体格检查胸部检查课件

汇报人：xxx20xx-03-15体格检查胸部检查ppt课件目录胸部检查概述胸部视诊胸部触诊胸部叩诊胸部听诊胸部影像学检查简介01胸部检查概述评估胸部器官和zu织的结构、功能状态，发现潜在疾病或异常情况。目的为临床诊断和治疗提供重要依据，有助于及早发现胸部疾病，避免病情恶化。意义胸部检查目的与意义询问病史→观察胸廓形态→触诊→叩诊→听诊视诊、触诊、叩诊、听诊等多种检查手段综合运用，以获取全面的胸部信息。胸部检查流程与方法方法流程以下附赠各项管理制度英文版（不需要可删）急救药品、器材管理制度:1.Rescuedrugsandequipmentshouldbe"fivefixed"(fixedquantityandvariety,designatedplacement,designatedpersonstorage,regulardisinfectionandsterilization,regularinspectionandmaintenance)and"twotimely"(timelyinspectionandmaintenance,timelyreceiptandsupplementation).Theitemisclearlymarkedandcannotbeusedarbitrarily.2.Thenecessaryrescueequipmentiscomplete,ingoodperformance,andinstandbycondition.3.Therescuedrugsarecomplete,withcleardruglabelsandnodiscoloration,deterioration,expiration,ordamage.Theyshouldbeplacedandusedintheorderofdrugexpirationdates(fromrighttoleft).4.Emergencydrugsanditemsforeachdepartment'srescuevehicleshallbeuniformlyequippedaccordingtorequirements.Specializedemergencydrugsanditemsmustbereviewedandapprovedbythedepartmentdirectortodeterminethetype,quantity,specifications,anddosagetobeequipped.Rescuevehiclesmustbeplacedindesignatedlocationsandmanagedbydesignatedpersonneltoensuresafetyandeaseofuse.5.Afterusingrescuedrugsandequipment,theyshouldbefullyreplenishedwithin24hours.Iftheycannotbereplenishedduetospecialreasons,theyshouldbenotedonthehandoverregistrationformandreportedtotheheadnurseforcoordinationandresolutiontoensuretimelyuseduringpatientrescue.6.Thereisaregistrationbookfortheprovisionofdrugsandequipment.Ensureconsistencybetweenaccountsandmaterials,andhandoverbetweenshifts.7.Managementofsealedrescuevehicles:Beforesealing,theheadnurse(ornurseincharge)andanothernurseshallcountthedrugsandequipmentaccordingtotheregistrationbookofdrugandequipmentequipment,verifytheiraccuracy,andsealthemwithaseal.Twopeopleshallsignandfillinthesealingtime.Nurseschecktheconditionofthesealsoncepershiftandcompletethehandover.Theresponsiblenursescheckonceaweek,andtheheadnurseandresponsiblenursesopenthesealsandinspectthedrugsandequipmentintheambulanceonceamonth,withrecordskept.8.Nonsealedrescuevehiclemanagement:Eachshiftshallcountthedrugsandequipmentaccordingtotheregistrationbookandcompletethehandover.Theresponsiblenurseshallinspectonceaweek,andtheheadnurseshallinspectonceeverytwoweeksandkeeprecords,ensuringthattheaccountsmatchthematerials.护理文书书写制度:

1.Nursingstaffstrictlyfollowthelatestrequirementswhenwritingnursingmedicalrecords.2.Thecontentofnursingrecordsshouldbeobjective,truthful,accurate,timely,complete,andstandardized.3.Allnursingdocumentsshouldbewrittenwithablueblackorcarboninkpen.4.AllnursingdocumentsshouldbewritteninArabicnumeralsfordateandtime,withdatesinyears,months,anddays,usinga24-hoursystem,specifictominutes.5.WritingshoulduseChinese,medicalterminology,andcommonlyusedforeignlanguageabbreviations;Completerecorditems