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正確版身評胸腔
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正確版身評胸腔
1.
2.
身體檢查與評估 - 胸腔 Physical
Assessment & Examination
3.
檢查前的準備 環境與用物 環境 安靜的環境>有助於正確地聽呼吸音 充足的光線>有助於視診的進行>自然光為佳 用物 手電筒、聽診器、標示筆、尺
4.
檢查步驟 一、視診 - 離個案一公尺 I.胸廓形狀 II.呼吸型態 III.皮膚 二、觸診 三、叩診 四、聽診
5.
一、視診 I.胸廓形狀 (thoacic configuration) 脊柱的曲度 肋骨斜度 肋緣角 前後徑與左右徑之比例 兩側肩胛骨與呼吸運動的對稱性
6.
一、視診 II.呼吸型態 觀察: 1.呼吸速率、深度、節律 2.呼吸時使用的姿勢及舒適程度 3.(呼吸時)是否使用呼吸輔助肌 4.(呼吸時)肋間肌是否突起或凹陷
7.
一、視診 III.皮膚 觀察: 1.顏色 2.是否乾燥 3.是否盜汗 4.是否有傷疤組織 5.是否有杵狀指
8.
檢查步驟 一、視診 - 離個案一公尺 二、觸診 I.皮膚與皮下組織 II.胸廓膨脹 III.觸覺震顫 IV.氣管的位置 三、叩診 四、聽診
9.
二、觸診 I.皮膚與皮下組織 觸診: 1.溫度 2.膨脹度 3.結構 4.是否有壓痛或腫塊
10.
二、觸診 II.胸廓膨脹 又稱呼吸離軌度(respiratory excursion)
11.
二、觸診 III.觸覺震顫 檢查者令個案說 : "阿~~~~~" 用手指基部的掌面(the
hall of the hand) 一手觸診可以使準確性達到最大
12.
二、觸診 IV.氣管的位置 了解氣管是否有偏移現象 檢查者將一手指置於氣管上,後此手指向左右兩 邊側移,以辨認三角區域是否相等
13.
檢查步驟 一、視診 - 離個案一公尺 二、觸診 三、叩診 I.叩診後胸 II.叩診前胸 III.橫膈膜離軌度 四、聽診
14.
三、叩診 I.叩診後胸 叩診時,須經過每一肩部頂端及其內側,以辨認 肺尖上大約5公分的反響帶,然後,當個案的雙 手抱胸,以約5公分間隔延胸壁向下叩擊肺臟兩 側,在肩胛骨以下除了沿兩外側對稱部位叩擊外, 也要叩擊內側
15.
三、叩診 I.叩診前胸 方法: 由上往下包括上鎖骨區及下鎖骨區,以5公分的間 隔由胸壁往下檢查 辨別: 由叩音的變化可以辨識肝濁音的上緣及胃部股音
16.
三、叩診 III.橫膈膜離軌度(diaphragmatic exursion) 目的:測量肺臟的容積、橫膈膜的功能 方法:叩診後胸 先讓個案正常呼、吸氣,再深吸氣後閉氣不動; 再讓個案正常呼、吸氣,在吐氣吐完閉氣不動; 以上兩動作後由肩胛骨下角以叩擊的方式垂直往下 並且聽到反響音變成濁音時坐下記號。 兩記號之差距及是所求。
17.
檢查步驟 一、視診 - 離個案一公尺 二、觸診 三、叩診 四、聽診 I.呼吸音 II.異常呼吸音 III.語音
18.
四、聽診 I.呼吸音 解釋: 是因為氣流通過氣管樹所產生的聲音 分析: 強度、音調 吸氣和呼氣持續時間及性質
19.
四、聽診 II.異常呼吸音 解釋: 不是指"正常呼吸音"改變,而是指"額外的聲音" EX: 囉音(rackles)、鼾音(rhonchi)、喘鳴聲(wheeze)、 摩擦音(frictiion rubs)
20.
四、聽診 III.語音 通常是在"觸覺震顫"、"叩診"或"聽診"有異常發 現時,才需要執行 語音產生的機轉同於觸覺震顫,不同之處在於與 音的測試需用聽診器。 EX:支氣管語響(bronchpphony)、 羊音語響(egophohy)、 耳語樣胸語響(whispered pectoriloquy)
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