physical assessment- 2nd lecture

8/2/2019 Physical Assessment- 2nd Lecture

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Learningis aconstantprocess

Boredomisonehindrancetoachieve full

understanding andcomprehension.

One must remember that,Knowledgeitself isPOWER!
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http://abstract.desktopnexus.com/wallpaper/131153/


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Physical

Assessment
http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://www.animationfactory.com/en/search/close-up.html?&oid=4952777&s=1&sc=1&st=191&category_id=E1HE&spage=1&hoid=7cc1a6d227359c72d21b0c23313d716bhttp://abstract.desktopnexus.com/wallpaper/34288/


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What is PhysicalAssessment?
http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/


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is hands-on examination of the client
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What are the purposes

of Physical Health

Examination?
http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/


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to obtain baseline data about theclients functional abilities

to supplement, confirm, or refute dataobtained in the nursing health history

to obtain data that will help the nurse

establish nursing diagnoses and planthe clients care

to evaluate the physiologic outcomes

of health care and thus the progress ofa clients health problem

To screen the presence of cancer.
http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/


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Letsget

started
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16

Components of the physical healthexamination1. Verbal explanations

includes:

when the exam will take placewhere the exam will take placewhy the exam is necessarywho will conduct the exam

what will happen during the examthat privacy will be provided at all times during the examthat confidentiality about the exam and results will not bebreached
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17

2. Physical preparation

emptying the bowel and bladder

changing into a gowndraping to prevent unnecessary exposure,provide privacy, and to keep the client warmassuming a special position

dorsal recumbentthe client lies on the back with thelegs separated, knees bent, and solesof the feet flat on the bed

areas examined:

head and neck, anterior thorax andlungs, breasts, heart, extremities,

peripheral pulses
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18

Supine

the client lies flat on the back with thelegs together but extended and slightly

bent at the kneesareas examined:

head and neck, anterior thorax and

lungs, breasts, heart, abdomen,extremities, peripheral pulses
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19

Sitting

the client sits upright in a chair or on the sideof an examining table or bed or, if physically

unable to maintain an upright position, may besupine in bed with the head elevated

areas examined:

head and neck, posterior and anterior

thorax, lungs, breasts, heart, upperextremities, and to take vital signs
http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/


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20

Lithotomy

the client is in the dorsal

recumbent position with thebuttocks at the edge of theexamining table and the feet

supported in stirrupsareas examined:

rectum and female genitalia


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21

Genupectoral (knee-chest)

the client kneels, using theknees and chest to bear weightof the body

areas examined:rectum
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22

SimS

the client lies on either the right or left sidewith the lower arm behind the body, the upperarm bent at the shoulder and elbow, both kneesbent, and the uppermost leg more acutely bentthan the lowermost leg

areas examined:

rectum, vagina


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23

Prone

the client lies on the abdomen, fat on the bed,

with the head turned to the sideareas examined:

posterior thorax, hip joint movement


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24

Physical assessment
http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://www.animationfactory.com/en/search/close-up.html?&oid=4955826&s=1&sc=1&st=84&category_id=E1A&q=nurse&spage=1&hoid=c2a1d623f444f45a268faed9155c5978


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1. Prepare the patient

Physically

Provide privacy

Expose only the part to inspect. Cover body

parts. Provide clean gown.

Psychologically
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2. Prepare the equipments

Flatform scale with height attachment

Skinfold caliper
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Sphygmomanometer

stetoscope
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Thermometer

Flashlight/penlight
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Otoscope

