HA Lab Practical

Lab Practical
WIPES
W: Wash
I: ID and Introduce
P: Privacy
E: Explain
S: Safety

*Need to Wear Lab Coat*

Approach client from Right side Introduce yourself to client & tell them you will be doing a physical exam that is going to comprise of respiratory,
listening to their heart and also evaluating their pulses & abdomen

RESPIRATORY / THORAX AND LUNG ASSESSMENT (IPPA)

Have patient face you on edge of bed
Look to make sure there is no respiratory distress (use of accessory muscles, pursed lips)
Breathing nice and easy, no nasal flaring, lips nice and pink
Color, lesions, symmetry
Go around the bed:
I: POSTERIOR Chest Component (Explain to client that you are inspecting their back)
AP diameter; Look to make sure no problems breathing
Explain you will be placing hands on back & as you place them, tell them to tell you if they feel pain or not
P: Palpate for tenderness and sensation (10 points & laterally)
Tactile Fremitus (Tell client that every time you place hands on back they should say word 99)
Chest expansion (Tell client to take a deep breath)
P: Percuss (tone = resonance) (20 points)
Percussion (Tell client you will be tapping on their back to hear proper sounds that should be in lungs;
please breathe normally)
Diaphragmatic excursion (Tell them you will measure the extent of their diaphragm)
- Left side first
- (Tell client to exhale completely & hold it; begin at T7, percuss downward (resonance to dullness), mark level)
- (Tell client to inhale completely & hold it; begin at mark, percuss downward (resonance to dullness), mark level)
- Measure level (Normal: 3-5 cm; well-conditioned pts: 7 or 8 cm)
- Repeat on right side (higher on right b/c of liver)
A: Auscultate (vesicular sounds) (20 points) (Tell client you will be listening to their lungs & to take a nice deep breath in &
out every time stethoscope is placed on her back)
Ask client to lie down; go to their right side (move bed to 30 angle)
I: Inspect ANTERIOR Chest Component
AP diameter
Make sure there is no nasal flaring, or retractions
P: Palpate for tenderness and sensation (8 points & laterally)
*Avoid palpating breast tissue in females*
Tactile Fremitus (Tell client that every time you place hands on back they should say word 99)
Chest expansion (Tell client to take a deep breath ; place hands under breasts in females)
P: Percuss (tone = resonance) (10 points & Laterally)
Percussion (Tell client you will be tapping on their chest to hear proper sounds that should be in lungs; please breathe
normally)
*No diaphragmatic excursion anteriorly*
A: Auscultate (vesicular sounds) (20 points) (Tell client you will be listening to their lungs & to take a nice deep breath in and
out every time stethoscope is placed on her back)

CARDIAC ASSESSMENT

Tell client you will now assess their heart
(*JVD is optional* Ask client to turn head; point to Jugular)
A: Auscultate carotid arteries (auscultate first to make sure there is no bruits;
breathe normally)
P: Palpate carotid arteries (head is straight)
I: Inspect the anterior chest
P: Palpate the 5 points (Palpate intercostal spaces to locate each point)
Aortic, Pulmonic, Erbs point, Tricuspid, Mitral
All Patients Eat Timely Meals
A: Auscultate the 5 points
*First use DIAPHRAGM to auscultate all 5 areas; then repeat w/ BELL in all 5 areas*

PERIPHERAL PULSES
(Find pulses bilaterally)
Temporal
Carotid Arteries (palpate one at a time) (already palpated)
Apical (already palpated)
Brachial
Radial
Femoral (just point to where they are located)
Popliteal
Posterior tibial
Dorsalis pedis

ABDOMEN (IAPP)
I: Inspect
Look for any abnormalities

Umbilicus: color, location, contour

Skin color, striae, scars, lesions, no hernias, surgical incisions

Contour of abdomen, visible types of palpations

A: Auscultate for bowel sounds

Start in RLQ first (use zig zag pattern, at least 2 points in each quadrant; clockwise)

Move to the next quadrant once you start hearing bowel sounds
*Dont forget epigastric area*
Auscultate Aortic Artery (should hear) & Right/Left Renal Arteries (should not hear)
P: Percuss for tone

Start in the RLQ

(use zig zag pattern, at least 2 points in each quadrant; clockwise)

*Dont forget epigastric area*

Tympany = normal; hallow space filled with air

Dullness = suggests fluid or feces

Percuss for liver span

- Begin RLQ at the midclavicular line and percuss upward
- Note change from tympany to dullness, mark point (lower border of liver)
- Next percuss underneath breast & percuss downward
- Note change from resonance to dullness, mark point
- Measure(6cm-12cm is normal)

Dont worry about spleen

P: Palpate (Ask patient if theres any pain)

Lightly

Deep

Bimanual

Palpate liver (place one hand in the back of client and palpate bimanually; ask client to inhale then compress upward and inward)

Rebound tenderness test (RLQ) (test for rebound tenderness by palpating deeply into abdomen and releasing)

Referred rebound test (LLQ) (palpate deeply and quickly release pressure)

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