe and detect any normal or abnormal findings. Maria Carmela L .Domocmat, RN, MSN
- 21. Maria Carmela L .Domocmat, RN, MSN
- 22. Inspection • Precedes the PPA because the latter techniques can potentially alter the appearance of what is being inspected Maria Carmela L .Domocmat, RN, MSN
- 23. • Note the following: – Color, patterns, symmetry, size, location, consistency, movement, behavior, odors, or sounds Maria Carmela L .Domocmat, RN, MSN
- 24. PALPATION Maria Carmela L .Domocmat, RN, MSN
- 25. 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 Maria Carmela L .Domocmat, RN, MSN
- 26. Palpation Maria Carmela L .Domocmat, RN, MSN
- 27. Parts of hands used – Fingerpads – fine discriminations, pulses, texture, size, consistency, shape, crepitus – ulnar/palmar surface – vibrations, thrills, fremitus – dorsal surface -temperature Maria Carmela L .Domocmat, RN, MSN
- 28. • 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. Maria Carmela L .Domocmat, RN, MSN
- 29. Type of palpation Maria Carmela L .Domocmat, RN, MSN
- 30. 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 Maria Carmela L .Domocmat, RN, MSN
- 31. Maria Carmela L .Domocmat, RN, MSN
- 32. Moderate palpation • Depress the skin surface 1 to 2 cm • size, consistency, mobility Maria Carmela L .Domocmat, RN, MSN
- 33. 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) Maria Carmela L .Domocmat, RN, MSN
- 34. • Feel very deep organs or structures that are covered with thick muscles Maria Carmela L .Domocmat, RN, MSN
- 35. 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 Maria Carmela L .Domocmat, RN, MSN
- 36. Maria Carmela L .Domocmat, RN, MSN
- 37. Maria Carmela L .Domocmat, RN, MSN
- 38. Percussion Maria Carmela L .Domocmat, RN, MSN
- 39. Percussion • Involves tapping the body parts to produce sound waves • The sound waves or vibrations enable the examiner to assess the underlying structures. Maria Carmela L .Domocmat, RN, MSN
- 40. Percussion • Uses: – Determining location, size, and shape – Determining density – Detecting abnormal masses – Eliciting pain – Eliciting reflexes Maria Carmela L .Domocmat, RN, MSN
- 41. Types of Percussion • Direct • Blunt • Indirect Maria Carmela L .Domocmat, RN, MSN
- 42. Percussion Maria Carmela L .Domocmat, RN, MSN
- 43. Percussion Sounds • Resonance • Hyperresonance • Dullness • Flatness • Tympany Maria Carmela L .Domocmat, RN, MSN
- 44. Percussion Sounds • Resonance: – heard over part air and part solid – normal lung – loud intensity, low pitch, long (length), hollow (quality) Maria Carmela L .Domocmat, RN, MSN
- 45. 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 Maria Carmela L .Domocmat, RN, MSN
- 46. • 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 Maria Carmela L .Domocmat, RN, MSN
- 47. AUSCULTATION Maria Carmela L .Domocmat, RN, MSN
- 48. 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 Maria Carmela L .Domocmat, RN, MSN
- 49. Auscultation • Classifications – Intensity: loud, soft – Pitch : high, low – Duration: length – Quality: musical, crackling, raspy Maria Carmela L .Domocmat, RN, MSN
- 50. Maria Carmela L .Domocmat, RN, MSN
- 51. 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 Maria Carmela L .Domocmat, RN, MSN
- 52. 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 Maria Carmela L .Domocmat, RN, MSN
- 53. Factors to consider • Eliminate any confusing artifacts Maria Carmela L .Domocmat, RN, MSN
- 54. 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 Maria Carmela L .Domocmat, RN, MSN
- 55. 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 Maria Carmela L .Domocmat, RN, MSN
- 56. 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? Maria Carmela L .Domocmat, RN, MSN
- 57. Let’s practice Maria Carmela L .Domocmat, RN, MSN