Main Body Show Percussion involves tapping the body to elicit sounds and determining whether the sounds are appropriate for a particular organ or area of the body. Try tapping different surfaces with your fingertips and compare the sounds: a firm hard surface like a wood desk or table, a thick textbook, a window, or even a drum. As you tap these surfaces, you can hear that each surface elicits a different sound based on the object’s consistency. This concept also applies to the body. Each body part that you percuss provides information about the consistency as well as the size and borders of the underlying structure. For example, the percussion sounds can tell you if the organ is:
Percussion can also help reveal the presence of masses, particularly if they are close to the surface of the body. There are three approaches to percussion, but the most widely used is indirect percussion, which is the application of a mediated force using parts of both of your hands. See Figure 1.8 demonstrating the technique of indirect percussion. Figure 1.8: Indirect percussion technique Indirect percussion is often used to assess the lungs and the abdomen (e.g., bowels, bladder, liver). The steps of this technique are as follows:
As a nurse, you need to become familiar with the expected percussion sounds so that you can identify what is normal and what is abnormal. See Figure 1.9 for the expected location of percussion sounds and Table 1.2 for an explanation of the types of percussion sounds heard including resonance, hyperresonance, tympany, dullness, and flatness. Figure 1.9: Expected location of percussion sounds Table 1.2: Percussion sounds
Another form of indirect percussion is used to assess the kidneys; this technique will be discussed in more detail when you learn about abdominal assessment. Direct percussion involves an unmediated approach with the use of only one of your hands; it is used to assess pain/tenderness associated with the sinuses or assessing the newborn/infant’s lungs. The steps of this technique involve flexing the index and pleximeter fingers of your dominant hand, and directly tapping the body’s surface with the tips of these fingers at a 90-degree angle. A third approach, tool-facilitated percussion, involves using an instrument to tap the body (e.g., a reflex hammer); this technique will be discussed in more detail when you learn about neurological assessment. You must keep your nails trimmed short to perform indirect and direct percussion so that you can perform the technique accurately and elicit a useful sound. It takes practice to perfect the technique. Keep in mind the phrase “don’t be a woodpecker” – when percussing, just use two taps on the pleximeter finger in each location, and focus on listening for sounds. With children, it is important to engage the client and incorporate play when appropriate. Percussion is one of the least used of all physical assessment techniques. It is a technique that is better confirmed using more accurate tests such as an X-ray. However, when such diagnostic tests are not readily available, such as in rural, remote or underdeveloped regions, percussion is an important non-invasive technique. Additionally, percussion is not effective when the client has a significant amount of adipose tissue or is very muscular, as these types of tissues modify the sounds you expect to hear. What is the correct order for an abdominal assessment?With abdominal assessment, you inspect first, then auscultate, percuss, and palpate. This order is different from the rest of the body systems, for which you inspect, then percuss, palpate, and auscultate.
What are the 4 parts in order for abdominal assessment?The abdominal examination consists of four basic components: inspection, palpation, percussion, and auscultation. It is important to begin with the general examination of the abdomen with the patient in a completely supine position.
When examining the abdomen which technique should be used first?In palpating the abdomen, one should first gently examine the abdominal wall with the fingertips. This will demonstrate the crunching feeling of crepitus of the abdominal wall, a sign of gas or fluid within the subcutaneous tissues.
What order should the techniques be performed what exception needs to be made for the abdominal assessment ?)?ANS: inspection. The skills requisite for the physical examination are inspection, palpation, percussion, and auscultation. The skills are performed one at a time and in this order (with the exception of the abdominal assessment, where auscultation takes place before palpation and percussion).
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