opthalmoscope
http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://rds.yahoo.com/_ylt=A0S020p_JbdLD2AAa5KJzbkF;_ylu=X3oDMTBqaTFoaGxvBHBvcwMxNwRzZWMDc3IEdnRpZAM-/SIG=1girm3dle/EXP=1270380287/**http%3a/images.search.yahoo.com/images/view%3fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253Dopthalmoscope%2526ei%253Dutf-8%2526fr%253Dyfp-t-701%26w=500%26h=375%26imgurl=farm1.static.flickr.com%252F178%252F450629878_634a29c83a.jpg%26rurl=http%253A%252F%252Fwww.flickr.com%252Fphotos%252Fnadiaahmad2%252F450629878%252F%26size=178k%26name=Visitors%26p=opthalmoscope%26oid=a44610fcf0ec451a%26fr2=%26fusr=nadja0313%26no=17%26tt=215%26sigr=11j179dsm%26sigi=11ke7uf04%26sigb=12i8avo5ohttp://rds.yahoo.com/_ylt=A0S020p_JbdLD2AAbZKJzbkF;_ylu=X3oDMTBqYWdlNjBlBHBvcwMxOARzZWMDc3IEdnRpZAM-/SIG=1gp1noe6q/EXP=1270380287/**http%3a/images.search.yahoo.com/images/view%3fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253Dopthalmoscope%2526ei%253Dutf-8%2526fr%253Dyfp-t-701%26w=400%26h=400%26imgurl=www.spservices.co.uk%252Fimages%252Fde130_133.jpg%26rurl=http%253A%252F%252Fwww.spservices.co.uk%252Fproduct_info.php%253FcPath%253D28_276%2526products_id%253D3684%26size=55k%26name=de130%2b133%2bjpg%26p=opthalmoscope%26oid=d44bae777c7e3c26%26fr2=%26no=18%26tt=215%26sigr=12aiih97k%26sigi=119g6u0ke%26sigb=12i8avo5ohttp://rds.yahoo.com/_ylt=A0S020pUJbdLumUAv0yJzbkF;_ylu=X3oDMTBpZTByOGFiBHBvcwMyBHNlYwNzcgR2dGlkAw--/SIG=1f3mqga4l/EXP=1270380244/**http%3a/images.search.yahoo.com/images/view%3fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253Dotoscope%2526ei%253Dutf-8%2526fr%253Dyfp-t-701%26w=400%26h=320%26imgurl=z.about.com%252Fd%252Fp%252F440%252Fe%252Ff%252F8771.jpg%26rurl=http%253A%252F%252Fadam.about.com%252Freports%252F000078_5.htm%26size=13k%26name=8771%2bjpg%26p=otoscope%26oid=e24f3bf2ade47662%26fr2=%26no=2%26tt=7297%26sigr=11a1cdsed%26sigi=110nkvos9%26sigb=12dv49k6rhttp://rds.yahoo.com/_ylt=A0S020pUJbdLumUAvkyJzbkF;_ylu=X3oDMTBpdnJhMHUzBHBvcwMxBHNlYwNzcgR2dGlkAw--/SIG=1f5gtjge8/EXP=1270380244/**http%3a/images.search.yahoo.com/images/view%3fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253Dotoscope%2526ei%253Dutf-8%2526fr%253Dyfp-t-701%26w=350%26h=230%26imgurl=www.wcvh.com.au%252Fuploads%252Ffiles%252Fotoscope.jpg%26rurl=http%253A%252F%252Fwww.wcvh.com.au%252Fwcvh.php%253Fsec%253D38%26size=14k%26name=otoscope%2bjpg%26p=otoscope%26oid=c0a5a19b3d77a45c%26fr2=%26no=1%26tt=7297%26sigr=116k41e62%26sigi=11a76qa79%26sigb=12dv49k6r


