{"id":5,"date":"2020-04-02T11:23:25","date_gmt":"2020-04-02T15:23:25","guid":{"rendered":"https:\/\/pressbooks.library.ryerson.ca\/ippa\/2020\/04\/02\/chapter-1\/"},"modified":"2020-10-05T22:46:27","modified_gmt":"2020-10-06T02:46:27","slug":"chapter-1","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/ippa\/chapter\/chapter-1\/","title":{"raw":"Objective Assessment","rendered":"Objective Assessment"},"content":{"raw":"Objective assessment involves the collection of data that you can<strong> observe and measure<\/strong> about the client\u2019s state of health. Examples of objective assessment include observing a client\u2019s [pb_glossary id=\"56\"]gait[\/pb_glossary], physically feeling a lump on client\u2019s leg, listening to a client\u2019s heart, tapping on the body to elicit sounds, as well as collecting or reviewing laboratory and diagnostic tests such as blood tests, urine tests, X-ray etc. Typically, an objective assessment is conducted following the collection of [pb_glossary id=\"57\"]subjective data[\/pb_glossary].\r\n<p class=\"no-indent\">The purpose of the objective assessment is to identify normal and abnormal findings. The abnormal findings are cues that signal a potential concern. An important part of the nursing process to ensure <strong>[pb_glossary id=\"58\"]client safety[\/pb_glossary]<\/strong> and <strong>effective care<\/strong> is:<\/p>\r\n\r\n<ul>\r\n \t<li><strong>Recognizing <\/strong>abnormal cues.<\/li>\r\n \t<li><strong>Acting <\/strong>on abnormal cues.<\/li>\r\n<\/ul>\r\nFailing to recognize or act upon abnormal cues can lead to significant negative consequences for the client.\r\n\r\nObjective data are analyzed in combination with your subjective assessment to make a clinical judgement. A <strong>clinical judgement<\/strong> is the outcome of thinking critically about the data, analyzing the cues as a whole, making decisions about the most significant concerns to address, and identifying how to best address these concerns based on the existing evidence (National Council of State Boards of Nursing, 2018). As a healthcare professional, developing strong clinical judgement is essential to ensuring client safety and maintaining your competency. Your clinical judgement will guide the prioritization and sequencing of assessment techniques. Your assessment of cues (both subjective and objective) will help you determine what data warrant further investigation and assessment. Therefore, it is important to think critically about the findings you collect during an assessment: Are they normal or abnormal for this specific client? Do they require you to act and\/or seek further assistance?\r\n<div class=\"textbox textbox--examples\"><header class=\"textbox__header\">\r\n<p class=\"textbox__title no-indent\" style=\"text-align: center\"><strong>Clinical Tip<\/strong><\/p>\r\n\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\n<strong>Recognizing and acting on assessment findings<\/strong>\r\n\r\nAs a nursing student, you must have timely discussions with your clinical instructor or preceptor to assess the significance of abnormal findings. You will need to take initiative, develop confidence in seeking assistance, and never ignore an abnormal finding.\r\n\r\n<\/div>\r\n<\/div>\r\nIn this chapter, you will focus on four objective assessment techniques: <strong>inspection<\/strong>, <strong>palpation<\/strong>, <strong>percussion<\/strong>, and <strong>auscultation.<\/strong> These involve your senses of sight, hearing, and touch (see <strong>Figure 1.1<\/strong>). You should also be aware of your sense of smell when conducting any physical assessment, as certain odours can act as a cue; for example, a foul odour may indicate an infection.\r\n<ul>\r\n \t<li>Inspection involves your visual sense to observe the client.<\/li>\r\n \t<li>Palpation involves your sense of touch to physically feel areas of the body.<\/li>\r\n \t<li>Percussion involves a combination of touch and hearing, but your focus is on hearing sounds when tapping the areas of the body.<\/li>\r\n \t<li>Auscultation involves your sense of hearing while listening to areas of the body with a stethoscope.<\/li>\r\n<\/ul>\r\n<img src=\"http:\/\/pressbooks.library.ryerson.ca\/ippa\/wp-content\/uploads\/sites\/114\/2020\/08\/unnamed-1024x1024.png\" alt=\"\" class=\"alignnone size-large wp-image-153\" width=\"1024\" height=\"1024\" \/>\r\n\r\n<span style=\"color: #000000\"><strong>Figure 1.1<\/strong>: Objective assessment techniques\u00a0<\/span>\r\n\r\nThese techniques should be performed with methodical and deliberate action. Always perform <strong>inspection first<\/strong> because it is the least invasive and does not involve physical touch. Inspection also allows you to establish a baseline for your assessment. For example, if you observe someone crouched over in pain, this will inform the sequence of your subsequent assessment techniques. Typically, palpation, percussion, and then auscultation follow inspection. The <strong>sequencing of techniques may be rearranged<\/strong> for several reasons, including which system is being assessed and for safety reasons. For example, when assessing the abdomen, auscultation is generally performed before percussion and palpation. Client safety and comfort also influence the sequence of objective techniques. For example, with a sleeping infant, you should perform inspection and auscultation while the child is calm and to avoid awakening the client. You will learn more about modifications to the sequencing of techniques as you learn about specific body systems. Determining technique sequence also comes with experience.