Temperature, skin texture, edema, anatomical landmarks, areas of tenderness, masses
Fingertips for swelling, pulsation and masses
dorsum of hand for temperature
Palomar of hand for locating general area of pulsation
Grasping with fingers and thumb for position, shape, consistency of mass
Tapping fingers on skin (short strokes)
For ovation, size, density
Direct percussion : with fingers on skin
Indirect percussion with 2 hands
Hearing to gather data
Direct auscultation : ear
Indirect auscultation : stethoscope
Diaphragm high pitched heart, lungs, abdomen
Bell low pitched heart murmurs, turbulent blood flow (bruits)
Alcohol, urine, fruity or acetone -> ketoacidosis (reduced alkalinity in blood accom. With diabetes) assess urine for ketones, diet: high-protein, high fat and low carbohydrate could cause build up of ketones
How treat infants
Patent can hold during examination
Otherwise on padded examination table (no fall)
How treat toddlers ?
Can be on parent's lap
Exam ear and mouth last
Let them make choices, show their skills, have parents help and watch interaction, praise toddler for abilities and coordination
How treat preschoolers ?
Demonstrate procedure if kid fearful on doll ...
Let child help with exam, can hold equipment, let them remember height and weight, praises, and reassurance "your lungs sound very healthy :-)
How treat school age children ?
Demonstrate equipment and communicate, opportunity to teach kid something new
How treat adolescents ?
Is self-conscious and introspective, may wish to be examined in privacy (offer choice),
Often worry if they are normal
Discuss normal physiological changes
Teach about diet, alcohol, a..a.screen for depression and suicide risk (third leading cause of death)
How to treat young and middle adults ?
Mostly able to cooperate, do not need a modified approach. Modification may be required if patient has chronic or acute illness or cannot understand or follow instructions
How treat older adults
Adjusting to changes in physical abilities and health
observe abilities, energy levels, provide rest
Be aware of stiff muscles, impaired vision and hearing, obtain feedback
SPICES sleep disorders, Problems with eating or feeding, incontinence, confusion, evidence of falls, skin breakdown