Okay if you're a nurse and you've ever gone into a patient's room and you're like I have
no idea where to even start with what has just been presented to me, I want to share with you
we already have a framework and we're going to talk about it it's called: inspection,
palpation, percussion, and auscultation. We call it the IPPA method that guides
all of our assessments when we come into a patient's room and we don't know where to start
so we're going to take care of that for you in this video today.
Welcome back my name is Tammy and this is NurseMinder and on this channel we
do everything nursing so if you're new here consider subscribing below so that you get the
next video when it's released. Okay so generally we move into the IPPA after we've done our health
assessment. We've gathered information about why they're here, what their current issue is,
their past medical history, allergies, medications, family history; that kind of stuff,
that's already out of the way and now we're getting into IPPA. Sometimes though we go
right into our IPPA because you've walked into a situation; maybe you've got a patient on the floor
and you don't really know what's going on so we get a really brief summary and then we start
our whole process before we lift them up off of the floor right. So first before we get into the
lesson I just want to share with you if you are new here, help me reach my goal. I have a goal of
a hundred thousand subscribers in 2021 and if you have never subscribed before and you find value in
this, hit that subscribe button, hit the bell, and the like button. What the bell does is it
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before anybody else, front of the line access! :) Okay so it's no secret that I'm a nurse educator
but what's interesting to me is that when I ask students "tell me about your IPPA" I sometimes get
this deer in the headlights look and I'm like ... inspection, palpation, percussion, auscultation?
So I found it interesting that sometimes my students don't know and I think what happens is
they're so far removed from that theory because it's very at the very beginning of your physical
assessment training that they need a little reminder; although it's embedded in every single
assessment you do when you do: the respiratory system, the cardiovascular system, the GI system.
We test you on this forever, so we're gonna like give you some insider information today too. Okay
so let's talk about inspection first. Typically when students learn about inspection they feel
pretty awkward because they know they're going to be like staring at people and when it comes
to the respiratory assessment in particular they feel really awkward because they're staring at the
chest right. So inspection is where you're going to use your senses of your eyes so that you can
see what's going on; you do this now when you're out in public and you notice somebody
who looks well-dressed versus somebody who's disheveled, that's part of your inspection
processes. What is the general appearance overall and then we focus it on a system
that's when we get a little bit more detailed in what we're looking for. So let me just share
with you first of all you do not have to stare at your patients to do your inspection, it's
part of when you come in and you just have your general conversation with them and you're maybe
doing a pulse check and you're noticing these things around you and I will say that probably
unless your patient has something wrong you don't really have your attention drawn to the fact that
you're inspecting because there's nothing obvious outside of the norm; it's only when
you do your focused assessment that you really hone in on things such as symmetry or is the you
know the vertebral column straight or is there a little bit of a curve we wouldn't normally
pick that up when they're fully dressed but you would notice that on your focused assessment.
Now inspection is the place that we always start so let's talk about what that is. Now when it
comes to your inspection we're really looking to see do we have symmetry, what are the colors,
you know you expect your fingernails to be pink and not blue for example, what is the movement
do they have a shoulder hike or a limp those are kind of things you're doing just as a quick
observation, and don't rush through that, like if you need to see somebody in a different position
ask them to stand up move, walk away, walk towards; that's all part of us gathering
information to get a good idea of where they are. Now when it comes to palpation we're going
to involve our hands and we're going to start to touch to see if there's any changes in temperature
and moisture, maybe there's some swelling or there's masses or lumps that you can't
see on inspection, but that when you start to touch you start to recognize hey you've got
a little bit of a mass here is this normal? You want to find out if they've noticed it.
You can also identify if there's any crepitus so when you put your hand on their joints and you're
moving them around you might feel something that you can't hear and that will give you some inside
information about what's happening inside the joint. Now when it comes to palpation we have two
types we have light and deep; typically our light palpation is we're going to use your fingertips
the pads of your fingers here and that would be when you do like a pulse check and you're checking
to see how bounding that pulse is, that's a palpation. Another type is when you're just
kind of you know gently moving around the skin or you're checking for lymph nodes for example
we're going to use our finger pads and just gently rotate to see if we notice any swelling in those
key areas for our lymph nodes. Now we can also use the back of our palm here to do a temperature
check and you can put it on their forehead you can put it on their arm and just get a sense
with light palpation if they feel warm or cold. Now deep palpation requires that we're taking
our finger pads and we're pushing in deeper and sometimes we're actually putting one hand
underneath and another hand on top to really compress and feel what's going on in between.
Deep palpation for nurses is typically when we would be assessing the abdomen and we're going
to press a little deeper to see what's happening inside. All right so let me know below if ever in
your inspection or palpation you actually found something abnormal and what happened. I remember
there was a time we were doing a health fair and this fellow had this massive mole on the top of
his head and I remember saying to my teacher oh my god he's got a mole should I tell him?!?
Yes of course! But I didn't say anything until after he had left
and that was when I started to panic thinking oh I wonder if he knows and so I kind of ran after
him" sir, sir iI don't know if you're aware of this but you have a mole on the back of your head
and he kind of chuckled, he goes yes it's been there for a long time so ... but I felt like I had
missed an opportunity to practice to my full scope and provide him with information
because when I saw it it was massive. I had never seen something like that before.
