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DISCUSSION
PHYSICAL EXAMINATION
a. Defenision
Physical examination was the review from head to toe on every system of
the body that provides information on clients and allows nurses to mebuat clinical
assessment. The accuracy of the physical examination affect selection of treatment
received by the client and the determination of response to therapy. (Potter and
Perry, 2005)
Physical examination is an examination of the client's body as a whole or
only certain parts as may be necessary, to obtain data and comprehensive
sistematif, ensure / prove results diagnose, determine the problem and to plan
appropriate nursing action for a client. (Goddess Sartika 2010) .
b. The purpose of the Physical Examination
All parts are palpable pain at the end For example: the presence of
tumor, edema, crepitus (fractures), and others.
3. Percussion
Percussion is tapping examination covering the body surface
fatherly produce sounds that will assist in helping to determine the density,
location, and position in the underlying structure (A.Talbot Laura and
Mary Meyers, 1997).
Percussion is the examination of the surface of the road knocking
specific body parts to compare with other body parts (left / right) to
produce a sound, which aims to identify limits / location and
consistency of the network. (Dewi Sartika, 2010). The voices are
found in percussion are: Sonor: percussion sounds normal tissue.
Dim: percussion sounds denser network, for example in the area of the
lungs in pneumonia.
Pekak: percussion sounds dense tissue such as the percussion area of
the heart, the liver area percussion.
hipersonor / timpani: the percussion sound more hollow areas, such as
the lung caverna, the client with chronic asthma.
4. Auscultation
Auscultation is the act of listening to sounds generated by various
organs and tissues of the body. (A.Talbot Laura and Mary Meyers, 1997).
Auscultation physical examination is done by listening to the sound
produced by the body. Usually using a tool called a stethoscope. The
things that are heard: heart sounds, breath sounds, and bowel sounds.
(Dewi Sartika, 2010).
Abnormal sound that can be auscultated in breath are:
Rales: sound produced from the sticky exudate while subtle channels
of respiratory expands on inspiration (rales fine, medium, coarse). For
example, the client pneumonia, tuberculosis.
Ronchi: low tone and very rough sounding both during inspiration and
expiration. Characteristic Ronchi is lost when the client coughs. For
example, in pulmonary edema.
Wheezing: sound is heard "ngiii ... .k". can be found in the phase of
inspiration and expiration. For example, in acute bronchitis, asthma.
Pleural Friction Rub; sound that sounds "dry" sound like rubbing
sandpaper on wood. For example, on the client with pleural
inflammation.
Control of infection
Includes washing hands, put sterile gloves, masks installing, and help clients
wearing check if there is.
Control the environment
Ie make sure the room in a state of comfortable, warm, and enough light to
perform a physical examination both for clients and for the inspectors
themselves. For example, closing the door / jendala or skerem to maintain the
privacy of clients.
Communication (explanation of the procedure)
Privacy and comfort of clients
Systematic and consistent (head to toe, internal to the external dr, dr normal
to ABN)
Being on the right side of the client
Efficiency
Documentation
Hair:
To determine the color, texture and branching in the hair
To find out easily fall out and dirty
actions:
I = disribusi hair evenly or not, dirty or not, branched
P = easy to fall / no, texture: rough / smooth
Nails:
P = Look for cuts, bulges pathologic, and response to pain by pressing the
head as needed
Eyes:
To determine the shape and function of the eye (field vision, visual acuity
and eye muscles)
To determine the presence of abnormalities or inflammation of the eye
actions:
I = no inflammation of the eyelids or not, the right and left symmetrical or not,
blink reflex good / not, conjunctiva and sclera: red / conjunctivitis, jaundice /
indication Hiperbilirubin / disorders of the liver, the pupil: isokor right and left
(normal), miosis / shrink, pin point / very small (suspected SOL), medriasis /
landscape / dilatation (deceased patients)Inspection of eye movements:
Ear
To determine the state of the outer ear, ear canal, eardrum
To determine the function of hearing
actions:
Outer ear:
I = auricle symmetrical or not, color, size, shape, cleanliness, presence of Lesy.
P = Press earlobe whether there is a response to pain, feel the resiliency of
cartilage.
Ear in:
Note: Adult: Leaves the ear is pulled up so you can easily see
Children: Leaves ears pulled down
I = inner ear with an otoscope note memberan tympani (color, shape) the presence
of cerumen, inflammation and foreign body, and blood.
