版權(quán)說明：本文檔由用戶提供并上傳，收益歸屬內(nèi)容提供方，若內(nèi)容存在侵權(quán)，請進(jìn)行舉報(bào)或認(rèn)領(lǐng)
文檔簡介
1、A.GENERALEXAMINATIONVITALSIGNS（一般檢查）（一般檢查）1.Introduceyourselftopatientusuallylastnametitlehavealittleconversationtorelaxthepatienttojudgementalstate.2.WashhsbefestartingexaminationPreferablythisshouldbedoneinviewofthepat
2、ient.3.Patientisseatedinachair4.Palpateradial(wrist)Pulsesfatleast30secondsrecdTheexaminerplacesthepadofhisindexdleringfingersovertheradialartery.Ifproperlydonetheexaminershouldbeabletofeelthearterypulsatingundertheexami
3、ner’sfingertips.Theradialpulsemaybemeasuredf30secondsthenthepulseperminutecanbefoundbymultiplyingbytwo.Attentionshouldalsobepaidtotherhythm.Theexaminershouldnotusehisthumbtopalpateanypulse.5.Palpatebothradial(wrist)pulse
4、ssimultaneouslyfsymmetryfatleast30seconds6.Measurerespiratyratef30secondsrecdTheexaminerunobtrusivelymeasurespatient’srespiratyrate.Thismaybeaccomplishedbytheexaminerleavinghishsonthepatient’swristsfanother30secondsafter
5、measuringtheradialpulsessothepatientdoesnotrealizethattheexamineriswatchinghimbreathe.Thedepthrhythmshouldalsobenoticed.Therespiratyratecanalsobemeasuredduringthebackexam.7.MeasurebloodpressureonrightarmBloodpressuremayb
6、emeasuredwiththepatientinasittinglyingposition.Ineachpositionthearteryinwhichthebloodpressureistobemeasuredshouldbeattheleveloftheheart(atthelevelofthefourthintercostalspaceinthesittingpositionatthelevelofthedleaxillaryl
7、ineinthelyingposition).Thepatient’sarmshouldberestingonasmoothtablesupptedbytheexaminerslightlyflexedattheelbow.8.Placecuffincrectlocation23cmabovetheatecubitalcreaseTheexaminersecuresthebloodpressurecuffsnuglyovertheupp
8、erarmsothatonefingercanbeadmittedunderthecuff.Thecuffshouldbepositioned2～3cmabovetheantecubitalcreaseelbowjoint.Putthedleofthecuffoverthebrachialartery.9.PalpatebrachialarteryTheexaminercanlocatethebrachialarterywhichlie
9、sslightlymedialtothetendonofthebicepsmuscleintheantecubitalfossa.Themercurycolumnonthemanometerdialshouldbeproperlycalibratedwiththepointerat“0”befethecuffisinflated(i.e.alltheairshouldbepressedoutofthecuffbefeitisinflat
10、ed).Thestethoscopeisplacedfirmlyoverthebrachialartery.Theexaminersinflatesthecuffslowlybutsteadily.Untilthebrachialarterypulsedisappears.Thenhecontinuestoinflatecuff2.6～4.0kPa(20～30mmHghighergenerallytoabout21.3kPa(160mm
11、Hg)).10.MeasurebloodpressureoverbrachialarterytwicerecdthelowerreadingDeflatethecuffslowlyattherateofabout0.26kPa(2mmHg)Persecond.Thenumberwheretheexaminerhearsthefirstpulsesoundisthesystolicpressure.Thepulsesoundwillwak
12、enthendisappear.Thenumberwherethepulsesounddisappearsisthediastolicpressure.Ifthedifferencebetweenweakeningofthesounditsdisappearanceis2.6kPa(20mmHg)greatertheexaminershouldrecdthesetwonumbers.Thecuffmustbecompletelyempt
13、iedwiththepointerat“0”befeitisreinflated.ThesameproceduremaybefollowedfasecondmeasurementofB.P.inthesameoppositearm.Thelowerpressureisrecdedasthepatient’sbloodpressure.Afterfinishingthemeasurementtheexaminerdeflatesrolls
14、upthecuffleansthemanometeroveralittlesothemercurycolumndisappearsclosesthemercurycolumnswitchputstheballoon3movesaway.Usethesamemethodtochecktheothereye.18.ObservepupillaryconsensualresponsetolightWiththesamemethodasobov
15、etheexaminershinesthelightintooneeyeinspectsfpupillaryconstrictionintheoppositeeyeobservespupillarydilationinoppositeeyeaslightisextinguished.19.CheckfconvergenceaccommodationTheexaminerpositionedinfrontofthepatientaskst