\r\n\r\nWhen applicable, these IPPA techniques are used to assess body systems (e.g., eyes, ears, heart and neck vessels, lungs and thorax, abdomen, musculoskeletal). However, not all techniques are applicable to all systems. For example, you would not auscultate an eye because it does not emit a sound that would give you relevant data. Additionally, developmental stage and age can influence how some IPPA techniques are performed and also the determination of normal and abnormal findings. For example, normal heart rates vary significantly between a newborn compared to an adult.\r\n\r\nBefore you explore each technique, let\u2019s discuss what you need to do before you begin the objective assessment!\r\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\r\n<p class=\"textbox__title no-indent\" style=\"text-align: center\"><strong>Voices of Experience<\/strong><\/p>\r\n\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n<p class=\"no-indent\">Your foundational IPPA assessment techniques and the resultant findings will give you a baseline understanding of the client\u2019s health status. These physical assessment skills, combined with subjective health assessment, are important parts of clinical judgement and can act as a prompt for urgent action, transfer to a higher level of care, and further diagnostic technologies. Your IPPA assessment skills will be even more important in areas with less access to resources and diagnostics (e.g., rural and remote areas and underdeveloped regions).<\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n<h2>Activity: Check Your Understanding<\/h2>\r\n[h5p id=\"1\"]\r\n\r\n&nbsp;","rendered":"<p>Objective assessment involves the collection of data that you can<strong> observe and measure<\/strong> about the client\u2019s state of health. Examples of objective assessment include observing a client\u2019s <button class=\"glossary-term\" aria-describedby=\"5-56\">gait<\/button>, physically feeling a lump on client\u2019s leg, listening to a client\u2019s heart, tapping on the body to elicit sounds, as well as collecting or reviewing laboratory and diagnostic tests such as blood tests, urine tests, X-ray etc. Typically, an objective assessment is conducted following the collection of <button class=\"glossary-term\" aria-describedby=\"5-57\">subjective data<\/button>.<\/p>\n<p class=\"no-indent\">The purpose of the objective assessment is to identify normal and abnormal findings. The abnormal findings are cues that signal a potential concern. An important part of the nursing process to ensure <strong><button class=\"glossary-term\" aria-describedby=\"5-58\">client safety<\/button><\/strong> and <strong>effective care<\/strong> is:<\/p>\n<ul>\n<li><strong>Recognizing <\/strong>abnormal cues.<\/li>\n<li><strong>Acting <\/strong>on abnormal cues.<\/li>\n<\/ul>\n<p>Failing to recognize or act upon abnormal cues can lead to significant negative consequences for the client.<\/p>\n<p>Objective data are analyzed in combination with your subjective assessment to make a clinical judgement. A <strong>clinical judgement<\/strong> is the outcome of thinking critically about the data, analyzing the cues as a whole, making decisions about the most significant concerns to address, and identifying how to best address these concerns based on the existing evidence (National Council of State Boards of Nursing, 2018). As a healthcare professional, developing strong clinical judgement is essential to ensuring client safety and maintaining your competency. Your clinical judgement will guide the prioritization and sequencing of assessment techniques. Your assessment of cues (both subjective and objective) will help you determine what data warrant further investigation and assessment. Therefore, it is important to think critically about the findings you collect during an assessment: Are they normal or abnormal for this specific client? Do they require you to act and\/or seek further assistance?<\/p>\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title no-indent\" style=\"text-align: center\"><strong>Clinical Tip<\/strong><\/p>\n<\/header>\n<div class=\"textbox__content\">\n<p><strong>Recognizing and acting on assessment findings<\/strong><\/p>\n<p>As a nursing student, you must have timely discussions with your clinical instructor or preceptor to assess the significance of abnormal findings. You will need to take initiative, develop confidence in seeking assistance, and never ignore an abnormal finding.<\/p>\n<\/div>\n<\/div>\n<p>In this chapter, you will focus on four objective assessment techniques: <strong>inspection<\/strong>, <strong>palpation<\/strong>, <strong>percussion<\/strong>, and <strong>auscultation.<\/strong> These involve your senses of sight, hearing, and touch (see <strong>Figure 1.1<\/strong>). You should also be aware of your sense of smell when conducting any physical assessment, as certain odours can act as a cue; for example, a foul odour may indicate an infection.<\/p>\n<ul>\n<li>Inspection involves your visual sense to observe the client.<\/li>\n<li>Palpation involves your sense of touch to physically feel areas of the body.<\/li>\n<li>Percussion involves a combination of touch and hearing, but your focus is on hearing sounds when tapping the areas of the body.<\/li>\n<li>Auscultation involves your sense of hearing while listening to areas of the body with a stethoscope.