30/57

Tuning fork

Nasal speculum
http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://rds.yahoo.com/_ylt=A0S020s6J7dL8xwA96uJzbkF;_ylu=X3oDMTBpY2Y5NXNiBHBvcwM2BHNlYwNzcgR2dGlkAw--/SIG=1g7g1mlg2/EXP=1270380730/**http%3a/images.search.yahoo.com/images/view%3fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253Dnasal%252Bspeculum%2526ei%253Dutf-8%26w=400%26h=400%26imgurl=www.museumboerhaave.nl%252FAAcollection%252FAAJPEGS%252FM18%252F1338.jpg%26rurl=http%253A%252F%252Fwww.museumboerhaave.nl%252FAAcollection%252Fenglish%252FM18V11.html%26size=36k%26name=1338%2bjpg%26p=nasal%2bspeculum%26oid=133a05fef7f4f4aa%26fr2=%26no=6%26tt=124%26sigr=11u61uvjc%26sigi=11ofenp6v%26sigb=126u8dofmhttp://rds.yahoo.com/_ylt=A0S020s6J7dL8xwA8quJzbkF;_ylu=X3oDMTBpdnJhMHUzBHBvcwMxBHNlYwNzcgR2dGlkAw--/SIG=1hcrtc2lb/EXP=1270380730/**http%3a/images.search.yahoo.com/images/view%3fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253Dnasal%252Bspeculum%2526ei%253Dutf-8%26w=320%26h=320%26imgurl=www.chmedical.co.kr%252Fimages%252Fgoods%252FProduct%252Fnasal%252520speculum.jpg%26rurl=http%253A%252F%252Fwww.chmedical.co.kr%252FMain%252FInstruments%252FInstrumentsSub.aspx%253Fidx%253D4%26size=31k%26name=nasal%2bspeculum%2bj...%26p=nasal%2bspeculum%26oid=26167710752fba98%26fr2=%26no=1%26tt=124%26sigr=125sa9cpv%26sigi=11tjoek1a%26sigb=126u8dofmhttp://rds.yahoo.com/_ylt=A0S020seJ7dLwCYANkiJzbkF;_ylu=X3oDMTBpdnJhMHUzBHBvcwMxBHNlYwNzcgR2dGlkAw--/SIG=1eqvlgsoa/EXP=1270380702/**http%3a/images.search.yahoo.com/images/view%3fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253Dtuning%252Bfork%2526ei%253Dutf-8%26w=590%26h=426%26imgurl=www.oasishouse1.com%252Fimages%252FreikiTuningFork.jpg%26rurl=http%253A%252F%252Fwww.oasishouse1.com%252Freiki.htm%26size=44k%26name=reikiTuningFork%2b...%26p=tuning%2bfork%26oid=ac63c81cc1259252%26fr2=%26no=1%26tt=17519%26sigr=114mgf6r8%26sigi=11esgcve8%26sigb=123sc9ib1http://rds.yahoo.com/_ylt=A0S020oYJbdLVGAAiGiJzbkF;_ylu=X3oDMTBpc2VvdmQ2BHBvcwM3BHNlYwNzcgR2dGlkAw--/SIG=1mj54hgen/EXP=1270380184/**http%3a/images.search.yahoo.com/images/view%3fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253Dwooden%252Btongue%252Bdeppressor%2526ei%253Dutf-8%2526fr%253Dyfp-t-701%26w=549%26h=470%26imgurl=image.ec21.com%252Fimage%252Foperson%252Foimg_GC02642583_CA02642677%252FWooden_Tongue_Depressor.jpg%26rurl=http%253A%252F%252Foperson.en.ec21.com%252Fproduct_detail.jsp%253Fgroup_id%253DGC02642583%2526product_id%253DCA02642677%2526product_nm%253DWooden_Tongue_Depressor%26size=45k%26name=Wooden%2bTongue%2bDe...%26p=wooden%2btongue%2bdeppressor%26oid=631b004e621d0684%26fr2=%26spell_query=wooden%2btongue%2bdepressor%26no=7%26tt=71%26sigr=13qnt01t5%26sigi=12jjefl47%26sigb=12t1vlblc