Let me know in the comments below if you have found something that has changed the course of a
patient's pathway as a result of your inspection or palpation. Now let's move on to the next two
percussion and auscultation. Now when it comes to percussion this is where we're going to actually
do some tapping and we're going to gentle tapping to see what elicit, to see what sound is elicited
righ. So we can use this to help locate organs and their size of them, it can help us identify
the density, so is there air in there, is there fluid in there, is it a solid mass. Now when it
comes to doing your percussion we're going to fan out our hand, does it matter which one you use as
the base and which one you use as the tap, you'll fan it out and we're going to use the middle
finger and we'll put the base on the place you're going to percuss, and so if you're going to do,
and I encourage you to do this at home - percuss your rib and then the space in between and then
the rib and the space in between and notice the differences in tone on your rib because
it's a firm structure it will be a dull thud. Now the key thing is when you're percussing is
you want to just strike twice and come up. Okay. You don't want to actually hold your hand there,
so if I were to do it here, I would strike twice and my hand is lifted because if you
if you keep your hand there it will dull the sound. So you don't want to ever leave it on there
you want to take it off okay. All right, and the fourth one is auscultation. So what we're going
to be doing with auscultation is listening and you're going to need a good stethoscope and the
systems that we're most likely to auscultate are the cardiovascular, the respiratory, and the GI
system. You want to eliminate any extra noises that might actually impact, so if you've got
someone who has a hairy chest and you put this on their chest and you're listening you might find
that you're getting some fine crackles as a result of the hair movement. Another one that you can
have is movement from touching on the outside here of the stethoscope head and so I tend to just put
my two fingers here when I plant it and then that way as it's planted on there I have a bit of a,
you don't want to go too hard because too hard can make some noise too, but you'll
find a nice light touch where you can support it without having to hear your fingers rubbing
and you'll know, like if you put your stethoscope in your ears and you put this down and you just
start just play around and you'll see what sounds you're going to make and then you can reduce them,
so maybe you're going to use two fingers or maybe use the two fingers like just a fingertip sorry
or you can use two fingers maybe even get the cord out of your way.
Lungs sound great! Now of course if you're listening through clothes that can also cause
some movement and some issues with getting a clear crisp sound of what's really happening.
Every assessment you're going to do is going to follow this order except for one
and that's the abdomen. With the abdomen we're going to go inspect first,
always that never changes, then we're going to listen and the reason we listen to the abdomen
before we palpate and because is because as we palpate we might create some sounds in there so
we're gonna listen first to see what's going on and then we'll come back and palpate and percuss.
Now you will find some system assessments you don't need to use all four. So for example if I
came in with a hand injury we can inspect it, look for um symmetry, deformities, swelling,
color and changes, if there's any redness. We can then palpate it and see if all of our joints feel
okay we're going to be fixing or i'm working with all of those. Percussion not likely to
happen in the hand and we're not going to listen to the hand but what would we do if it was say
a respiratory system? All right so I'm going to show you the best I can with the limitations of
being an office of one we're going to look at the respiratory system. Why would I pick
that one? Because it's the most common I think so iIm going to show you how to do your inspection,
palpation, percussion, and auscultation in that order with the respiratory assessment.
Let's give it a try shall we, and I hope you have something more beneficial to practice on at home
than yourself but I tell you what, if you are the only thing you have to practice,
do it because I will share with you when it comes to implementing it, in terms of your testing your
CIAs if that's what you call them - your clinical integration assessments - or in real life,
if you don't practice, if you've never done it, it will feel like you're a fish out of water, so
if you are the only thing you have I'll demonstrate how you can do that on yourself,
and if otherwise maybe you've got like a stuffed animal or somebody else who's willing to be a
patient for you - my husband never was - then you can practice on them. So let's get into the demo.
Okay so with your patient either sitting or standing let's just go through the respiratory
system as an example. So I'm going to turn to the side here and part of your inspection is
just to notice my effort of breathing so is my breathing relaxed, of course I need to,
I need to shut up for that. All right so first inspection: we're going to notice any skin color
changes - are they pale in pink or blue and we want them to be pink, you may need to ask
them to remove a layer of clothing so that you can fully inspect their breathing effort. So
on their inhalation exhalation is there equal rise and fall? Do they have any
shoulder hiking or nasal flaring? and do they look like they're at rest with their breathing?
Moving into palpation you're going to start at the top of the chest on the anterior or posterior,
you will do both, and then just palpate down to the lower level of the ribs where the lungs end
looking for any masses, lesions any lumps or bumps that maybe they're just not aware of.
Now of course it's ideal if your patient is able to remove their top and you can fully
inspect with the top up you can then do the chest expansion assessment where you put your hands at
about the T9 T10 and then you have them take a deep breath in and exhale so you can assess
for symmetrical rise and fall. Next it's time to move into percussion. So let's just listen here
Notice the quick two strikes and then how the striking finger lifts up
When moving on to auscultation you'll want to make sure you're listening for a full
inhalation exhalation before you're moving on to the other side and always listening right
to left as you go down. If you have troubles hearing it's advisable to ask the patient to
inhale through the mouth so really really deep breath and then exhale.
Awesome. So let me know in the comments below has any part of your assessment inspection, palpation,
percussion, or auscultation led to new information about a patient and changed their care plan? I'd
love to hear how your work as a nurse is creating positive change so please share that below.
Second share this with your nursing colleagues because I will tell you it isn't always something
that people think about because they forget it if they're in a workplace that they haven't used it
and they're far removed from their training where they have forgotten all about it. So
sometimes it's more about bringing it forward and helping people out so let's elevate the practice
of those around us and share this video with your friends. Third if you haven't subscribed below
remember I've got a goal 100 000 subscribers in 2021 and you are a part of my vision. So
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