16、hepatienttolookintothedistancethenathisfinger.Theexaminersfingerstartsfrom1meterawaytheexaminerwillimmediatelymove5cmawayfromthebridgeofthepatient’snose.Theexaminerisobservingthepatient’seyesf:a)pupillaryconstrictionb)co
17、nvergence(thecodinatedmovementofbotheyestowardfixationatthesamenearpointasthepatientfocusesonanearobject).Accommodationincludesconvergencepupillaryconstrictionasthepatientfocusesonthenearobject.Theaccommodationwillvanish
18、whencranialnerveⅢisdamaged.EarsTempomanaibularjoint30.ObservepalpatetheauriclesobservepostauricularregionsbilaterallyTheexaminerpullspalpatestheauricles(outerears)palpatesthepreauricular(infrontof)posteriauricularregions
19、(behindtheears)bilaterally.Tendernessusuallyindicatesinflammation.31.Palpatetempomibularjointftendernessswelling(omitted)Thetempomibularjoint(TMJ)isanteritotheexternalauditycanaloftheear.Examinefswellingtenderness.32.Fee
20、lthemovementoftheTMJwithindexfingersinsidepatient’searsoverjointTopalpatetheTMJjointtheexaminerpressesbothsidessimultaneouslywithonetwofingersasksthepatienttoopenclosehismouththeexaminerplaceshisindexfingerinthepatient’s
21、eargentlypullsfward(anterily)askingthepatienttoopenclosehismouth.(omitted)Nose38.InspectpalpateexternalnosefmalfmationinflammationBeginbyexaminingtheexternalnose.Theexaminerfacesthepatient.Observeskincolshapeofnoseanypal
22、pateflossofstructuretendernessfrombridgetotiptowingsofnose.39.ObservenasalvestibulewithoutotoscopeAviewofthenasalcavitiesisobtainedbytiltingthepatient’sheadbackelevatingthetipofthenosewiththethumb.Theexaminershoulduseali
23、ght.Thenasalvestibulecontainsthenasalhairsvibrissae.Payattentiontoanyfolliculitisfniclesdeviatednasalseptum.40.Turnthetipofthenoseupwardsthetipofthespeculumtoinspectnasalvestibuleanteripartofnasalcavityfulcercrustswellin
24、gdisgeatrophyperfation41.Testpatencybyinhalingthrougheachnostrilseparatelywhiletheoppositenostrilisheldoccluded(omitted)42.PalpatepercussmaxillarysinusfswellingtendernessExaminationoftheparanasalsinusesisdonemeindirectly
25、thanotherotolaryngealprocedures.Theexaminercannotseeintoanyofthesinuses.Palpationpercussionmaybeusedoverthemaxillarysinuses.Simultaneousfingerpressureoverbothmaxillaewilldemonstratedifferencesintenderness.43.palpatepercu
26、ssfrontalsinusfswellingtendernessThefrontalsinusesarepalpatedattheinnerpartoftheupperbderofthebonybitbyfingerpressuredirectedupwardtowardthefloofthesinuswherethesinuswallisthin.Tendernessmaybeelicitedinthisway.Swellingca
27、usedbytumsretainedsecretionsmaycauseadownwardbulgeinthefloofthefrontalsinus.Thefrontalsinusesmayalsobepercussed.MouthlipsPharynx44.ObservelipsbuccalmucosateethgumstongueTheexaminerinspectsthelipsallsurfacesofthetonguegum
溫馨提示
- 1. 本站所有資源如無特殊說明，都需要本地電腦安裝OFFICE2007和PDF閱讀器。圖紙軟件為CAD,CAXA,PROE,UG,SolidWorks等.壓縮文件請下載最新的WinRAR軟件解壓。
- 2. 本站的文檔不包含任何第三方提供的附件圖紙等，如果需要附件，請聯(lián)系上傳者。文件的所有權(quán)益歸上傳用戶所有。
- 3. 本站RAR壓縮包中若帶圖紙，網(wǎng)頁內(nèi)容里面會(huì)有圖紙預(yù)覽，若沒有圖紙預(yù)覽就沒有圖紙。
- 4. 未經(jīng)權(quán)益所有人同意不得將文件中的內(nèi)容挪作商業(yè)或盈利用途。
- 5. 眾賞文庫僅提供信息存儲(chǔ)空間，僅對用戶上傳內(nèi)容的表現(xiàn)方式做保護(hù)處理，對用戶上傳分享的文檔內(nèi)容本身不做任何修改或編輯，并不能對任何下載內(nèi)容負(fù)責(zé)。
- 6. 下載文件中如有侵權(quán)或不適當(dāng)內(nèi)容，請與我們聯(lián)系，我們立即糾正。
- 7. 本站不保證下載資源的準(zhǔn)確性、安全性和完整性, 同時(shí)也不承擔(dān)用戶因使用這些下載資源對自己和他人造成任何形式的傷害或損失。
評論
0/150
提交評論