Physical examination(體格檢查)ppt課件.ppt

Physicalexamination DepartmentofEndocrinologyHainanmedicalcollegeWangXinjun 王新軍 Physicalexamination Itistheprocessofexaminingthepatient sbodytodeterminethepresenceorabsenceofphysicalproblems Weuseeachofourfoursensestoelicitsignsofdisease Inspection視診 sightandsmell Palpation觸診 touch Percussion叩診 touchandhearing Auscultation聽(tīng)診 hearing teachtheeyetosee thefingertofeel andtheeartohear Whatisthefifth Smelling 嗅診 Inspection Inspectionisthesearchforphysicalsignsbyobservingthepatientwithyoureyesandsenseofsmell Firststepinexaminingapatientorbodypart Itincludesageneralsurveyofthepatient smentalstatus 精神狀況 posture 姿勢(shì) bodymovementgait 步態(tài) breathodor 呼吸氣味 skintypepatternofspeechstature 身材 stateofnutrition 營(yíng)養(yǎng)狀況 acromegly Howtoinspect MakesuretheroomisinacomfortabletemperatureUsegoodlighting preferablysunlightLookandobservebeforetouchingComparesymmetricalbodyparts Mentalstatusandpersonalgrooming Doesthepatientlookwellorsick Ishecomfortableinbed Doesheappearindistress Ishealertorishegroggy Doeshelookacutelyorchronicallyill poornutritionsunkeneyestemporalwastinglooseskinDoesthepatientappearclean Isherhaircombed Doesshebitehernails Posture姿勢(shì) ItmayrevealsignificantinformationCongestiveheartfailure sitinachairtheentirenightThusthepositionsofthepatientatthetimeoftheexaminationmaysuggestcertaindiseasepossibilities Palpation Palpationisemployedoneverypartofthebodyaccessibletotheexaminingfingers Thepalpationofabdomenisparticularlyimportant Theexaminertouchesandfeelsthepatient sbodypartwithhishandstoexaminetexture 質(zhì)地 Moistureskintemperaturecharacteristicsofmassestenderness 觸痛 ofanorganorbodypart Characteristicofmasses size 大小 shapeconsistency 密度 motilitysurfaceregularitypresenceorabsenceofexpansileortransmittedpulsation Methodsofpalpation Alwaysbeginpalpationinanareaoftheabdomenthatisfarthestfromthelocationofpain Typesofpalpation Lightpalpation 淺部觸診 Deeppalpation 深部觸診 Bimanualpalpation 雙手觸診法 Lightpalpation Deeppalpation UsedtodetermineorgansizeaswellasthepresenceofabdominalmassesThepatientshouldbeinstructedtobreathequietlythroughthemouthandtokeeparmsatthesides Deeppalpation Bimanualpalpation Usestwohands oneoneachsideofthebodypartbeingpalpatedItisemployedduringtheprocessesofbreastsliver spleen kidneyorabdominalmassesexamination Bimanualpalpation Percussion Percussionistheactofstrikingthesurfaceofthebodytoelicitasound PercussionofabodypartproducesasoundthatindicatesthetypeoftissuewithintheorganItisparticularlyimportantinexaminingthechestandabdomen Percussion Itisusedtodetectdiaphragmaticmovement 橫隔膜運(yùn)動(dòng) thesizeofheart edgeofliverandspleenetal MethodsofPercussion Indirectpercussion 間接叩診法 Directpercussion 直接叩診法 IndirectPercussion Theexaminerplacesthemiddlefingerofonehand lefthand firmlyagainstthepatient ssurfacewall chestorabdomen withpalmandotherfingersheldoff 離開(kāi) theskinsurfaceThetipoftherightlongfingerofthehandstrikesaquick sharpblowtotheterminalphalanxoftheleftfingerontheskinsurface IndirectPercussion Themotionofthestrikingfinger 叩擊手指的運(yùn)動(dòng) shouldcomefromthewrist 手腕 andnotfromtheelbow 肘 Usually