31/57

Tongue depressor

Pocket vision screener
http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://rds.yahoo.com/_ylt=A0S0205nJ7dL0g4AXgOJzbkF;_ylu=X3oDMTBpdnJhMHUzBHBvcwMxBHNlYwNzcgR2dGlkAw--/SIG=1ikc92ko6/EXP=1270380775/**http%3a/images.search.yahoo.com/images/view%3fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253Dpocket%252Bvision%252Bscreener%2526ei%253Dutf-8%26w=400%26h=659%26imgurl=www.medexsupply.com%252Fimages%252FGRF-1243-1.jpg%26rurl=http%253A%252F%252Fwww.medexsupply.com%252Fexam-room-equipment-eye-charts-test-cabinets-grafco-pocket-size-plastic-eye-chart-6-3-8-x-3-1-2--x_pid-3237.html%26size=130k%26name=GRF%2b1243%2b1%2bjpg%26p=pocket%2bvision%2bscreener%26oid=2bc21f2015de7268%26fr2=%26no=1%26tt=2%26sigr=14b43k2au%26sigi=1198vvicu%26sigb=12esg349shttp://rds.yahoo.com/_ylt=A0S0205nJ7dL0g4AXwOJzbkF;_ylu=X3oDMTBpZTByOGFiBHBvcwMyBHNlYwNzcgR2dGlkAw--/SIG=1j0t2hovp/EXP=1270380775/**http%3a/images.search.yahoo.com/images/view%3fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253Dpocket%252Bvision%252Bscreener%2526ei%253Dutf-8%26w=80%26h=69%26imgurl=www.schoolkidshealthcare.com%252Ftmp_image.php%253Fitem_id%253D1261%2526amp%253Bwidth%253D80%2526amp%253Bheight%253D80%26rurl=http%253A%252F%252Fwww.schoolkidshealthcare.com%252Fcategory%252FVision-Screeners-and-Slides.html%26size=3k%26name=tmp%2bimage%2bphp%2bit...%26p=pocket%2bvision%2bscreener%26oid=1ccb1187f3404af8%26fr2=%26no=2%26tt=2%26sigr=12d7s7at8%26sigi=12imip93o%26sigb=12esg349shttp://rds.yahoo.com/_ylt=A0S020oYJbdLVGAAiGiJzbkF;_ylu=X3oDMTBpc2VvdmQ2BHBvcwM3BHNlYwNzcgR2dGlkAw--/SIG=1mj54hgen/EXP=1270380184/**http%3a/images.search.yahoo.com/images/view%3fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253Dwooden%252Btongue%252Bdeppressor%2526ei%253Dutf-8%2526fr%253Dyfp-t-701%26w=549%26h=470%26imgurl=image.ec21.com%252Fimage%252Foperson%252Foimg_GC02642583_CA02642677%252FWooden_Tongue_Depressor.jpg%26rurl=http%253A%252F%252Foperson.en.ec21.com%252Fproduct_detail.jsp%253Fgroup_id%253DGC02642583%2526product_id%253DCA02642677%2526product_nm%253DWooden_Tongue_Depressor%26size=45k%26name=Wooden%2bTongue%2bDe...%26p=wooden%2btongue%2bdeppressor%26oid=631b004e621d0684%26fr2=%26spell_query=wooden%2btongue%2bdepressor%26no=7%26tt=71%26sigr=13qnt01t5%26sigi=12jjefl47%26sigb=12t1vlblc


32/57

Skin-marking pen

Tape measure
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33/57

Reflex hammer or percussion hammer

Cotton balls
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34/57

Clean gloves

Pulse oximeter (if necessary)
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Bivalve speculum ( for advance practice)
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3. Clean field.
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37

Assessment Sequencing

Head to - Toe Assessment

Body Systems Assessment
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38

Assessment techniques

Inspection

Palpation

Percussion

Auscultation


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39

Inspection

Close and careful visualization of the personas a whole and of each body system

Ensure good lighting

Perform at every encounter with your client
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Uses of Inspection

to determine the presence of normal and/orabnormal size, shape, color, symmetry, and/or

position of an area of the body need to take into consideration normal variations

as a result of developmental age

need to take into consideration normal variationsas a result of race

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Palpation

an assessment technique in which the examiner feels an

area of the body with the palmar surface of the pads of

the fingers and/or the dorsum of the hand

.
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Uses of Palpation:

to determine texture (e.g., hair)

to determine temperature (e.g., of a skin area)

to determine vibration (e.g., of a joint)

to determine the position, size, consistency, andmobility of organs or masses

to determine distention (e.g., the urinary bladder)

to determine the presence and rate of peripheralpulses

to determine tenderness or pain.

