Chapter 8 - Jarvis

Chapter 8 - Jarvis

1. Cultivating Your Senses

   • Physical Examination
     • During Physical examination your senses are used to gather data -Sight, Smell, Touch, Hearing
     • Inspection
       • Is concentrated watching
         • -It begins when you first meet the patient -It is done initially -use the left side of the patient to measure the right side of the patient (due to its symmetry) - need a good environment to conduct inspection : good lighting, good exposure and adequate use of designated equipment 
     • Palpitation
       • Palpation technique should be done: slow, systematic, calm and gentle
       • Follows Inspection & Applies Sense of Touch To Accesss Temperature, Texture, Moisture, Organ Location & Size
         • These following parts of the hands are best suited for assessing different factors (like vibration, temperature and swelling) -Fingertips -The Dorsa (back) of the hand and fingers  -  The base of the fingers 
     • Percussion
       • Percussion should occur 2 times to the applied area
       • Is tapping the patients skin with short sharp strokes to assess the underlying structures
         • The strokes yield a palpable vibration and a characteristic sound that yields the location, size, and density of the organ structure
         • Stationary Hand
           • -Hyperextend the middle finger and place on the box lifting the pinky finger -The palm should be lifted of the body of the patient
         • Striking Hand
           • - use the middle finger on the dominant hand and strike below the nail on the extended middle finger 
           • Production of Sound (Notes)
             • Percussion over a body structure causes vibrations and produces waves that are heard as notes 
             • Amplitude
               • a loud or soft sound
             • Pitch
               • the number of vibrations per second
             • Quality
               • A subjective difference caused by the distinctive overtones of a sound
             • Duration
               • the length of time the note lingers
       • 5 Characteristics of Percussion Notes
         • Resonant
         • Hyper-Resonant
         • Tympany
         • Dull
     • Ausculation
       • Is listening to the sounds produced by the body (heart, lungs, blood vessels & abdomen
         • Stethoscope - is needed for hearing body sounds that are soft and not audible to the ear
           • The stethoscope consist of the ear piece slopes with rubbing tubing and an end piece with a diaphragm and bell
           • The Diaphragm
             • The larger, flat end piece of the stethoscope used for hearing Higher frequency sounds (breath, bowel and normal heart sounds)
           • Bell
             • The bell end piece is a small and cup shaped and is used to hear low frequency sounds

2. Setting of the Physical Examination

   • The Examination Room: It Should be
     • Comfortable
     • Well Lit
     • Warm
     • Quiet
   • Lighting
     • With Natural Day Light
     • Tangential Lighting
       • Tangential Lighting is lighting that is directed at an angle 
   • The Examination Table
     • Should be positioned for access for both patient and examiner
     • Should be at a height which you can stand without stooping
   • Rolling-up Stool
     • Is used for sections of the examination that involve sitting
   • Bedside Stand or Table
     • Is needed to lay out all of your equipment

3. Equipment

   • Have Equipment ready prior to examination and organized
     • Otoscope (Ear)
       • Funnels light into the ear canal and onto the tympanic membrane
     • Ophthalmoscope (eye)
       • Illuminates the eternal eye structure where the funds is visible through the pupil

4. A Safer Environment

   • Wash your Hands
     • Before and After Physical patient encounter
       • you wash your hands to decrease the risk of microorganism transmission 
     • After removal of gloves, touching contaminated equipment and procedures with blood and urine
   • The Use of Alcohol Based hand rubs can be used in the place of hand washing

5. The Clinical Setting

   • The General Approach
     • Reduce The anxiety of the patient when having to examine a new patient
   • Hands On
     • Interaction with the patient : includes measurements, conversation (collecting medical history of the patient and collecting data)
       • Measurements of Height
       • Measurements of weight
       • Measurements of Blood pressure
       • Measurements of Temperature
       • Measurements of Pulse and Respirations