1. inspection
2. palpation
3. percussion
4. auscultation

(IPPA)

• concentrated watching; close, careful scrutiny of the individual as a whole and then of each body system
• use each person as his/her own control by comparing the right and left sides of the body

• follows inspection → confirms points noted during inspection
• applying sense of touch to assess texture, temperature, moisture, organ location/size, swelling, vibration/pulsation, rigidity/spasticity, crepitation, presence of lumps/masses, presence of tenderness/pain

• texture
• temperature
• moisture
• organ location/size
• swelling, vibration/pulsation
• rigidity/spasticity
• crepitation
• presence of lumps/masses
• presence of tenderness/pain

• fingertips
• fingers and thumb
• dorsa of hands
• base of fingers/metacarpophalangeal joints/ulnar surface

• fine tactile discrimination
• texture, swelling, pulsation, presence of lumps

• requires the use of both hands to envelop or capture certain body parts/organs
• kidneys, uterus, adnexa

1. light palpation
2. deep palpation
3. bimanual palpation

• tapping the skin with short, sharp strokes to assess underlying structures
• strokes yield a palpable vibration and characteristic sound that depicts location, size, and density of underlying organ

• mapping location/size of organ
• signaling density of a structure
• detecting abnormal mass if fairly superficial
• eliciting pain if underlying structure is inflamed
• eliciting deep tendon reflex (reflex hammer)

1. direct
2. indirect

• aka immediate percussion
• striking hand directly contacts body wall
• produces a sound
• used in percussing infant's thorax or the adult's sinus areas

• aka mediate percussion
• used more often
• involves both hands
• striking hand contacts the stationary hand fixed on the person's skin
• yields a sound and a subtle vibration

1. hyperresonant
2. resonant
3. tympany
4. dull
5. flat

1. amplitude
2. pitch
3. quality
4. duration

• aka intensity
• how loud or soft a sound is
• ↑ force = ↑ sound = ↑ of this percussion note

• aka frequency
• # of vibrations/second
• ↑ speed of vibration = ↑ pitched tone

• aka timbre
• subjective difference due to a sound's distinctive overtones

• the length of time the note lingers
• structure with more air = longer duration

• used for high-pitched sounds
• breath, bowel, normal heart murmurs
• held FIRMLY to the the skin

• used for low pitched sounds
• extra heart sound and murmurs
• held LIGHTLY against the skin

• funnels light into the ear canal and onto the tympanic membrane 
• five specula

• illuminates the internal eye structures
• system of lenses and mirrors that enables you to look through the pupil at the fundus (background) of the eye 
• five different parts to the head

red-free filter

• hemorrhage = black 
• melanin deposits = gray

what part of the

ophthalmoscope head brings objects into focus?

part of the

ophthalmoscope head shows a number (diopter) that indicates the value of the lens in position

1. standard precautions
2. transmission-based precautions

• intended for use with all patients regardless of their risk or presumed infection status
• designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources
• apply to blood, all body fluids, secretions/excretions (except sweat), non-intact skin, and mucuous membranes

• blood
• all body fluids, secretions, and excretions (except sweat)
• non-intact skin
• mucuous membranes

• airborne
• droplet
• contact

• erikson stage: TRUST
• parent always present 
• 6 months = sit in parent's lap
• 9-12 months = parent MUST be in full view
• 1-2 hours after feeding
• leave diaper on boys
• lock eyes, smile, soft, crooning voice
• sequence: invasive steps last (eye, ear, throat, nose) and Moro/startle reflex at end of exam

• erikson stage: autonomy
• sitting up in parent's lap or lying knee-to-knee on examiner and parent
• 1-2 yrs = understand symbols (security object)
• 1-6 yrs = focus more on parent
• 2 years = don't like to take off clothes
• 1-2 yrs = like to say "no" → only offer limited options
• demonstrate and praise
• sequence: head, ear, nose, throat = last

• erikson stage: initiative
• 3 yrs = on parent's lap
• 4-5 yrs = exam table
• willing to undress and likes to help
• feedback and reassurance; compliment them
• seqence: thorax, abdomen, extremeties. and genitalia first → head, eyes, ears, nose, and throat last

• erikson stage: industry
• level of understanding ≠ match level of speech
• sit on exam table
• 5 yrs = sense of modesty
• sequence: head to toe

• erikson stage: identity
• sitting on exam table
• alone
• needs feedback that body is healthy and developing normally
• ripe for health teaching
• sequence: head to toe; genitalia last and very quickly

• erikson stage: life review
• sitting or supine
• adjust pace and rest periods; few position changes
• do not mistake diminished hearing and vision for confusion
• lose is inevitable
• sequence: head to toe

• gather a mini-data base first → examine the body areas appropriate to the problem
• return to finish complete assessment after the initial distress is resolved