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Light palpation

Use this technique to feel for surfaceabnormalities.

Depress the skin to or 1.5 to 2 cm withyour finger pads, using the lightest touchpossible

Assess for texture, tenderness,temperature. Moisture, elasticity, pulsations,superficial organs, and masses
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Deep palpation

Use this technique to feel internal organsand masses for size, shape, tenderness,symmetry and mobility.

Depress the skin 1 to 2 inches (4 to 5 cm)with firm, deep pressure.

Use one hand on top of the other to exertfirmer pressure if needed.
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Characteristics of masses determined

by palpation:

shape (round, ovoid, tubular, irregular)

size (measured in centimeters)

consistency (firm, edematous, spongy, cytic)

surface (smooth, nodular, granular)

mobility (fixed or immobile, mobile)

tenderness (amount of tenderness to touch) pulsatile (pulsations can or cannot be felt in the

mass)

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Percussion an assessment technique in which

the examiner strikes an area of thebody with the fingers

Uses of percussion:

to determine the borders of anunderlying structure of the body byestablishing the difference betweentissue that is fluid-filled, air-filled, orsolid

to determine the absence orpresence of normal and/oradventitious sounds elicited whilepercussing over an area of thebody

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Types of Percussion :

direct percussion the examiner strikes an area of the body to be percussed

directly with the pads of two, three, or four fingers or withthe pad of the middle finger

indirect percussion first, the examiner places the middle finger of the

nondominant hand, referred to as the pleximeter, firmly onthe clients skin over the area of the body to be percussed.

second, the examiner strikes the distal interphalangeal jointof the pleximeter with the tip of the flexed middle finger ofthe dominant hand, referred to as the plexor

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Indirect percussion

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Direct Percussion

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Sounds elicited by Percussion :
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Sounds elicited by Percussion :

flatness

a soft, high-pitched, "dead stop of sound, absolutedullness" sound of short duration

where found:typically over muscle, bone

dullness

a medium, medium-pitched, "thudlike" sound ofmoderate duration

where found:typically over the liver, heart

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resonance

a loud, low-pitched, "hollow" sound of longduration

where found:typically over the lung

hyperresonance a very loud, very low-pitched, "booming" sound of

very long duration

where found :typically over the emphysematous lung

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tympany

a loud, high-pitched, "musical" sound of

moderate duration where found :

typically over the stomach filled with

gas.

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Auscultation

an assessment technique inwhich an examiner listens tosounds produced from within

an area of the body

Instrument: stethoscope (toskin)

Diaphragmhigh pitched sounds

Heart

Lungs

Abdomen

Bell low pitched sounds

Blood vessels
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Uses of auscultation

to determine the absence orpresence of normal and/or

adventitious sounds produced fromwithin an area of the body

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Types of Auscultation :

direct auscultation

the examiner listensto sounds producedwithin the body byuse of the unaided

ear.

indirect auscultation

the examiner listens tosounds produced fromwithin the body by useof a stetoscope.

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thanks for listening
http://abstract.desktopnexus.com/wallpaper/34288/http://abstract.desktopnexus.com/wallpaper/34288/http://www.animationfactory.com/en/search/close-up.html?&oid=5301113&s=1&sc=1&st=4452&category_id=E1H&spage=1&hoid=365b704e98fcd93b7fa72bd857c1d9b6http://www.animationfactory.com/en/search/close-up.html?&oid=5301113&s=1&sc=1&st=4452&category_id=E1H&spage=1&hoid=365b704e98fcd93b7fa72bd857c1d9b6

physical assessment- 2nd lecture

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