體格檢查胸部檢查課件

匯報(bào)人：xxx20xx-03-15體格檢查胸部檢查ppt課件目錄胸部檢查概述胸部視診胸部觸診胸部叩診胸部聽診胸部影像學(xué)檢查簡(jiǎn)介01胸部檢查概述評(píng)估胸部器官和zu織的結(jié)構(gòu)、功能狀態(tài)，發(fā)現(xiàn)潛在疾病或異常情況。目的為臨床診斷和治療提供重要依據(jù)，有助于及早發(fā)現(xiàn)胸部疾病，避免病情惡化。意義胸部檢查目的與意義詢問病史→觀察胸廓形態(tài)→觸診→叩診→聽診視診、觸診、叩診、聽診等多種檢查手段綜合運(yùn)用，以獲取全面的胸部信息。胸部檢查流程與方法方法流程以下附贈(zèng)各項(xiàng)管理制度英文版（不需要可刪）急救藥品、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.護(hù)理文書書寫制度:

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.環(huán)境安靜暴露部位保暖措施尊重隱私胸部檢查注意事項(xiàng)確保檢查環(huán)境安靜，有利于準(zhǔn)確聽診。注意為受檢者保暖，避免受涼。充分暴露胸部，以便進(jìn)行觀察和觸診。保護(hù)受檢者隱私，避免不必要的尷尬和誤解。02胸部視診觀察胸廓形狀，有無(wú)扁平胸、桶狀胸、佝僂病等異常表現(xiàn)。胸部外形注意有無(wú)皮疹、瘢痕、靜脈曲張等，觀察顏色及溫度。皮膚觸診時(shí)，將兩手放于胸廓兩側(cè)，并輕輕按壓，若感覺氣體在皮下zu織內(nèi)移動(dòng)，則提示皮下氣腫。皮下氣腫胸部外形與皮膚觀察觀察呼吸次數(shù)及節(jié)律，有無(wú)增快、減慢或不規(guī)則。呼吸頻率呼吸深度呼吸方式觀察呼吸時(shí)胸廓起伏的幅度，有無(wú)淺快或深慢呼吸。觀察是以胸式呼吸為主，還是腹式呼吸為主，或兩者并用。030201呼吸運(yùn)動(dòng)觀察從前面、側(cè)面和后面觀察胸廓的對(duì)稱性，有無(wú)一側(cè)膨隆或塌陷。對(duì)稱性觀察胸廓在吸氣和呼氣時(shí)的活動(dòng)度，有無(wú)活動(dòng)受限或反常呼吸?；顒?dòng)度觀察肋間隙的寬度，有無(wú)增寬或變窄，觸診時(shí)有無(wú)壓痛或異常感覺。肋間隙胸廓對(duì)稱性與活動(dòng)度評(píng)估03胸部觸診胸壁壓痛檢查用手指輕壓胸壁，觀察患者是否出現(xiàn)疼痛反應(yīng)，以及疼痛的部位、范圍和程度。胸壁摩擦感檢查將手掌平放在胸壁表面，讓患者進(jìn)行深呼吸，感受胸壁在呼吸運(yùn)動(dòng)中的摩擦感，判斷是否存在胸膜炎癥等病變。胸壁壓痛與摩擦感檢查乳房觸診技巧采用指腹觸診法，用指腹輕壓乳房，按一定順序進(jìn)行滑動(dòng)觸診，以發(fā)現(xiàn)乳房?jī)?nèi)的腫塊、結(jié)節(jié)等異常。異常識(shí)別根據(jù)觸診結(jié)果，判斷乳房是否存在腫塊、結(jié)節(jié)、疼痛等異常，并結(jié)合患者年齡、病史等因素進(jìn)行綜合分析。