视触叩听学习笔记

护理专业英语第二章视触叩听，讲述了胸部检查、触诊、打击乐器、听诊等内容，内容丰富全面且简单明了，值得收藏学习哦！

Chest Examination

• Inspection
  • Inspection is an active process.
    • It is done with the eyesand the intellect.
    • It begins with the initial greeting and continues uninterruptedly during the entire data collection process.
  • Active observation skills are used to search for theuse 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 flaring of the nasal alae
    • the presence of jugularvenous distention
    • the degree of comfort and the presence of cyanosis and clubbing
  • May avoluntary smile be helpful in assessing neurologic function.
  • Inspection of the teeth at that time may reveal extensive pyorrhea that serves to alert the nurses to a dental problem that has a potential as a bacterial source for necrotizing pneumonia.
• Palpation
  • Parts
    • With the patient disrobed , place the entire palm of each hand first on the superior portion of both hemi thoraces
    • Gently though firmly, move the hand inferiorly to just belowthe twelfth rib
    • Repeat the process moving laterally and subsequentlyanteriorly search for rib deformities, nodules , and areas of tenderness
    • In the face of a history ofchest 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
    • Pay particular attention to thecostochondral junctions in patients reporting anteriorchest pain to evaluate the possibility of costochondritis
  • A part of the palpatory portion of the chest examinationis to assess the position of the trachea.
    • This is accomplishedbest with the examiner stationed behind the patient, palpating the anterior inferior neck just above the jugular notch by gently pressing the fingertips between the lateral tracheal wall and the medial portion of the sternocleidomastoid muscle.
    • Comparing one side to the other, an assessment is made of the positionof the trachea midline or deviation away from the centrist position.
• percussion
  • Purpose
    • to determine if the areaunder the percussed finger is air,fluid or solid filled.
  • Resonance
    • The normal percussion note over adult lung fields is called resonance ,small children will percuss more hyperresonant .
  • Assessment
    • Percussion also is useful in assessing diaphragmatic excursion, the distance the diaphragm moves from expiration to inspiration.
    • First, have thepatient exhale fully and then hold her or his breath as you percuss fromresonance over the lung tissue to dullness over the diaphragm. Mark this area.
    • Next, have the patient take a deep breath andhold it.Continue percussing at the same location, moving from resonance to diaphragmatic dullness. Again, mark the area.
    • Normally,the percussion that was previously dull at the diaphragm should changeto resonance as the lung fills with air and the diaphragm moves downward.
    • Measure the distance between the two marks in centimeters.
    • Repeat the procedure on the opposite side. Normal diaphragmatic excursion is 3 to 6 cm.
  • Remember
    • Work quickly to get the most accurate results and not tire the patient.
• Auscultation
  • Auscultation involves using your sense of hearing tocollect data.
  • Assessment
    • Auscultation of thechest ideally is performed in a quiet room with the patient either sittingor standing.
    • Use auscultation to assess airflow through the upper airwaysand lungs.
    • As you listen with the diaphragm of the stethoscope , note normal, abnormal, and adventitious breath sounds, as well as abnormal vocal sounds.
    • Be sure the room isprivate, warm, and quiet, and warm the diaphragm of the stethoscopebetween your hands before you begin.
  • Auscultation sites are the same asfor percussion.