twoorthreestaccatoblowsarestruckinoneplace andthenthepleximeterismovedelsewhereforasecondseriesofblowstocomparethesounds Directpercussion Whenyouelicitsoundbystrikingthebodysurfacedirectlywithyourfingers hand orreflexhammer theprocedureiscalleddirectorimmediatepercussion Percussion Accordingtotheidentityofthetissue amountofairgascontaininganddistanceoftheorganfromtheskinsurface thepercussionsoundinclude resonance 清音 Tympany 鼓音 Hyperresonance 過(guò)清音 Dullness 濁音 Flatness 實(shí)音 QualityofPercussion Resonance清音 percussionoverastructurecontainingairwithinatissue suchasthelung producesaresonantTympany鼓音 percussionoverahollowair containingstructure suchasthestomach QualityofPercussion Hyperresonance過(guò)清音 thequalityofpercussionsoundsuchasinpulmonaryemphysema 肺氣腫 Dullness濁音 percussionoverasolidorgan suchastheliver QualityofPercussion Flatness實(shí)音 flatnessoccurswhenthereisnoairpresentintheunderlyingtissue Forexample flatnessisfoundoverthemuscleofthearmorthigh SoundsproducedbyPercussion RecordoffindingQualityWhereheardResonanceHollowNormallungHyperresonanceBoomingAir filledlungsTympanyDrumlikeAbdomenDullnessThudlikeLiverFlatnessFlatMuscle bone Auscultation Amethodusedto listen tothesoundsofthebodyduringaphysicalexaminationAuscultationisusedtoexaminetheheartandlungs stethoscope Auscultation DirectauscultationIndirectauscultation Howtousethestethoscope Do swarmthediaphragmorbellexplainwhatyou relisteningforandanswerpatient squestionpromptlyDon tsdonotapplytoomuchpressurewhenusingthebelldonottrytolistenthroughclothing Howtoauscultate EliminatedistractingnoisesExposethebodypartyouaregoingtoauscultateUsethediaphragm 膜型 tolistenfornormalheartsounds andbowelsoundsPressthediaphragmfirmlyUsethebell 鐘型 tolistenforabnormalheartsoundsorbruits 雜音 Holdthebelllightly SMELL Odorsonthebreathfromacetone alcohol andsomepoisonsmayleadquicklytoadiagnosis Foul smellingsputumsuggestsbronchiectasisorlungabscess Vitalsigns生命征andanthropomorphicdata TemperaturePulseRespirationsBloodpressure Measurementofthebrachialarterypressure Thepatientmaybeeithersittingorlyinginthesupineposition仰臥位 Thepatientshouldhavebeenrestingforsometime Measurementofthebrachialarterypressure Barethearmandaffixthecollapsedcuff氣袖snuglyandsmoothly sothedistalmarginofthecuffisatleast3cmproximaltotheantecubitalfossa肘窩 Restthesupinatedarmonthetableorbedwiththeantecubitalfossaapproximatelyattheleveloftheheart Measurementofthebrachialarterypressure Palpatefortheexactlocationofthebrachialarterialpulse Measurementofthebrachialarterypressure Inflatethecufftoapressureabout30mmHgabovethepointwherethepalpablepulsedisappears Openthevalveslightlysothepressuredropsgradually nomorethan2mmHgpersecond whilemakingobservationsbyauscultation Measurementofthebrachialarterypressure Withthebellofthestethoscopepressedlightlyoverthebrachialartery notethepressureatwhichsoundsfirstbecomeaudible thisreadingistakenasthesystolicpressure收縮壓 Measurementofthebrachialarterypressure Asdeflationproceeds thesoundsbecomelouderandmaintainamaximumforaconsiderablerangebeforebecomingmuffled Finally notethepointwherethesoundsdisappear thisreadingistakenasthediasto