Cognitive-perceptual pattern Show
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U.S. History1st EditionJohn Lund, Paul S. Vickery, P. Scott Corbett, Todd Pfannestiel, Volker Janssen 567 solutions ANS: Warm the hands first before touching the patient., Start with light palpation to detect surface characteristics., Use the fingertips to examine skin texture, swelling, pulsation, and presence of lumps., Identify any tender areas, and palpate them last. Always warm the hands before beginning palpation. Use intermittent pressure rather than one long continuous palpation; identify any tender areas, and palpate them last. Fingertips are used to examine skin texture, swelling, pulsation, and presence of lumps. Use the dorsa (backs) of the hands to assess skin temperature because the skin on the dorsa is thinner than on the palms. 1, 2, 3, 5 To get the best results from inspection, there should be adequate lighting for easy viewing. The nurse should use a penlight or lamp for inspecting body cavities. An indirect light source may not help in the visualization of inside of the body cavity. The nurse should inspect each area for size, shape, color, symmetry, position, and abnormality to detect any changes. Checking for side-to-side symmetry ensures that the inspected area has no deviation. The patient should not be completely exposed. Expose body parts only as needed to maintain privacy. Test-Taking Tip: Look for answers that focus on the patient or that are directed toward the patient's feelings. Another way to think of this tip is "How would you feel if you were the patient?" Then reexamine the answers. For this question, would you want to be exposed completely? No, so you've eliminated that choice. 1 The nurse inspects appearance and behavior first as part of the nursing assessment. As the patient enters the room, the nurse can observe the patient's appearance and behavior, noting any unusual choice of clothing or hygiene or any signs of confusion, anxiety, or unhappiness. Taking vital signs, observing body systems, and conducting a health history come after inspecting appearance and behavior. Test-Taking Tip: When responding to a question like this one, consider the variety of information you gather visually. Observation can give you clues about ambulation, gait and balance, as well as general appearance and behavior. You may be able to detect an odor, a change in the color of mucosa or conjunctiva, or a posture that indicates pain, even before you begin your examination. Inspection is the only technique that is used when assessing every body part and system. Palpation is the use of touch to assess texture, temperature, moisture, size, shape, location, position, vibration, crepitus, tenderness, pain, and edema. Percussion is used to illicit sound or determine tenderness. Auscultation is used to listen to sounds. Palpation, percussion and auscultation are not used to assess every body part or system. The knee-chest position is useful for examining the rectum. In this position, the client kneels on the examination table with the weight of the body supported by the chest and knees. In the prone position, the client lies down on the abdomen with the head to the side. The prone position is used primarily to assess the hip joint. In the supine position, the client lies down with the legs together on the examination table. This position allows the abdominal muscles to relax and provides easy access to peripheral pulse sites. Areas assessed with the client in this position may include the head, neck, chest, breasts, axillae, abdomen, heart, lungs, and all extremities. In the dorsal recumbent position, the client lies down on the examination table or bed with the knees bent, the legs separated, and the feet flat on the table or bed. Areas that may be assessed with the client in this position include the head, neck, chest, axillae, lungs, heart, extremities, breasts, and peripheral pulses. Palpation is the use of touch to assess texture, temperature, moisture, size, shape, location, position, vibration, crepitus, tenderness, pain, and edema. Inspection is used to conduct the general survey, observing for body positioning, appearance, and behavior. Percussion is used to illicit sound or determine tenderness. Auscultation is used to listen to sounds. Sets with similar termsWhich physical examination technique is the nurse performing when listening to heart sounds?Auscultation is listening to the sounds of the body during a physical examination. Auscultation is a method used to listen to the sounds of the body during a physical examination by using a stethoscope. A patient's lungs, heart, and intestines are the most common organs heard during auscultation.
Which physical assessment technique involves listening to the sounds of the body quizlet?Auscultation is a physical examination technique that involves listening to sounds the body makes.
When Auscultating heart sounds which technique should the nurse use?For best results, the nurse would use the diaphragm of the stethoscope and have the client sit up, lean forward, exhale, and hold his or her breath. The left lateral position may be used to hear an S3 or S4 heart sound or a murmur of mitral stenosis that was not detected in the supine position.
Which physical examination technique is the nurse performing when using the bell of the stethoscope to hear a patient's heart sounds?Auscultation
Auscultation involves listening for various lung, heart, and bowel sounds with a stethoscope.
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