It is done with the eyes and the intellect.（由大脑和眼睛来完成）
Must note the dynamics of the patient's facial expression（必须动态的观察病人的表情）
In relationship to physiologic activities（在生命活动过程中）
To the questions asked by the examiner(在询问病史过程中)
Search for(寻找是否有以下情况)
The use of pursed lips during expiration
The activity and development of the sternocleidomastoid muscles
The use of other accessory muscles of ventilation
The presence of shoulder girdle fixation in relationship to the use of these accessory muscles
The presence of jugular venous distention
The flaring of the nasal alae
The degree of comfort
The presence of cyanosis and clubbing
palpation触诊
It is the next stage of the examination(它是检查的下一个阶段)
Search for areas of lesion in the chest(寻找病变区域)
With the patient disrobed, place the entire palm of each hand first on the superior portion of both hemi thoraces, and then, gently though firmly, move the hand inferiorly to just below the twelfth rib. Repeat the process moving laterally and subsequently anteriorly search for rib deformities, nodules, and areas of tenderness.
In the face of a history of chest discomfort, ask the patient to point to the areas of greatest discomfort. Palpate the area with increasing firmness in an attempt to elicit tenderness and to assess if this maneuver reproduces the patient's symptoms.
To assess the position of the trachea(评估气管的位置)
This is accomplished best with the examiner stationed behind the patient, palpating the anterior inferior neck jus above the jugular notch by gently pressing the fingertips between the lateral tracheal wall and the media portion of the sternocleidomastoid muscle. Comparing one side to the other, an assessment is made of the position of the trachea: midline or deviation away from the centrist position
percussion叩诊
purpose(目的)
The purpose of percussion is to determine if the area under the percussed finger is air filled， fluid filled or solid.(叩诊的目的是判断被叩诊手指下的区域的脏器是否充满空气、液体还是固体)
Normal percussion sound（正常叩诊音）
adult
The normal percussion note over adult lung fields is called resonance(清音).
small children
Small children will percuss more hyperresonant.（鼓音）
Percussion also is useful in assessing diaphragmatic excursion（叩诊可以有效的判断横膈肌的肺底移动度）
The distance the diaphragm moves from expiration to inspiration(便宜的程度是指横膈肌在随呼气和吸气时移动的距离)
Step(步骤)
First, have the patient exhalc fully and then hold her or his breath as you percuss from resonance over the lung tissue to dullness over the diaphragm. Mark this area
Next, have the patient take a deep breath and hold it. Continue percussing al ihe same location, moving from resonance to diaphragmatic dullness. Again, mark the area.
Normally, the percussion that was previously dull at the diaphragm should change to resonance as the lung fills with air and the diaphragm moves downward
Measure the distance between the two marks in centimeters.Normal diaphragmatic excursion is 3 to 6 cm
auscultation听诊
Auscultation involves using your sense of hearing to collect data.（由听觉来收收集数据）
Environmental conditions of auscultation（听诊的环境条件）
Auscultation of the chest ideally is performed in a quiet room with the patient either sitting or standing.
Be sure the roorn is private, warm, and quiet, and warm the diaphragm of the stethoscope between your hands before you begin
The role of auscultation（听诊的作用）
Use auscultation to assess airflow through the upper airways and lungs