<\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/pressbooks.library.ryerson.ca\/ippa\/wp-content\/uploads\/sites\/114\/2020\/08\/unnamed-1024x1024.png\" alt=\"\" class=\"alignnone size-large wp-image-153\" width=\"1024\" height=\"1024\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-content\/uploads\/sites\/114\/2020\/08\/unnamed-1024x1024.png 1024w, https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-content\/uploads\/sites\/114\/2020\/08\/unnamed-300x300.png 300w, https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-content\/uploads\/sites\/114\/2020\/08\/unnamed-150x150.png 150w, https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-content\/uploads\/sites\/114\/2020\/08\/unnamed-768x768.png 768w, https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-content\/uploads\/sites\/114\/2020\/08\/unnamed-1536x1536.png 1536w, https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-content\/uploads\/sites\/114\/2020\/08\/unnamed-2048x2048.png 2048w, https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-content\/uploads\/sites\/114\/2020\/08\/unnamed-65x65.png 65w, https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-content\/uploads\/sites\/114\/2020\/08\/unnamed-225x225.png 225w, https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-content\/uploads\/sites\/114\/2020\/08\/unnamed-350x350.png 350w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/p>\n<p><span style=\"color: #000000\"><strong>Figure 1.1<\/strong>: Objective assessment techniques\u00a0<\/span><\/p>\n<p>These techniques should be performed with methodical and deliberate action. Always perform <strong>inspection first<\/strong> because it is the least invasive and does not involve physical touch. Inspection also allows you to establish a baseline for your assessment. For example, if you observe someone crouched over in pain, this will inform the sequence of your subsequent assessment techniques. Typically, palpation, percussion, and then auscultation follow inspection. The <strong>sequencing of techniques may be rearranged<\/strong> for several reasons, including which system is being assessed and for safety reasons. For example, when assessing the abdomen, auscultation is generally performed before percussion and palpation. Client safety and comfort also influence the sequence of objective techniques. For example, with a sleeping infant, you should perform inspection and auscultation while the child is calm and to avoid awakening the client. You will learn more about modifications to the sequencing of techniques as you learn about specific body systems. Determining technique sequence also comes with experience.<\/p>\n<p>When applicable, these IPPA techniques are used to assess body systems (e.g., eyes, ears, heart and neck vessels, lungs and thorax, abdomen, musculoskeletal). However, not all techniques are applicable to all systems. For example, you would not auscultate an eye because it does not emit a sound that would give you relevant data. Additionally, developmental stage and age can influence how some IPPA techniques are performed and also the determination of normal and abnormal findings. For example, normal heart rates vary significantly between a newborn compared to an adult.<\/p>\n<p>Before you explore each technique, let\u2019s discuss what you need to do before you begin the objective assessment!<\/p>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title no-indent\" style=\"text-align: center\"><strong>Voices of Experience<\/strong><\/p>\n<\/header>\n<div class=\"textbox__content\">\n<p class=\"no-indent\">Your foundational IPPA assessment techniques and the resultant findings will give you a baseline understanding of the client\u2019s health status. These physical assessment skills, combined with subjective health assessment, are important parts of clinical judgement and can act as a prompt for urgent action, transfer to a higher level of care, and further diagnostic technologies. Your IPPA assessment skills will be even more important in areas with less access to resources and diagnostics (e.g., rural and remote areas and underdeveloped regions).<\/p>\n<\/div>\n<\/div>\n<h2>Activity: Check Your Understanding<\/h2>\n<div id=\"h5p-1\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-1\" class=\"h5p-iframe\" data-content-id=\"1\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Objective Assessment\"><\/iframe><\/div>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"glossary\"><div class=\"glossary__tooltip\" id=\"5-56\" hidden><p>A person\u2019s pattern of walking including movement of limbs.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"5-57\" hidden><p>Information that the client shares with you.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"5-58\" hidden><p>Client safety is the reduction and mitigation of preventable unsafe acts and practices during the process of healthcare.<\/p>\n<\/div><\/div>","protected":false},"author":34,"menu_order":1,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[47],"contributor":[],"license":[],"class_list":["post-5","chapter","type-chapter","status-publish","hentry","chapter-type-standard"],"part":3,"_links":{"self":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-json\/pressbooks\/v2\/chapters\/5","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-json\/wp\/v2\/users\/34"}],"version-history":[{"count":24,"href":"https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-json\/pressbooks\/v2\/chapters\/5\/revisions"}],"predecessor-version":[{"id":275,"href":"https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-json\/pressbooks\/v2\/chapters\/5\/revisions\/275"}],"part":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-json\/pressbooks\/v2\/parts\/3"}],"metadata":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-json\/pressbooks\/v2\/chapters\/5\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-json\/wp\/v2\/media?parent=5"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-json\/pressbooks\/v2\/chapter-type?post=5"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-json\/wp\/v2\/contributor?post=5"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-json\/wp\/v2\/license?post=5"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}