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Unit 7
Health Care Skills
Chapter 20
Physical Assessment
H&P
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Date
Demographic data
Source of referral
Chief complaint(s)
History of present illness
Past history
(continued)
H&P
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Current health status
Family history of illness
Psychosocial history
Review of all systems
Information called baseline
Variances from Normal
• Discriminate normal from abnormal
– Use observation skills
– Ask questions
– Note changes in condition
– Employ strong assessment skills
• Report variances to supervisor
General Survey
• Look at patient as whole
• Overall impression valuable
– Determines where to focus if time limited
• What to look for in general survey
Psychosocial Observations
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Part of general survey
Emotional status
Mental status
Appearance
Question
• True or False:
– A critical function of the health care worker is to
be able to discriminate between normal and
abnormal conditions and situations.
Answer
• True
• Critical function of health care worker:
– Discriminate between normal and abnormal
conditions and situations
Physical Assessment Skills
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Inspection
Auscultation
Palpation
Percussion
Assess Systems
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Musculoskeletal
Integumentary
Circulatory
Respiratory
Digestive
Urinary
(continued)
Assess Systems
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Eyes
Ears
Nervous
Endocrine
Female reproductive
Male reproductive
Question
• Which of the following is using the senses
of vision, hearing, and smell for observation
of patient condition?
A. Auscultation
B. Palpation
C. Inspection
Answer
• C. Inspection
• Inspection
– Using senses of vision, hearing, and smell for
observation of patient condition
• Auscultation
– Listening to sounds inside body with aid of
stethoscope
Answer
• C. Inspection
• Palpation
– Using hands and fingers on exterior of body to
detect evidence of abnormalities in various
internal body organs
Pain Evaluation
• Subjective information
• Use pain rating scale
– 0 to 10
• 0 = no pain
• 10 = worst pain imaginable
– Wong-Baker FACES Pain Rating Scale
– Oucher Scale
(continued)
Pain Scale Rating
Numeric Rating Scale for Pain
Mild
pain
0
No
Pain
1
2
Moderate
pain
3
4
5
6
Severe
pain
7
8
9
10
Most
severe
pain
imaginable
Pain Evaluation
• Compare levels before and after pain
medications
• Note nonverbal cues
Activities of Daily Living (ADL)
Evaluation
• Actions done on regular basis to meet
physical needs
• Inability to perform ADLs
– Assistance needed as long as unable to do so
Vital Signs (VS)
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Temperature
Pulse
Respiration
Blood pressure
Temperature
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Normal range essential to homeostasis
Afebrile and febrile
Intermittent fever
Continuous fever
Night sweats
Thermometer Routes
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Oral
Axillary
Rectal
Aural
Temporal artery
Question
• Which of the following would be an ADL
(activity of daily living)?
A. Doing laundry
B. Gardening
C. Playing piano
Answer
• A. Doing laundry
• Doing laundry is ADL
– Action done on regular basis to meet physical
needs
• Gardening and playing piano are not
actions required to meet physical needs
Pulse
• Pulse points
• Rate
• Rhythm
– Regular rhythm
– Irregular rhythm
• Regular irregular rhythm
• Irregular irregular rhythm
(continued)
Pulse
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Pulse volume
Radial pulse
Stethoscope
Apical pulse
Bradycardia
(continued)
Pulse
• Tachycardia
• Pulse rates vary with age
• Apical-radial pulse deficit
Respiration
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Process of moving air through lungs
Inhalation (inspiration)
Exhalation (expiration)
Eupnea
Tachypnea
Bradypnea
(continued)
Respiration
• Ensure patient is unaware of respirations
being counted
• Rate
• Rhythm
– Apnea
– Cheyne-Stokes
(continued)
Respiration
• Respiratory effort
• Respiratory rates vary with age
Question
• What is tachycardia?
A. Abnormally high heart rate
B. Abnormally high respiratory rate
C. Abnormally low heart rate
Answer
• A. Abnormally high heart rate
• Tachycardia
– Abnormally high heart rate
• Tachypnea
– Abnormally high respiratory rate
• Bradycardia
– Abnormally low heart rate
Blood Pressure (B/P)
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Systolic
Diastolic
Hypotension
Hypertension
Sphygmomanometer
(continued)
Blood Pressure (BP)
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White coat syndrome
Orthostatic (postural) hypotension
Blood pressure readings vary with age
When not to use arm to take blood
pressure
Question
• True or False:
– Orthostatic hypotension is a rapid rise in blood
pressure when the patient stands.
Answer
• False
• Orthostatic hypotension
– Blood pressure falls when patient stands
• Rather than rises
Height and Weight
• Height usually stable after adulthood
– Except with osteoporosis
• Many factors affect weight
(continued)
Height and Weight
• Types of scales:
– Standing balance
– Chair and wheelchair
– Mechanical lift
– Bed
• BMI