;Thetextisneat,thehandwritingisclear,andthelayoutisclean;Accurateexpression,fluentsentences,simpleandconcise:correctformatandpunctuation,notypos.6.Whenerrorsoccurduringthewritingprocess,doublelinethemonthewrongwords,keeptheoriginalrecordclearanddistinguishable,signthemodifier,indicatethemodificationtime,continuetowritethecorrectcontent,anddonotusescraping,sticking,paintingorothermethodstocoveruporremovetheoriginalhandwriting.Eachpageshouldbemodifiednomorethantwotimes,otherwisetheoriginalrecorderwillpromptlycopyagain(exceptformodificationsmadebysuperiors).7.Nursingrecordswrittenbyinternnurses,probationarynurses,orunregisterednursesshouldbereviewedandsignedbynurseswithlegalprofessionalqualificationsinthismedicalinstitution.8.Furthertrainingnursescanonlywritenursingdocumentsafterbeingrecognizedbythemedicalinstitutionreceivingthetrainingfortheirworkability.9.Superiornursingstaffhavetheresponsibilitytoreviewandmodifythewrittenrecordsofsubordinatenursingstaff.Whenmakingmodifications,reddoublelinesshouldbeusedtomarkerrors,writethemodifiedcontent,signandindicatethemodificationtime.10.Temperaturerecords,medicalorders,patientcarerecords,andsurgicalinventoryrecordsshouldbearchivedontime.环境安静暴露部位保暖措施尊重隐私胸部检查注意事项确保检查环境安静，有利于准确听诊。注意为受检者保暖，避免受凉。充分暴露胸部，以便进行观察和触诊。保护受检者隐私，避免不必要的尴尬和误解。02胸部视诊观察胸廓形状，有无扁平胸、桶状胸、佝偻病等异常表现。胸部外形注意有无皮疹、瘢痕、静脉曲张等，观察颜色及温度。皮肤触诊时，将两手放于胸廓两侧，并轻轻按压，若感觉气体在皮下zu织内移动，则提示皮下气肿。皮下气肿胸部外形与皮肤观察观察呼吸次数及节律，有无增快、减慢或不规则。呼吸频率呼吸深度呼吸方式观察呼吸时胸廓起伏的幅度，有无浅快或深慢呼吸。观察是以胸式呼吸为主，还是腹式呼吸为主，或两者并用。030201呼吸运动观察从前面、侧面和后面观察胸廓的对称性，有无一侧膨隆或塌陷。对称性观察胸廓在吸气和呼气时的活动度，有无活动受限或反常呼吸。活动度观察肋间隙的宽度，有无增宽或变窄，触诊时有无压痛或异常感觉。肋间隙胸廓对称性与活动度评估03胸部触诊胸壁压痛检查用手指轻压胸壁，观察患者是否出现疼痛反应，以及疼痛的部位、范围和程度。胸壁摩擦感检查将手掌平放在胸壁表面，让患者进行深呼吸，感受胸壁在呼吸运动中的摩擦感，判断是否存在胸膜炎症等病变。胸壁压痛与摩擦感检查乳房触诊技巧采用指腹触诊法，用指腹轻压乳房，按一定顺序进行滑动触诊，以发现乳房内的肿块、结节等异常。异常识别根据触诊结果，判断乳房是否存在肿块、结节、疼痛等异常，并结合患者年龄、病史等因素进行综合分析。乳房触诊技巧及异常识别让患者采取坐位或卧位，检查者用指腹轻压患者腋窝，按照一定顺序进行滑动触诊，以发现肿大的淋巴结。腋窝淋巴结触诊方法在触诊过程中，要注意观察淋巴结的大小、形态、质地和活动度等特征，并结合患者病史进行综合分析。同时，要避免过度用力或刺激患者皮肤，以免引起不必要的疼痛和不适。注意事项腋窝淋巴结触诊方法04胸部叩诊123清音、浊音、鼓音在胸部的正常分布区域及特点。正常叩诊音实音、过清音、浊鼓音等异常叩诊音的出现原因及临床意义。异常叩诊音不同疾病状态下叩诊音的变化规律及诊断价值。叩诊音变化与疾病关系叩诊音分布及特点分析肺界叩诊方法前界、后界、下界的叩诊技巧及注意事项。肺界叩诊结果解读正常肺界范围及异常肺界的临床意义，如肺界扩大、缩小等。肺界变化与疾病关系肺部疾病对肺界的影响及肺界变化在疾病诊断中的应用。肺界叩诊技巧与结果解读积液量、部位与叩诊音的关系，以及如何鉴别漏出液与渗出液。胸腔积液的叩诊表现气胸部位、范围与叩诊音的关系，以及如何判断气胸的严重程度。气胸的叩诊表现实变部位、范围与叩诊音的关系，以及实变的原因及临床意义。肺部实变的叩诊表现肺气肿部位、程度与叩诊音的关系，以及肺气肿对肺功能的影响。肺气肿的叩诊表现异常情况下的叩诊表现05胸部听诊03识别正常支气管肺泡呼吸音为上述两种呼吸音混合而成，吸气音与肺泡呼吸音相似，呼气音与支气管呼吸音相似。01识别正常肺泡呼吸音轻柔吹风样，吸气相长于呼气相，音调较高，音响较弱。02识别正常支气管呼吸音类似将舌抬高张口呼出空气所发出的“哈”音，吸气相短于呼气相，音调较肺泡呼吸音低，音响较强。正常呼吸音听诊要点减弱或消失常见于胸廓活动受限、呼吸肌疾病、支气管阻塞等；增强常见于发热、代谢亢进、贫血等。异常肺泡呼吸音如在正常肺泡呼吸音部位听到支气管呼吸音，则为异常，常见于肺zu织实变、肺内大空腔、压迫性肺不张等。异常支气管呼吸音根据异常呼吸音的类型和病因，采取相应的治疗措施，如针对病因治疗、改善呼吸功能等。处理建议异常呼吸音识别与处理建议啰音分为干啰音和湿啰音，干啰音音调较高，持续时间长，吸气及呼气时均可听及；湿啰音为呼吸音外的附加音，断续而短暂，一次常连续多个出现，于吸气时或吸气终末较为明显。胸膜摩擦音当胸膜面由于炎症而变得粗糙时，随着呼吸便可出现脏胸膜和壁胸膜间的摩擦声，即胸膜摩擦音，常于前下侧胸壁听到，吸气末