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Inspection visual examination of body (movement, posture, including smell), stated age?, dress and personal hygiene, body and breath odors, assistive devices, behavior body structure upon inspection stature, posture, gait, coordination, symmetry between right and left sides Four skills/Techniques Inspection, palpation, percussion, auscultation palpation sensation of hands to feel texture, size, shape, consistency, location of certain parts, painful/tender areas; need to move into personal space; touch (gentle, warm hands, short nails); gloves worn: mucous membranes, body fluids; palmar surface of fingers/finger pads more sensitive than fingertips; ulnar surface vibration; dorsal surface temperature; palmar surfaces of fingers (light/deep -light before deep) percussion evaluate size, borders, consistency, tenderness, extent of fluid; direct striking finger/hand directly against body: sinuses, indirect: both hands required; methods vary by system being assessed; wrist action: rapid flexion, relaxed; forearm stationary Striking produces what vibration (sound waves) obese/muscular individuals: stronger percussion: dense tissue: quiet sounds five percussion tones tympany: loud, high pitched (abdomen); resonance: lung; hyperresonance hyperinflated lung; dullness: liver; flatness: bone, muscle auscultation listening for sounds:bell-low-pitched sounds; lightly against skin (vascular sounds, extra heart sounds); diaphragm: high-piched sounds; firmly against skin (breath/bowel sounds); sounds: intensity, pitch, duration, quality; selective listening stethoscope earpieces: (Hard and soft, fit snuglly, fill ear canal); binaurals: adjust angle, earpieces pointed toward nose; tubing: thick, firm rubber, no longer than 12-18 inches; if longer, sounds distorted; decorative fabric on tubing source of infection blood pressure sphygmomanometer aneroid (glass-enclosed gauge, not as reliable; mercury: upright manometer filled with mercury, most reliable (mercury hazard) NIBP electronic device on BP cuff; blood flow vibrations converted to electriacl impulses; BP/pulse/MAP: can't determine pulse quality If blood pressure cuff is too wide underestimate BP if bp cuff is too narrow overestimate BP fifth vital sign pulse oximetry (noninvasive) LED probe reflects off oxygenated/deoxygenated Hgb for estimation of oO2 percentage/pulse, highly accurate Snellen chart wall chart 20 feet from client measuring visual acuity and screening; top number is distance from chart; bottom number= distance with normal vision should be able to read line Doppler amplifies sounds too difficult to hear with acoustic stethoscope; ultrasonic waves (fetal heart tones, pulses); gel/transducer slid over skin until blood flow heard goniometer determine degree of flexion or extension of joint; 2-piece ruler, jointed with protractor type of measuring device; placed over joint-either flexion or extension and degree measured on protractor calipers for skinfold thickness measure thickness of subcu tissue to estimate amount of body fat; different models for different points on body; most frequent location: posterior aspect of triceps testing deep tendon reflex, you would use reflex hammer vaginal speculum spread walls of vagina canal to visualize vaginal tissue and cervix; three types ( graves: variety of sizes and blade lengths, pedersen's blades as long as Graves but narrower and flatter and helps visualization); pediatric (virginal) smaller in all dimesions; plastic or metal differ in ease and positioning principles of infection control standard precautions apply to all clients; assessment safe but still potential for infection transmission; (handwashing, PPE, protect client and healthcare worker, standard precautions, CDC guideline) intensity loudness of the sound, described as soft, medium or loud pitch frequency or number of sound waves generated per second. duration of sound vibrations short, medium, long, layers of soft tissue dampen the duration of sound from deep organs quality refers to the description of the sounds (hollow, dull, crackle) dorsal recumbent position used for abdominal assessment because it promotes relaxation of abdominal muscles lithotomy osition provides maximal exposure of genitalia and facilitates insertion of vaginal speculum sims flexion of hip and knee improves exposure of rectal area lateral recumben position aids in detecting murmurs (lying on left side with top leg bent over bottom leg) knee-chest position provides maximal exposure of rectal area diaphragm of stethoscope used to hear high-pitched sounds like breath sounds, bowel sounds, normal heart sounds bell of stethoscope used to hear soft, low-pitched sounds such as extra heart sounds or vascular sounds (bruit) fetoscope used to auscultate fetal heart NIBP monitor is an electronic device attached to a bp cuff and operates by sensing circulating blood flow vibraitons through a blood pressure cuff sensor and converting these vibrations into electric impulses, used when clients need bp taken repeatedly, notifies of abnormal results pulse oximetry to estimate the arterial oxygen saturation in the blood Jaeger and Rosenbaum charts used to evaluate near vision ophthalmoscope to inspect the internal structures of the eye otoscope to inspect the external auditory canal and tympanic membrane penlight to provide a focused light source to facilitate inspection, used for illuminiation of mouth, nose, highlight a lesion, or pupillary constriction nasal speculum to spread the opening ofthe nares so the internal surfaces of the nose may be inspected