Physical examination(体格检查).ppt

Physicalexamination DepartmentofEndocrinologyHainanmedicalcollegeWangXinjun 王新军 knewman1 Physicalexamination Itistheprocessofexaminingthepatient sbodytodeterminethepresenceorabsenceofphysicalproblems 2 Weuseeachofourfoursensestoelicitsignsofdisease Inspection视诊 sightandsmell Palpation触诊 touch Percussion叩诊 touchandhearing Auscultation听诊 hearing teachtheeyetosee thefingertofeel andtheeartohear Whatisthefifth Smelling 嗅诊 3 Inspection Inspectionisthesearchforphysicalsignsbyobservingthepatientwithyoureyesandsenseofsmell Firststepinexaminingapatientorbodypart 4 Itincludesageneralsurveyofthepatient smentalstatus 精神状况 posture 姿势 bodymovementgait 步态 breathodor 呼吸气味 skintypepatternofspeechstature 身材 stateofnutrition 营养状况 5 acromegly 6 Howtoinspect MakesuretheroomisinacomfortabletemperatureUsegoodlighting preferablysunlightLookandobservebeforetouchingComparesymmetricalbodyparts 7 Mentalstatusandpersonalgrooming Doesthepatientlookwellorsick Ishecomfortableinbed Doesheappearindistress Ishealertorishegroggy Doeshelookacutelyorchronicallyill poornutritionsunkeneyestemporalwastinglooseskinDoesthepatientappearclean Isherhaircombed Doesshebitehernails 8 Posture姿势 ItmayrevealsignificantinformationCongestiveheartfailure sitinachairtheentirenightThusthepositionsofthepatientatthetimeoftheexaminationmaysuggestcertaindiseasepossibilities 9 Palpation Palpationisemployedoneverypartofthebodyaccessibletotheexaminingfingers Thepalpationofabdomenisparticularlyimportant 10 Theexaminertouchesandfeelsthepatient sbodypartwithhishandstoexaminetexture 质地 Moistureskintemperaturecharacteristicsofmassestenderness 触痛 ofanorganorbodypart 11 Characteristicofmasses size 大小 shapeconsistency 密度 motilitysurfaceregularitypresenceorabsenceofexpansileortransmittedpulsation 12 Methodsofpalpation Alwaysbeginpalpationinanareaoftheabdomenthatisfarthestfromthelocationofpain 13 Typesofpalpation Lightpalpation 浅部触诊 Deeppalpation 深部触诊 Bimanualpalpation 双手触诊法 14 Lightpalpation 15 Deeppalpation UsedtodetermineorgansizeaswellasthepresenceofabdominalmassesThepatientshouldbeinstructedtobreathequietlythroughthemouthandtokeeparmsatthesides 16 Deeppalpation 17 Bimanualpalpation Usestwohands oneoneachsideofthebodypartbeingpalpatedItisemployedduringtheprocessesofbreastsliver spleen kidneyorabdominalmassesexamination 18 Bimanualpalpation 19 20 Percussion Percussionistheactofstrikingthesurfaceofthebodytoelicitasound PercussionofabodypartproducesasoundthatindicatesthetypeoftissuewithintheorganItisparticularlyimportantinexaminingthechestandabdomen 21 Percussion Itisusedtodetectdiaphragmaticmovement 横隔膜运动 thesizeofheart edgeofliverandspleenetal 22 MethodsofPercussion Indirectpercussion 间接叩诊法 Directpercussion 直接叩诊法 23 IndirectPercussion Theexaminerplacesthemiddlefingerofonehand lefthand firmlyagainstthepatient ssurfacewall chestorabdomen withpalmandotherfingersheldoff 离开 theskinsurfaceThetipoftherightlongfingerofthehandstrikesaquick sharpblowtotheterminalphalanxoftheleftfingerontheskinsurface 24 IndirectPercussion Themotionofthestrikingfinger 叩击手指的运动 shouldcomefromthewrist 手腕 andnotfromtheelbow 肘 Usually