Physical examination(体格检查).ppt

Physical examination Department of Endocrinology Hainan medical college Wang Xinjun（王新军） Physical examination lIt is the process of examining the patients body to determine the presence or absence of physical problems. We use each of our four senses to elicit signs of disease: lInspection视诊 （sight and smell） lPalpation触诊（touch） lPercussion叩诊（touch and hearing） lAuscultation听诊（hearing） “teach the eye to see, the finger to feel, and the ear to hear” lWhat is the fifth? Smelling（嗅诊） Inspection lInspection is the search for physical signs by observing the patient with your eyes and sense of smell. lFirst step in examining a patient or body part It includes a general survey of the patients mental status （精神状况） posture （姿势 ） body movement gait （步态) breath odor （呼吸气味） skin type pattern of speech stature （身材 ） state of nutrition （营养状况) lacromegly How to inspect lMake sure the room is in a comfortable temperature lUse good lighting, preferably sunlight lLook and observe before touching lCompare symmetrical body parts Mental status and personal grooming lDoes the patient look well or sick? lIs he comfortable in bed? lDoes he appear in distress? lIs he alert or is he groggy? lDoes he look acutely or chronically ill? poor nutrition sunken eyes temporal wasting loose skin lDoes the patient appear clean? lIs her hair combed? lDoes she bite her nails? Posture姿势 lIt may reveal significant information lCongestive heart failure: sit in a chair the entire night lThus the positions of the patient at the time of the examination may suggest certain disease possibilities Palpation lPalpation is employed on every part of the body accessible to the examining fingers. lThe palpation of abdomen is particularly important lThe examiner touches and feels the patients body part with his hands to examine texture（质地） Moisture skin temperature characteristics of masses tenderness（触痛） of an organ or body part Characteristic of masses size（大小） shape consistency（密度） motility surface regularity presence or absence of expansile or transmitted pulsation. Methods of palpation lAlways begin palpation in an area of the abdomen that is farthest from the location of pain Types of palpation lLight palpation（浅部触诊） lDeep palpation（深部触诊） lBimanual palpation（双手触诊法） Light palpation Deep palpation lUsed to determine organ size as well as the presence of abdominal masses lThe patient should be instructed to breathe quietly through the mouth and to keep arms at the sides Deep palpation Bimanual palpation lUses two hands, one on each side of the body part being palpated lIt is employed during the processes of breasts liver, spleen, kidney or abdominal masses examination Bimanual palpation Percussion lPercussion is the act of striking the surface of the body to elicit a sound. lPercussion of a body part produces a sound that indicates the type of tissue within the organ lIt is particularly important in examining the chest and abdomen Percussion It is used to detect diaphragmatic movement（横隔 膜运动）, the size of heart, edge of liver and spleen et al. Methods of Percussion lIndirect percussion（间接叩诊法） lDirect percussion（直接叩诊法） Indirect Percussion lThe examiner places the middle finger of one hand (left hand) firmly against the patients surface wall (chest or abdomen), with palm and other fingers held off (离开) the skin surface lThe tip of the right long finger of the hand strikes a quick, sharp blow to the terminal phalanx of the left finger on the skin surface Indirect Percussion lThe motion of the striking finger （叩击 手指的运动）should come from the wrist （手腕）and not from the elbow（肘） lUsually, two or three staccato blows are struck in one place, and then the pleximeter is moved elsewhere for a second series of blows to compare the sounds. Direct percussion lWhen you elicit sound by striking the body surface directly with your fingers, hand, or reflex hammer, the procedure is called direct or immediate percussion. Percussion According to the identity of the tissue, amount of air gas containing and distance of the organ from the skin surface, the percussion sound include: resonance（清音） Tympany（鼓音） Hyperresonance（过清音） Dullness（浊音） Flatness（实音） Quality of Percussion lResonance清音: percussion over a structure containing air within a tissue, such as the lung, produces a resonant lTympany鼓音: percussion over a hollow air- containing structure, such as the stomach Quality of Percussion lHyperresonance过清音: the quality of percussion sound such as in pulmonary emphysema（肺气 肿） lDullness浊音: percussion over a solid organ, such as the liver Quality of Percussion lFlatness实音: flatness occurs when there is no air present in the underlying tissue. For example, flatness is found over the muscle of the arm or thigh. Sounds produced by Percussion Record of finding Quality Where heard Resonance Hollow Normal lung Hyperresonance Booming Air-filled lungs Tympany Drumlike Abdomen Dullness Thudlike Liver Flatness Flat Muscle, bone Auscultation lA method used to “listen” to the sounds of the body during a physical examination lAuscultation is used to examine the heart and lungs. stethoscope Auscultation lDirect auscultation lIndirect auscultation How to use the stethoscope lDos warm the diaphragm or bell explain what youre listening for and answer patients question promptly lDonts do not apply too much pressure when using the bell do not try to listen through clothing How to auscultate lEliminate distracting noises lExpose the body part you are going to auscultate lUse the diaphragm(膜型） to listen for normal heart sounds, and bowel sounds lPress the diaphragm firmly lUse the bell（钟型） to listen for abnormal heart sounds or bruits（杂音) lHold the bell lightly SMELL lOdors on the breath from acetone, alcohol, and some poisons may lead quickly to a diagnosis. lFoul-smelling sputum suggests bronchiectasis or lung abscess. Vital signs生命征 and anthropomorphic data lTemperature lPulse lRespirations lBlood pressure Measurement of the brachial artery pressure lThe patient may be either sitting or lying in the supine position仰卧位. lThe patient should have been resting for some time. Measurement of the brachial artery pressure lBare the arm and affix the collapsed cuff 气袖 snugly and smoothly, so the distal margin of the cuff is at least 3cm proximal to the antecubital fossa肘窝. lRest the supinated arm on the table or bed with the antecubital fossa approximately at the level of the heart. Measurement of the brachial artery pressure lPalpate for the exact location of the brachial arterial pulse. Measurement of the brachial artery pressure lInflate the cuff to a pressure about 30 mmHg above the point where the palpable pulse disappears. lOpen the valve slightly so the pressure drops gradually(no more than 2mmHg per second) while making observations by auscultation. Measurement of the brachial artery pressure lWith the bell of the stethoscope pressed lightly over the brachial artery, note the pressure at which sounds first become audible: this reading is taken as the systolic pressure收缩压. Measurement of the brachial artery pressure lAs deflation proceeds, the sounds become louder and maintain a maximum for a considerable range before becoming muffled. lFinally, note the point where the sounds disappear: this reading is