BS Physical examination 3

c. Eye sclera: color and presence or absence of bleeding. Technique for examining the sclera With 2 fingers pulling the palpebrae, the patient looks down. d. Conjunctiva: color, presence or absence of bleeding, anemic or not. Circumstances Anemia can be checked by the pale color of the palpebral conjunctiva inferior. Blood seepage in the palpebral conjunctiva will cause color blueness throughout the eyelid is called Black Eye or Brill hematoma if about both eyes. e. Pupils: normal pupils, equal in size (isochores) approximately 3 mm in diameter. when given light, the diameter will decrease left and right which is called a reflex direct and indirect light (nervus 6 / abducens). a. Eyeball pressure/Intraocular pressure (IOP): palpation using both index finger to palpate the left and right eyeballs in eye condition closed, the nurse compares the elasticity of the left and right eyeballs. 9. Vision a. Vision / Sharpness of Vision Using a Snellen optotype installed 6 meters from the patient, then The patient is asked to name the letter or number indicated by the examiner. b. View / field of vision: patient and examiner sit facing each other around 60-100 cm, the patient closes the other eye using palms and eyes that are not closed, looking at objects regulated by examiner. c. Oculomotor nerve, Trochlearis, abducens (3,4, & 6). Nerves 3 and 4: Threat reflex (corneal reflex): using cotton brought close to the cornea, the cornea will spontaneously close. Nerve 6: checked by assessing the ability to move the eyeball in all directions. 10. Nose -Inspection: inspected with a speculum tool to help open nose to see clearly. The findings are the location of the concha, the presence of inflammation, lesions, polyps, hair and secretions. - Smell test (olfactory nerve / nervus 1): The patient is given the smell of coffee and tea. 11. Ears - Inspection: using a penlight, the aim is to see the intact tympanic membrane in a good position it will reflect the politzer light reflex on the pen illumination light. Tympanic membrane intact with negative Politzer reflex, convex (pus present). in the ear) or concave due to retraction (the middle ear is lower than the atmosphere). - To check hearing function with the Rinne, Weber, Schwabach test. a. Rinne test (256 Hz tuning fork): the tuner is vibrated, the stem is pressed on proc. Mastoid, just when the patient doesn't hear a sign, then move the vibrating tip to the face of the patient's ear canal. Still normal a sound is heard, which is called positive rinne (normal or non-total perceptive deafness). Conductive deafness gives a negative Rinne result. b. Weber test (512 Hz tuning fork): The tuning fork is vibrated with the stem attached in the midline of the patient's head at the vertex or glabella. The patient is asked Say which side of the ear hears louder. The answer may be wrong one sounds louder or equally loud. One side is harder called lateralization to the right or left side. Louder sounds on the left could mean 2 things: a. Conductive deafness in the left ear. b. Right ear writes perceptively. Same hard means: a). Both ears are normal. b). Both ears are conductive deaf. c). Both ears are perceptive deaf. c. Schwabach test (512 Hz tuning fork) To compare the conduction of sound through the skull to the cochlea between examiner and patient. Requirements: the hearing examiner is normal. After the tuning fork is vibrated, it is attached to the proc. The patient's mastoid, Immediately when no sound is heard, the patient gives a signal. Then moved to examiner's mastoid proc. If you can still hear it, say so The patient's Schwabach is shortened. If the order is reversed, it means there is interference in the patient's cochlea system (perceptive deafness). Normal Schwabach, same result with the examiner. 12. Mouth a. Oral Cavity: checked for bad breath, inflammation of the mucosa (stomatitis) and the presence of canker sores (aphatae). b. Teeth: checked for food, tooth decay, carries, remaining roots, teeth the date. c. Tongue: dirty or clean tongue. d. Tonsils: checked whether they are inflamed or not. 13. Neck a. Thyroid Checked by inspection and palpation. Inspect the shape and size if there is real enlargement, it looks symmetrical or not. Palpation with one hand from the side or two hands from behind, fingers touch the surface of the gland and the patient is asked to swallow. b. Lymph, sub mandibular by palpation. This check is for find out if there is an infection in the area around the gland to be examined. Palpate from below the ear to the middle of the neck (thyroid). c. JVP (jugular vein pressure), the aim is to find out the presence of fluid overload and an indirect picture of the top ventricular pumping function. JVP measurement: the patient is laid down with a pillow at a 45-degree position degrees. Bend the supraclavicular area so that the jugular vein is clearly visible. Then press the proximal end of the jugular vein (near the mandibular angle) while removing the supra clavicular dam. Observe the high level of blood in the colon There is. Measure the vertical distance from the top surface of the blood column found to horizontal plane passing through the angle of ludovici. Let's say the distance is a cm below or above the horizontal plane. JVP= 5- a cm (if below the horizontal plane). 5 + a cm (if above the horizontal plane). 5 + 0 cm (right on the horizontal plane). The normal value is 5-2 cm of water. d. Stiff neck The aim is to determine whether there are abnormalities or damage to the brain. Examination with one hand under the head, one hand the other is in the upper chest to keep the client from getting up. 14. Chest and Back 1. Lungs a. Inspection Inspection of the shape of the thorax, breathing pattern or rhythm and signs cyanosis. There are 4 types of thorax shape, namely: 1). Bird chest shape: protruding sternum (pigeon chest). 2). Concave chest shape: funnel chest 3). Barrel chest: large bulging rear face. 4). Kyposis (back bulging out), lordosis (back bottom in and buttocks out), scoliosis (back forming an inverted c/c). There are 3 types of breathing patterns or rhythms, namely: 1). Normal = 12-20x/minute. 2). Tachypnea= More than 20 x/minute. 3). Bradypnea = Less than 12x/minute. Signs of cyanosis on the nail tips are pale in color. b. Palpation The aim is to assess left and right lung vibrations and compare which part vibrates more or less. Palpate the wall thorax using the entire palm and fingers on the left and right side of the patient's thorax while the patient utters seventy-seven over and over again. The vibrations that are felt are called vocal fremitus. Touch throughout the surface of the chest (left, right, front, back). If there Compaction of lung tissue (pneumonia, malignancy) will be felt more shiver. Pleural effusion and pneumo thorax will feel less vibrating. c. Percussion Percuss the thorax wall by tapping with the middle finger right on the middle finger- of the left hand which is firmly attached to the walls in the intercostal gaps. There are 4 thorax percussion sounds: 1). Sonor is the percussion sound of normal lung tissue. 2). Dimness is a denser/consolidated tissue percussion sound lungs like pneumonia. 3). Deafness is the percussion sound of dense tissue as it is fluid in the pleural cavity, percussion of the heart area and percussion of the liver area. 4). Hypersonor/tympany is a percussion sound in a larger area empty hollow like chronic asthma sufferers, especially with the shape barrel chest. Chest percussion can also assess the boundaries of the heart, where it is normally: a). Upper heart limit ICS 2-3 b). Right border of the heart right linea sternalis, ICS 5 c). The left border of the heart is the left medio-clavicular line (1 finger medial to the linea left mid-clav). d. Auscultation The goal is to listen to sounds on the thorax wall with how to use a stethoscope. There are 3 sounds that can be heard, namely: 1. Breath sounds a). Vesicular: heard throughout normal lung fields. Smooth, low tone, inspiration longer than expiration.