乳房觸診技巧及異常識(shí)別讓患者采取坐位或臥位，檢查者用指腹輕壓患者腋窩，按照一定順序進(jìn)行滑動(dòng)觸診，以發(fā)現(xiàn)腫大的淋巴結(jié)。腋窩淋巴結(jié)觸診方法在觸診過程中，要注意觀察淋巴結(jié)的大小、形態(tài)、質(zhì)地和活動(dòng)度等特征，并結(jié)合患者病史進(jìn)行綜合分析。同時(shí)，要避免過度用力或刺激患者皮膚，以免引起不必要的疼痛和不適。注意事項(xiàng)腋窩淋巴結(jié)觸診方法04胸部叩診123清音、濁音、鼓音在胸部的正常分布區(qū)域及特點(diǎn)。正常叩診音實(shí)音、過清音、濁鼓音等異常叩診音的出現(xiàn)原因及臨床意義。異常叩診音不同疾病狀態(tài)下叩診音的變化規(guī)律及診斷價(jià)值。叩診音變化與疾病關(guān)系叩診音分布及特點(diǎn)分析肺界叩診方法前界、后界、下界的叩診技巧及注意事項(xiàng)。肺界叩診結(jié)果解讀正常肺界范圍及異常肺界的臨床意義，如肺界擴(kuò)大、縮小等。肺界變化與疾病關(guān)系肺部疾病對(duì)肺界的影響及肺界變化在疾病診斷中的應(yīng)用。肺界叩診技巧與結(jié)果解讀積液量、部位與叩診音的關(guān)系，以及如何鑒別漏出液與滲出液。胸腔積液的叩診表現(xiàn)氣胸部位、范圍與叩診音的關(guān)系，以及如何判斷氣胸的嚴(yán)重程度。氣胸的叩診表現(xiàn)實(shí)變部位、范圍與叩診音的關(guān)系，以及實(shí)變的原因及臨床意義。肺部實(shí)變的叩診表現(xiàn)肺氣腫部位、程度與叩診音的關(guān)系，以及肺氣腫對(duì)肺功能的影響。肺氣腫的叩診表現(xiàn)異常情況下的叩診表現(xiàn)05胸部聽診03識(shí)別正常支氣管肺泡呼吸音為上述兩種呼吸音混合而成，吸氣音與肺泡呼吸音相似，呼氣音與支氣管呼吸音相似。01識(shí)別正常肺泡呼吸音輕柔吹風(fēng)樣，吸氣相長(zhǎng)于呼氣相，音調(diào)較高，音響較弱。02識(shí)別正常支氣管呼吸音類似將舌抬高張口呼出空氣所發(fā)出的“哈”音，吸氣相短于呼氣相，音調(diào)較肺泡呼吸音低，音響較強(qiáng)。正常呼吸音聽診要點(diǎn)減弱或消失常見于胸廓活動(dòng)受限、呼吸肌疾病、支氣管阻塞等；增強(qiáng)常見于發(fā)熱、代謝亢進(jìn)、貧血等。異常肺泡呼吸音如在正常肺泡呼吸音部位聽到支氣管呼吸音，則為異常，常見于肺zu織實(shí)變、肺內(nèi)大空腔、壓迫性肺不張等。異常支氣管呼吸音根據(jù)異常呼吸音的類型和病因，采取相應(yīng)的治療措施，如針對(duì)病因治療、改善呼吸功能等。處理建議異常呼吸音識(shí)別與處理建議啰音分為干啰音和濕啰音，干啰音音調(diào)較高，持續(xù)時(shí)間長(zhǎng)，吸氣及呼氣時(shí)均可聽及；濕啰音為呼吸音外的附加音，斷續(xù)而短暫，一次常連續(xù)多個(gè)出現(xiàn)，于吸氣時(shí)或吸氣終末較為明顯。胸膜摩擦音當(dāng)胸膜面由于炎癥而變得粗糙時(shí)，隨著呼吸便可出現(xiàn)臟胸膜和壁胸膜間的摩擦聲，即胸膜摩擦音，常于前下側(cè)胸壁聽到，吸氣末