Physicalexamination(体格检查).ppt

Physicalexamination DepartmentofEndocrinologyHainanmedicalcollegeWangXinjun 王新军 knewman 18789826999 Physicalexamination Itistheprocessofexaminingthepatient sbodytodeterminethepresenceorabsenceofphysicalproblems Weuseeachofourfoursensestoelicitsignsofdisease Inspection视诊 sightandsmell Palpation触诊 touch Percussion叩诊 touchandhearing Auscultation听诊 hearing teachtheeyetosee thefingertofeel andtheeartohear Whatisthefifth Smelling 嗅诊 Inspection Inspectionisthesearchforphysicalsignsbyobservingthepatientwithyoureyesandsenseofsmell Firststepinexaminingapatientorbodypart 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 acromegly Howtoinspect MakesuretheroomisinacomfortabletemperatureUsegoodlighting preferablysunlightLookandobservebeforetouchingComparesymmetricalbodyparts Mentalstatusandpersonalgrooming Doesthepatientlookwellorsick Ishecomfortableinbed Doesheappearindistress Ishealertorishegroggy Doeshelookacutelyorchronicallyill poornutritionsunkeneyestemporalwastinglooseskinDoesthepatientappearclean Isherhaircombed Doesshebitehernails Posture姿势 ItmayrevealsignificantinformationCongestiveheartfailure sitinachairtheentirenightThusthepositionsofthepatientatthetimeoftheexaminationmaysuggestcertaindiseasepossibilities Palpation Palpationisemployedoneverypartofthebodyaccessibletotheexaminingfingers Thepalpationofabdomenisparticularlyimportant Theexaminertouchesandfeelsthepatient sbodypartwithhishandstoexaminetexture 质地 Moistureskintemperaturecharacteristicsofmassestenderness 触痛 ofanorganorbodypart Characteristicofmasses size 大小 shapeconsistency 密度 motilitysurfaceregularitypresenceorabsenceofexpansileortransmittedpulsation Methodsofpalpation Alwaysbeginpalpationinanareaoftheabdomenthatisfarthestfromthelocationofpain Typesofpalpation Lightpalpation 浅部触诊 Deeppalpation 深部触诊 Bimanualpalpation 双手触诊法 Lightpalpation Deeppalpation UsedtodetermineorgansizeaswellasthepresenceofabdominalmassesThepatientshouldbeinstructedtobreathequietlythroughthemouthandtokeeparmsatthesides Deeppalpation Bimanualpalpation Usestwohands oneoneachsideofthebodypartbeingpalpatedItisemployedduringtheprocessesofbreastsliver spleen kidneyorabdominalmassesexamination Bimanualpalpation Percussion Percussionistheactofstrikingthesurfaceofthebodytoelicitasound PercussionofabodypartproducesasoundthatindicatesthetypeoftissuewithintheorganItisparticularlyimportantinexaminingthechestandabdomen Percussion Itisusedtodetectdiaphragmaticmovement 横隔膜运动 thesizeofheart edgeofliverandspleenetal MethodsofPercussion Indirectpercussion 间接叩诊法 Directpercussion 直接叩诊法 IndirectPercussion Theexaminerplacesthemiddlefingerofonehand lefthand firmlyagainstthepatient ssurfacewall chestorabdomen withpalmandotherfingersheldoff 离开 theskinsurfaceThetipoftherightlongfingerofthehandstrikesaquick sharpblowtotheterminalphalanxoftheleftfingerontheskinsurface IndirectPercussion Themotionofthestrikingfinger 叩击手指的运动 shouldcomefromthewrist 手腕 andnotfromtheelbow 肘 Usually twoorthreestaccatoblowsarestruckinoneplace andthenthepleximeterismovedelsewhereforasecondseriesofblowstocomparethesounds Directpercussion Whenyouelicitsoundbystrikingthebodysurfacedirectlywithyourfingers hand orreflexhammer theprocedureiscalleddirectorimmediatepercussion Percussion Accordingtotheidentityofthetissue amountofairgascontaininganddistanceoftheorganfromtheskinsurface thepercussionsoundinclude resonance 清音 Tympany 鼓音 Hyperresonance 过清音 Dullness 浊音 Flatness 实音 QualityofPercussion Resonance清音 percussionoverastructurecontainingairwithinatissue suchasthelung producesaresonantTympany鼓音 percussionoverahollowair containingstructure suchasthestomach QualityofPercussion Hyperresonance过清音 thequalityofpercussionsoundsuchasinpulmonaryemphysema 肺气肿 Dullness浊音 percussionoverasolidorgan suchastheliver QualityofPercussion Flatness实音 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 钟型 tolistenforabnormalheartsoundsorbruits 杂音 Holdthebelllightly SMELL Odorsonthebreathfromacetone alcohol andsomepoisonsmayleadquicklytoadiagnosis Foul smellingsputumsuggestsbronchiectasisorlungabscess Vitalsigns生命征andanthropomorphicdata TemperaturePulseRespirationsBloodpressure Measurementofthebrachialarterypressure Thepatientmaybeeithersittingorlyinginthesupineposition仰卧位 Thepatientshouldhavebeenrestingforsometime Measurementofthebrachialarterypressure Barethearmandaffixthecollapsedcuff气袖snuglyandsmoothly sothedistalmarginofthecuffisatleast3cmproximaltotheantecubitalfossa肘窝 Restthesupinatedarmonthetableorbedwiththeantecubitalfossaapproximatelyattheleveloftheheart Measurementofthebrachialarterypressure Palpatefortheexactlocationofthebrachialarterialpulse Measurementofthebrachialarterypressure Inflatethecufftoapressureabout30mmHgabovethepointwherethepalpablepulsedisappears Openthevalveslightlysothepressuredropsgradually nomorethan2mmHgpersecond whilemakingobservationsbyauscultation Measurementofthebrachialarterypressure Withthebellofthestethoscopepressedlightlyoverthebrachialartery notethepressureatwhichsoundsfirstbecomeaudible thisreadingistakenasthesystolicpressure收缩压 Measurementofthebrachialarterypressure Asdeflationproceeds thesoundsbecomelouderandmaintainamaximumforaconsiderablerangebeforebecomingmuffled Finally notethepointwherethesoundsdisappear thisreadingistakenasthediastolicpressure舒张压 Pulsepressure脉压 Thepulsepressureisthedifferencebetweenthearterialsystolicanddiastolicpressures Examinationofthelymphnodes Palpationofthecervicallymphnodes颈部淋巴结Palpationofaxillarylymphnodes腋窝淋巴结 cervicallymphnodes颈部淋巴结 Preauricular耳前Postauricular耳后Suboccipital枕后Submandibular颌下Submental颏下Jugular anteriortriangle 颈前Poststernocleidomastoid颈后Supraclavicular锁骨上 cervicallymphnodes axillarylymphnodes腋窝淋巴结 Lateralaxillarygroup外侧淋巴结群Pectoralgroup胸肌淋巴结群Subscapulargroup肩胛下淋巴结群Centralgroup中央淋巴结群Infraclaviculargroup腋尖 锁骨下 淋巴结群 questions Howtomeasuretheboodpressure Whatispulsepressure SoundsproducedbyPercussion PalpationofthecervicallymphnodesPalpationofaxillarylymphnodes