Methods and pysical examination. 1Inspection 2Palpation ▲ 3Percussion ▲ 4Auscultation ▲...
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Transcript of Methods and pysical examination. 1Inspection 2Palpation ▲ 3Percussion ▲ 4Auscultation ▲...
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Methods and pysical exaMethods and pysical examinationmination
Methods and pysical exaMethods and pysical examinationmination
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1Inspection2Palpation ▲3Percussion ▲4Auscultation ▲5Smell
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1inspection
Definition:By observing the patients systemic and local features with eyes to draw a conclusion or presume a diagnosis.
least mechanical,hardest to learn
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General visual inspection—as a whole
Contents: age,facial expression,skin type tone and pattern of speech,position posture , gait, nutrition,deformity
or asymmetry of face,limbs,trunk
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Close visual inspection—
a single anatomic region
Contents : mucous membrane,eyes,nose,mouth,
tongue , muscle,bones, joints (the closer you look,the more you see)
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2Palpation
intrductionspecific qualities elicited by palpatio
nmethods of palpationannouncements
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introduction
definition:the act of feeling using the sense of touch to judge.
structures:(every part of the body) external structures, structures accessib
le through the body orifices, bones,joints,muscles,superficial nerves, ligaments,tendon sheaths
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range:exclusive,important for abdomenthe most sensitive locus of the examiner: (1)finger pulp (2) palmar surface of the metacarpophala
ngeal joint is sensitive to vibration (3)skin of back hand is sensitive to tempera
ture
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specific qualities elicited by palpationTextur MoistureSkin temperatureCharacteristics of massesPrecordial cardiac thrust Crepitus tenderness thrills vocal fremitus
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Methods of palpation
Light palpationDeep palpationBimanual palpation
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Light palpation• Suitable for: joints,soft tissue,superficia
l arteries,vein and nerve• Depth: 1 cm• Method:gently slide fingertips over skin
surface,then use cooperatiing action of metacarpophalangeal joint and wrist joint to rotate and glide.• Notices:lightly touch
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Deep palpation• Suitable for:celiac change and neck,breasts,large muscle masses• depth :2 cm• Methods:deep slipping palpation deep press palpation ballottement
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Bimanual palpationSuitable for: liver, spleen,kidney, Methods:put left palm on the back of
the organ,then hold to the right hand to make the organ betwwen two hands.
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NoticeInform motive to patientsWarm and gentleProper position ( lie on one side ) Urinate if palpate inferior bellyDo and think
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3percussion• Definition:the act of striking the surface
of the body to elicit a sound.• Method of percussion : direct percussi
on inderect percussion
Most commonly used
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Direct percussion
• Definition:striking the body surface directly with fingers,hand,reflex hammer
• Method:move intermedial tridactylism of right hand to each other,then slap the site
• Suitable for:exclusive change of chest and abdomen(pneumothorax , generous pleural fluid)
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indirect percussion
Methods (1)press the palmar surface of the left long fin
ger firmly onto the body surface as a pleximeter,only the distal phalanx should touch the wall,other fingers slightly uplift. the tip of the right long finger strike a sharp blow on the distal interphalangeal joint of the pleximeter as a plexor .
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corecct wrong pose of indirect percussion
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(2)The examiner holds the plexor finger flexed and rigid and delivers the blow by bending only the wrist; the elbow and shoulder should not move.
(3)After the stroke ,the plexor rebound quickly from the pleximeter
(4)Struck two or three staccato blows in one place.
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Suitable for: thorax , abdomenNotices:environment is quiet proper position compare symmetrical site change of percussion sound proper strength
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percussion soundResonance: airfilled lung(normal lung)Dullness:percussion over the heart when it
is covered by lung Tympany:percussion the gastric air bubbleFlatness:percussion the thigh musclesHyperresonance:emphysematous lung
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4Auscultation
Direct auscultationInderect auscultation:through stethoscop
e
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Inderect auscultationLung:breath souds,whispers,voice sounds, crackles,frictionHeart:normal heart sounds,gallops,murmu
rs rhythm disturbances,pericardial rubs and knocks
Vessels of neck:murmurs in the thyroid, carotid,subclavian arteries,venous hums
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Abdomen:bowel sounds,murmurs from aneurysms and stenotic arteriesSkull:bruit of an arteriovenous fistulaJoints,tendon sheaths,muscles for crepi
tus
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stethoscope
Vibrating air column:connect the body wall to the ears.
Chestpiece:combines the bell and diaphragm
Earpiece:connected by a spring
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earpieces
chestpiece
diaphragm
Air column
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Air column
earpieces
diaphragm
chestpiece bell
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Using the stethoscope,one shoud pay attention: earpiece without air leakage,pain,discomfort diaphragm pressed tightly against the wall eliminate the extraneous noises practice
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5smellDefinition:the act by judging the relatio
nship between abnormal smell and disease.Source of smell:breath,sputum,vomitu
s feces,urine,pus