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Examination of hearing:
1) Examination with a whisper
Set the patient standing back to the examiner at a distance of 4-6 m
instructed the client to cover one ear that is not checked.
gasped out a number like "6 or 5"
Telling the patient to repeat what is heard
Examining the ear
Compare the left and right ear hearing ability
2) Examination of the timepiece
Set susasana calm.
Hold a watch in addition to the client's ear.
Telling a client state whether hear the beating of a watch.
Move the watch slowly away. ear and told the patient said he did not hear
anymore.
Normally at a distance of 30 cm can still be heard.
Examination of the tuning fork:
a. Rinne test
Hold the tuning fork (GT) on the stalk and hit into the palm of the
hand
Put the client's GT on the mastoid process
Encourage the client has told the examiner does not feel any vibration
Then lift GT quickly and place it in front of the outer ear canal a
distance of 1-2 cm, with a position parallel with the ear.
Mengistrusikan on whether the client is still mendengara or not.
Record the results of the examination
b. Weber test
Grasp the handle and hit the GT on the palm of the hand or fingers
Put the stalk in the middle of the top of the head GT / os. Frontal
above.
Tanayakan on the client if the voice sounds the same clear distinction
between right and left ear or only apparent on one side only.
Record the results of the examination
c. tests Swebeck
To find out comparing patients with a hearing examiner
Put your GT in the client's ear and then quickly hold your ear to the
examiner.
Mouth and Pharynx:
To determine the shape and abnormalities in the mouth
To determine the oral hygiene
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actions:
Observe what I = no abnormalities kogenital lip (cleft lip), color, symmetry,
moisture, swelling, lesions.
Observe the number and shape of teeth, cavities, color, plaque, and dental hygiene
Inspection of the mouth and pharynx:
Telling the patient open mouth mucosa observed: texture, color, moisture,
and the presence of lesions
Observe the tongue texture, color, moisture, lesions
To see the pharynx use tongspatel already wrapped sterile gauze, then ask
the client stuck out his tongue and said "AH" observe ovules / epiglottis is
not symmetrical to the pharynx, observe inflamed tonsils or not (tonsillitis
/ tonsillectomy).
P = Hold and press the cheek then felt what no mass / tumor, swelling and
pain.
Palpate floor of the mouth using the index finger using handscond, then
tell the patient to say the word "EL" as he stuck out his tongue, hold the tip of
the tongue with gauze and press the tongue with a finger, thumb hold the
position of the chin. Note whether there is a response to pain on the action.
d. neck
To determine the structural integrity of the neck
To determine the shape of the neck and organs associated
To check the lymphatic system
actions:
I=Observe the shape, color of skin, scar tissue
Observe for swelling glands tirod / goiter, and the presence of mass
Observe kesimeterisan neck from the front, back and sides of the right and
left
Ask the patient to work the neck (flexion-extension ka.ki), and
merotasi- can easily observe whether and what pain response.
P = Put both hands on the neck of the client, tell the patient to swallow and
feel the presence of the thyroid gland (examine the size, shape, a surface.)
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Stand in front of the client and put both hands in the chest under the papilla
examiner, instruct the patient took a deep breath, feel the same if the right and
left lung
Standing behind the patient, place the palms on the bottom line of scapula /
high costa 10th, right thumb and left on hold do not get stuck, and stretch
your fingers at approximately 5 cm from the thumb. Have the patient back
breathing in and observe the movement of the right thumb and left the same
or not.
Palpation of the posterior and anterior Tactile vremitus:
Place your right palm on the back of the chest right at the apex of the
lung / stinggi supra scapula (posterior position).
instruct the patient to say "Ninety-nine" (low tone)
Ask the client to repeat the word mengucapkkan, while the examiner
moving the position to the right and left then down to the basal lung or
vertebral height thoraxkal 12th.
Compare vremitus on both sides of the lung
When the patient asked to speak fremitus dim lower
Repeat / do on the anterior chest
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Pe / Percussion =
Set the patients with supination
For anterior percussion began last clavikula limit down to fifth
intercostal tentukkan limit the right lung and the left (normal lung
sounds: resonant entire lung field, limits liver lung and heart: dim)
If there is pulmonary edema and effusion plura voice faded.
Aus / auscultation =
Gunakkan diaphragm bell stethoscope for adults and children
Place the stethoscope on the intercostals, menginstruksikkan patient
to breath slowly and listen later in the breath sounds: vesicular /
wheezing / creckels
Heart / Cordis
I = Observe the heart rate in the area of moldy midsternu approximately
2 cm below the xiphoid besides.
