Huda Al-Owairdy

Clinical Pharmacy Dept.

Physical Assessment Skills

Learning Objectives

Name the four fundamental physical assessment techniques

Describe how to perform each of the techniques

Identify the components of Equipment used in physical examination

Describe how to assess each of the major organ systems.

Define common physical assessment terms

Interpret common physical assessment abbreviations.

Physical Assessment

Information obtained from the physical examination along with data obtained during a patient medication history interview and laboratory data are used to assess patient response to drug and nondrug therapy.

A physical examination

PE is an evaluation of the body and its functions using inspection, palpation, percussion, and auscultation.

All pharmacists need a basic understanding of physical assessment

skills.

WHY ?

understand the meaning of specific physical assessment findings documented by other health care professionals

Pharmacists in some clinical settings

(e.g., ambulatory care clinics)

routinely assess patient response to medication regimens themselves using a variety of physical assessment skills

grow as pharmacists assume more direct patient care responsibilities.

Physical Assessment Sequence

1Vital signs

2. Appearance and behavior

3. Skin

4. Head

5. Eyes

6. Ears

7. Nose

8. Mouth

9. Neck

10. Breasts

11. Chest and lungs

12. Heart

13. Abdomen

14. Extremities

15. Back and spine

16. Nervous system

17. Mental status

18. Genitalia and rectum

Review PA abbreviation table 4-1

HEENT : Head, eyes, ears, nose, and throat

WNL: Within normal limits

WDWN: Well-developed, well-nourished

VS : Vital signs

HR: Heart rate

Assessment Sequencing Head – to - Toe Assessment

• Most comprehensive• Used to obtain baseline information to identify changes

in patient status◦ organized - everything assessed from head progressing

down to toes- combines Body Systems Assessment

◦ one system at a time◦ Cardiac: heart sounds, pulses, capillary refill, B/P◦ Respiratory: breath sounds, rate and depth, skin color◦ organized per body systems i.e. lung assessment,

abdominal assess, cardiovascular, neuro system◦ best used for focused physical assessment

Performing Physical Exam(ROS and PE)

Review of Symptoms

▫ Observation and Interview

▫ Head to toe verbal review of all relevant symptoms

▫ Gather subjective information from patient

• Physical Exam

▫ Inspection, palpation, percussion, auscultation

▫ Physical assessment of all relevant body systems

▫ Gather objective information yourself

Assessment techniquesThe PA consists of detailed patient evaluation that consist of four fundamental techniques (IPPA).

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Assessment Techniques

Inspection - critical observation

Take time to “observe” with eyes, ears, nose

Use good lighting

Look at color, shape, symmetry, position

Odors from skin, breath, wound Inspection is done alone and in combination with other assessment techniques

Assessment Techniques

Palpation ◦Using hands to fell areas that cannot be seen◦ light and deep touch◦ Back of hand to assess skin temperature◦ Fingers to assess texture, moisture, areas of

tenderness◦ Assess size, shape, and consistency of lesions◦ Organ size and location◦ Rigidity or spasticity◦ Crepitation & Vibration◦ Position & Size◦ Presence of lumps or masses◦ Tenderness, or pain

Assessment Techniques

Percussion

Sounds produced by striking body surface

Produces different notes depending on underlying mass (dull, resonant, flat, tympani)

Used to determine size and shape of underlying structures by establishing their borders and indicates if tissue is air-filled, fluid-filled, or solid

Assessment techniques - Cont.Percussion

Direct – tapping the body directly with the distal end of a finger◦ sinus tenderness

Indirect- tapping a finger placed on the body, only the finger being struck touches the body◦ lung percussion

Blunt percussion-organ tenderness 19

Assessment Techniques

Auscultation listening to sounds produced by the body

Direct auscultation – sounds are audible without stethoscopeIndirect auscultation – uses stethoscope

Describe sound characteristics (frequency, pitch intensity, duration, quality)

Flat diaphragm picks up high-pitched respiratory sounds bestBell picks up low pitched sounds such as heart murmurs

Assessment techniques - Cont.Auscultation

Instrument: stethoscope (to skin)

Diaphragm –high pitched sounds

HeartLungsAbdomen

Bell – low pitched soundsBlood vessels

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Physical Assessment Equipment

Table 4-2.

Stethoscope

Sphygmomanometer

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