twoorthreestaccatoblowsarestruckinoneplace andthenthepleximeterismovedelsewhereforasecondseriesofblowstocomparethesounds 25 Directpercussion Whenyouelicitsoundbystrikingthebodysurfacedirectlywithyourfingers hand orreflexhammer theprocedureiscalleddirectorimmediatepercussion 26 Percussion Accordingtotheidentityofthetissue amountofairgascontaininganddistanceoftheorganfromtheskinsurface thepercussionsoundinclude resonance 清音 Tympany 鼓音 Hyperresonance 过清音 Dullness 浊音 Flatness 实音 27 QualityofPercussion Resonance清音 percussionoverastructurecontainingairwithinatissue suchasthelung producesaresonantTympany鼓音 percussionoverahollowair containingstructure suchasthestomach 28 QualityofPercussion Hyperresonance过清音 thequalityofpercussionsoundsuchasinpulmonaryemphysema 肺气肿 Dullness浊音 percussionoverasolidorgan suchastheliver 29 QualityofPercussion Flatness实音 flatnessoccurswhenthereisnoairpresentintheunderlyingtissue Forexample flatnessisfoundoverthemuscleofthearmorthigh 30 SoundsproducedbyPercussion RecordoffindingQualityWhereheardResonanceHollowNormallungHyperresonanceBoomingAir filledlungsTympanyDrumlikeAbdomenDullnessThudlikeLiverFlatnessFlatMuscle bone 31 Auscultation Amethodusedto listen tothesoundsofthebodyduringaphysicalexaminationAuscultationisusedtoexaminetheheartandlungs 32 stethoscope 33 Auscultation DirectauscultationIndirectauscultation 34 Howtousethestethoscope Do swarmthediaphragmorbellexplainwhatyou relisteningforandanswerpatient squestionpromptlyDon tsdonotapplytoomuchpressurewhenusingthebelldonottrytolistenthroughclothing 35 Howtoauscultate EliminatedistractingnoisesExposethebodypartyouaregoingtoauscultateUsethediaphragm 膜型 tolistenfornormalheartsounds andbowelsoundsPressthediaphragmfirmlyUsethebell 钟型 tolistenforabnormalheartsoundsorbruits 杂音 Holdthebelllightly 36 SMELL Odorsonthebreathfromacetone alcohol andsomepoisonsmayleadquicklytoadiagnosis Foul smellingsputumsuggestsbronchiectasisorlungabscess 37 Vitalsigns生命征andanthropomorphicdata TemperaturePulseRespirationsBloodpressure 38 Measurementofthebrachialarterypressure Thepatientmaybeeithersittingorlyinginthesupineposition仰卧位 Thepatientshouldhavebeenrestingforsometime 39 Measurementofthebrachialarterypressure Barethearmandaffixthecollapsedcuff气袖snuglyandsmoothly sothedistalmarginofthecuffisatleast3cmproximaltotheantecubitalfossa肘窝 Restthesupinatedarmonthetableorbedwiththeantecubitalfossaapproximatelyattheleveloftheheart 40 Measurementofthebrachialarterypressure Palpatefortheexactlocationofthebrachialarterialpulse 41 Measurementofthebrachialarterypressure Inflatethecufftoapressureabout30mmHgabovethepointwherethepalpablepulsedisappears Openthevalveslightlysothepressuredropsgradually nomorethan2mmHgpersecond whilemakingobservationsbyauscultation 42 Measurementofthebrachialarterypressure Withthebellofthestethoscopepressedlightlyoverthebrachialartery notethepressureatwhichsoundsfirstbecomeaudible thisreadingistakenasthesystolicpressure收缩压 43 Measurementofthebrachialarterypressure Asdeflationproceeds thesoundsbecomelouderandmaintainamaximumforaconsiderablerangebeforebecomingmuffled Finally notethepointwherethesoundsdisappear thisreadingistakenasthediastolicpr