P = Sensing pulsation
percussion =
auscultation =
f. Stomach / Abdomen
To determine the shape and wiggle stomach
To listen to the sound of gut pristaltik
To study the response of tenderness in the abdominal organs
actions:
I = Observe the general shape of the stomach, skin color, presence of retraction,
protrusion, the existence of the simetrisan, the presence of ascites.
P = mild Palpation: To determine the response of a mass and tenderness in the
abdomen place the palms are crossed, and evenly press the appropriate quadrant.
Palpation in: To determine the position of internal organs are like liver, kidney,
spleen with bimanual method / 2 hands.
hepatic:
Place the examiner's hand with finger up position on the right hypochondria,
think; sometime in the intercostal to 11-12
Press when the patient inhaled approximately 4-5 cm deep, feel the presence
of
the
liver
organ.
Assess
hepatomegaly.
spleen:
Method of tools such as the examination hapar
Instruct the patient tilted to the right and place your hand under the left
intercostal and asking the patient take a deep breath and press when inhaled
determine the presence of the spleen.
In normal adults are not palpable
renal:
To place the hand palpation of the right kidney on the upper and lower
abdomen as high as 3-4 under the right costal lumbar.
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To place the hand palpation of the left kidney as high as 1-2 Lumbar under
the left rib.
Press the 4-5 cm depth after inhalation if patients feel palpable kidney shape,
contour,
size,
and
response
to
pain.
genetalia
To determine the presence of lesions
To determine the presence of infection (gonorrhea, shipilis, etc.)
To determine the cleanliness of the genetalia
actions:
male genetalia:
female genitalia:
or
not
P = Pull the labia majora gently with the fingers of the one hand to determine the
state of the clitoris, hymen, orifice and perineum.
Rectum and Anal
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-To determine the mobility, muscle strength, and disturbances in certain areas.
actions:
Muskuli / Muscle:
Inspection of the size and the presence of atrophy and hypertrophy (measure
and record if there is a difference with the meter)
Palpation of the muscles rest and during muscle contraction to find a
weakness and a sudden contraction
Perform test of muscle strength by having the patient pull or push the
examiner's hand and compare hands ka.ki
Observe the strength of a muscle to give custody to the upper and lower
limbs, tell the patient to hold hands or feet while pulling inspectors from the
weak to the strongest observed whether the patient can withstand.
Bone / ostium:
Observe normality and bone composition abnormalan
palpation to determine the presence of tenderness and swelling
Joints / Articulasi:
Inspection of all joints for the presence of joint disorder.
Palpation of the joints is no tenderness
Assess the range of mosion / range of motion (abduction-adduction, rotation,
flexion-extension, etc.)
actions:
Assessment of cranial nerve 12 (O.O.O.T.T.A.F.A.G.V.A.H)
1. olfactory / smell:
Asking the patient smell a rat smell of coffee and vanilla or other scent that
is not overpowering. Whether the patient can recognize the scent.
2. Optic / vision:
Asking the client to read material and identify objects around, clear or not.
3. Oculomotor / contraction and dilation of the pupil:
Assess the direction of view, measuring pupillary reaction to light and
accommodation reflection.
4. Trokhlear / move your eyeballs up and down:
Assess the direction of gaze, ask the patient to see k Etas and under
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Use objects with moderate sharpness (pencil / ballpoint pen) or the end of
the stick harmmer
scratched in the lateral part of the patient's foot, starting from the end of the
soles of the feet up to the corner and turn the palm of the little finger to the
thumb. Positive reflexes feet will be drawn into.
7. reflex cutaneous
a. gluteal
Ask the patient to perform a position lying on her side and open
the necessary briefs
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a. Conclusion
Physical examination dalah checks the client's body as a whole or just certain
sections as deemed necessary, to obtain systematic and comprehensive data,
ensure / prove results diagnose, determine the problem and to plan appropriate
nursing action for a client.
Physical examination to be conducted on every client, especially on clients,
new to the health service for in-patient, routine on the client being treated, at any
time as per client requirements. So the physical examination is very important and
should be done on these conditions, both the client in a state of conscious or
unconscious.
Physical examination is very important because it is very helpful, either for
nursing diagnosis, selecting appropriate interventions for the nursing process, as
well as to evaluate the outcomes of nursing care.
b. suggestion
In order for physical examination can be done well, then the nurse must
understand the science of physical examination perfectly and physical
examination must be performed sequentially, systematic, and done with proper
procedures.
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BIBLIOGRAPHY
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