Physical Assessment Techniques (Skill) In Pharmaceutical Care (PC)

Physical assessment in pharmaceutical care (PC) is defined as the systemic acquisition of physical data and symptomatology of patients for the purpose of initial evaluation and care recommendation in process case management, medical referral or outcome assessment. The information can be collected through patient record review or by performing physical assessment.

Physical assessment techniques

Physical assessment makes use of four techniques or skills. They are inspection, palpation, percussion, and auscultation done in this order unless you're performing an abdominal assessment. Palpation and percussion can alter bowel sounds, so you'd inspect, auscultate, percuss, then palpate an abdomen. It is not always necessary to carry out each of these activities every time. Each skill requires practice to master, some more than others.

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Physical assessment is part of objective data. Objective data are observable and measurable data (“signs”) obtained through observation, physical examination, and laboratory and diagnostic testing. The choice of objective procedure is determined partly by results of subjective interview. Good subjective data gives clearer diagnosis and leads the path for pharmaceutical care. Subjective data is information from the client's point of view (“symptoms”), including feelings, perceptions, and concerns obtained through interviews. A good subjective interview will streamline diagnosis and reduce the need for extensive physical and laboratory examination. The hallmark of an effective patient subjective interview is effective and good communication. Knowing what to ask and how to ask it is crucial.

Definitions of Basic Physical Assessment Skills

Inspection

The observation of physical signs displayed by the patient, depends to a large extent upon the knowledge of the examiner. Inspect each body system using vision, smell, and hearing to assess normal conditions and deviations. Assess for color, size, location, movement, texture, symmetry, odors, and sounds as you assess each body system. Example is skin rash, itchy skin, dry scalp, etc

Palpation

Various ways of perceiving by the sense of touch using varying degrees of pressure. Since your hand is the tool here, keep fingernails short and hands dry. Wear gloves when palpating mucous membranes or areas where you may encounter body fluid. Palpate tender areas last. Examples are bradycardia, hypotension, etc.

Types Of Palpation

1. Light palpation: assess surface abnormalities like for texture, tenderness, temperature, moisture, elasticity, pulsations, and masses. Use minimal pressure to depress the area with a finger pad not more than 2cm or above 1cm.

2. Deep Palpation: for assessing internal organs for size, shape, tenderness, symmetry, and mobility. Require high pressure achieved by using one hand to press against the other onto the area between 4-5 cm deep.

Percussion

Procedure used to evaluate structures lying no deeper than 4-5 cm under the skin. Involves tapping your fingers or hands quickly and sharply against parts of the patient's body to help you locate organ borders, identify organ shape and position, and determine if an organ is solid or filled with fluid or gas. There are four types of percussion sounds: resonant, hyper-resonant, stony dull or dull. A dull sound indicates the presence of a solid mass under the surface. A more resonant sound indicates hollow, air-containing structures. Examples are chest, gastrointestinal system and lung sound.

Type Of Percussion

1. Direct Percussion: one or two fingers press against a location and the response of the patient expression or complaint is used for diagnosis. This method determines the tenderness of the body part.

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2. Indirect Percussion: in this method, sound is used for diagnosis.

Procedure

▪ Press the distal part of the middle finger of your nondominant hand firmly on the body part.

▪ Keep the rest of your hands off the body surface.

▪ Flex the wrist of your nondominant hand.

▪ Using the middle finger of your dominant hand, tap quickly and directly over the point where your other middle finger touches the patient's skin.

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▪ Listen to the sounds produced.

Auscultation

Process of listening to sounds originating within an organ or body cavity and is usually augmented by use of an acoustically well-built, personally fitted stethoscope. Example bradycardia, hypotension, etc.

How To Use Stethoscope

To be able to carry out auscultation, the environment should be quiet. Also, there should not be any barrier between the diaphragm or bell of the stethoscope and the skin. Lastly, you get better results when your eyes are closed.

Steps

1. Warm the stethoscope using hands

2. To determine high pitched sound, press the diaphragm hard enough to leave a ring mark on the skin after the process. The sound is known as the S1 and S2 heart sounds. To determine low pitch sound, invert the diaphragm and use the bell. Press the bell hard enough to leave a seal mark after the process. But not too hard to make the skin the diaphragm. This sound is called the S3 and S4 sound of heart. Determine the charactics of the sound.