IPPA is a physical examination of the body and its functioning with four key steps inspection, palpation, percussion and auscultation. A comprehensive physical examination provides an opportunity for the healthcare professional to obtain baseline information about the patient for future use, and to establish the relationship before problem happens. It provides an opportunity to answer questions and teach good health practices (Proctor & Rickards, 2020). Detecting a problem in early stages can have good long-term results. It is done systematically or head to toe or cephalocaudal. However, the exact procedure will vary according to the needs of the patient and the preference of the examiner.
Inspection – It is a visual examination. This examination must be systematic to assess color, body shape, wounds, facial expression, motor behaviors, and some are to be examined. Nurses must use their clinical eye to further assess using visualization or looking at the different part of their body.
Palpation – It is an examination using the sense of touch. The pads of the fingers are used because the concertation of nerves endings are highly sensitive to tactile discrimination. It is used as a part of physical examination in which an object is filled to determine its size, shape, firmness or location (Staines et al., 2019). Palpation is typically used for thoracic and abdominal examination but can also be used to diagnosed edema and to measure the pulse. It is used by veterinarians to check animals, for pregnancy, and by mid wives to determine the position of the fetus.
Percussion – The examiner places one hand on the patient and then tap a finger on that hand, with index finger of the other hand. It can determine the position, size, and consistent of an internal organ. It is done over the chest to determine the presence of normal air content in the lungs, and over the abdomen to evaluate air in the loops of the intestine (Reardon et al., 2017). Since hollow and solid areas generate vibration, the physician or the other examiner uses this technique. This technique to determine if various organ (Heart, Liver etc.) are in enlarged or not. Percussion is also used to diagnose fluid and abdominal and chest cavities and make one suspect the presence of pneumonia. Their two types of percussions; direct, which uses only one or two fingers, and indirect, which uses middle/flexor finger. There are four types of percussion sound, resonant, hyper resonant, stony dull or dull. A dull sound indicates the presence of solid mass under the surface. A more resonant sound indicates hollow, air containing structures.
Auscultation: Auscultation is a technical term for listening to the internal sound of the body, using ordinarily using a stethoscope; based on the Latin verb auscultare “To Listen”. Auscultation is a skill that required substantial clinical experience, a fine stethoscope and good listening skill. Nurse listens to the patient’s heartbeat, lungs and blood vessels of the neck and groin.
In the given case (Video), case of healthcare, where nurse is in conversation with the patient to find out his health problem. She observes her work process is,
1. Inspection: In the first step of health assessment RN checked blood pressure of the patient.
As the patient describes his heart rate was faster, felt giddy and palpitations were fast. So, she checked blood pressure only which was lower than the normal expected number of BP and it was a correct inspection.
2. Palpating: Neuro vascular observation was conducted by the Nurse for the next step.
3. Auscultation: Sound of breathing and heartbeat.
According to IPPA, in this case, only three components have been used inspection, palpating, and auscultation where “Percussion “is missing which could have been done to check the Internal Organs of the patient.
In Inspection, ECG, blood pressure, cap refill has been assessed where in Palpating; EDEMA, pulse, Neuro vascular observations and in Auscultation, sound of breath, sound of heartbeat, irregular sound beat were confirmed.
Vital signs observed; already addressed but ensure required depth and relate to pathos-physiology of patient with history and symptoms.
History of health: for historic condition it should have been dived deep to find out the reason of aortic valve replacement (Reardon et al., 2017). Cardiovascular assessment would have been done in more detail. Same signs are also seen in case of anxiety, thyroid etc. so to confirm the actual problem patient is facing. Pathophysiology has different kind of activity and exercise which is taken with patient to improve their condition so its important to know the kind of exercised and technique used for patient along with exact duration it was carried out. As deep analysis result to correct diagnosis of ailment of the patient and it has long term effect of right kind of treatment and recovery of patient which is ideally good for the practice of Medical profession.
Proctor, J., & Rickards, E. (2020). How to perform chest auscultation and interpret the findings. Nursing Times, 116(1), 23-26.
Staines, D., Sheridan, S., & Pickering, G. (2019). Respiratory assessment. In Fundamentals of paramedic practice: A systems approach (pp. 264-279). Wiley-Blackwell.
Reardon, M. J., Van Mieghem, N. M., Popma, J. J., Kleiman, N. S., Søndergaard, L., Mumtaz, M., ... & Chetcuti, S. (2017). Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. New England Journal of Medicine, 376(14), 1321-1331.
Hasanin, A. M., Mokhtar, A. M., Amin, S. M., & Sayed, A. A. (2017). Preprocedural ultrasound examination versus manual palpation for thoracic epidural catheter insertion. Saudi journal of anaesthesia, 11(1), 62.
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