Chapter 2. Patient Assessment Show A comprehensive head-to-toe assessment is done on patient admission, at the beginning of each shift, and when it is determined to be necessary by the patient’s hemodynamic status and the context. The head-to-toe assessment includes all the body systems, and the findings will inform the health care professional on the patient’s overall condition. Any unusual findings should be followed up with a focused assessment specific to the affected body system. A physical examination involves collecting objective data using the techniques of inspection, palpation, percussion, and auscultation as appropriate (Wilson & Giddens, 2013). Checklist 17 outlines the steps to take. Checklist 17: Head-to-Toe Assessment
Which techniques help correctly identify auscultation sounds?[Angling the stethoscope earpieces in the ear correctly can help identify sounds when auscultating, because it allows the nurse to hear sounds more accurately.] [Placing the stethoscope directly on the patient's skin ensures accurate auscultation findings.]
What should the examiner do during auscultation of breath sounds?The breath sounds should be assessed during both quiet and deep breathing. A full breath should be auscultated in each location. The examiner should listen for the pitch, intensity, duration, and distribution of breath sounds, as well as note any abnormal or adventitious sounds.
Which techniques are required to conduct accurate percussion?Which techniques are required to conduct accurate percussion? A downward strike is required to percuss correctly. Tapping sharply and rapidly is required to percuss correctly. The finger should be lifted quickly to prevent dampening the sound.
What intervention can we take to reduce extraneous noise when Auscultating lung sounds?Make sure you place the entire surface of the diaphragm firmly on the patient's skin. If the area is excessively hairy, you can improve diaphragm contact and reduce extraneous noise by applying water or water-soluble jelly to the skin before auscultating.
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