Auscultation - ndi ... palpation, percussion, auscultation

Palpation, percussion, auscultation - ndi njira thupi Kupenda ntchito ndi madokotala padziko lonse mu ndondomeko ya matenda a matenda osiyanasiyana. Njirazi ntchito molumikizana ndi mitundu amuzolengedwa ndi zina za kufufuza, kufufuza malangizo, luso ntchito, pali ambiri. N'zochititsa chidwi kuti cholinga Kupenda imathandiza kwambiri mu matenda.

Auscultation - ndi njira kwambiri mabuku ndi nkhani. Izo ntchito matenda opaleshoni, mankhwala mkati, obstetrics, Pediatrics. Ndi njira imeneyi, kumvera ndi kugunda wa mwana wosabadwayo, kudziwa pamaso pa chibayo, chifuwa, kupunduka mtima ndi matenda ena ambiri mu ana ndi akulu.

Auscultation wa mtima wamkulu

Pamodzi ndi kwambiri nkhani, izo ndi njira yovuta kwambiri Kupenda thupi. Iye amafuna khutu wangwiro, lingaliro la mungoli ndi kuchita zonse, monga lili ndi chiwerengero chachikulu cha mfundo zina zabwino. Matendawa zachipatala auscultation njira kudziwa matenda a mtima ndi matenda a m'mapapo pa siteji oyambirira chitukuko.

Kumvetsera mtima ikuchitika atagona kapena ataima malo. Matenda ena, yodziwika ndi kusintha kwa kugunda kwa mtima pambuyo thupi, kotero nthawizina, chifukwa matenda zolondola, woleza mtima ndi kudzipatula kwa boma la mpumulo thupi. auscultation njira amafuna kutsatira malamulo:

• kusakonda kwa phokosolo yozungulira;
• auscultation za mtima ikuchitika pa kupuma kugwira (ngati nkotheka), komanso padera pa inhalation ndi mpweya;
• amafuna kugwiritsa ntchito stethoscope ndi stethoscope kwa auskultirovaniya kamvekedwe mkulu ndi otsika;
• woyamba wa zonse kudziwa kupezeka ndi kulunjika mawu pa mfundo zosiyanasiyana, ndi kumvetsera kwa phokoso zokhudza thupi kapena pathological.

mtima percussion

Izo ntchito kudziwa malire a thupi ndi afiira mtima. Posachedwapa, njira zimatenga mpando wakumbuyo. Akatswiri ena kwathunthu kuisiya, chifukwa zotsatira za percussion si zolondola kwambiri ndipo ndi anthu ambiri subjectivity. M'malo mwa njira imeneyi anabwera radiography ndi ultrasound, omwe akutipatsa chithunzi thunzi chokwanira cha kukula ndi malo a thupi.

mtima palpation

Chimagwiritsidwa ntchito matenda. Palpation za mtima ikuchitika bwino chimatanthauza udindo ndi mphamvu ya kugunda apical ndi kukanikiza chala m'dera yoyenera. Mu matenda yodziwika ndi inagwedezeka yabwino ya chifuwa, kapena "mphaka wa purr syndrome."

Luso kumva ndi kumvera

The mtima samandivera m'njira wachisokonezo. Pali zolosera kuli nthambi mtima pa chifuwa. Onse anai a iwo.

1. Mitral - IV nthiti kumanzere kwa sternum lapansi.
2. Kung'ambika - III m'mphepete, kudzanja lamanja la sternum lapansi.
3. The m'mapapo mwanga vavu - III intercostal danga kumanzere.
4. Tricuspid - IV intercostal danga kumanja.

Komabe, mfundo ya auscultation zosiyana pang'ono kuchokera ziyerekezo mwachindunji, chifukwa phokoso mu malo awa momveka kwambiri ndiponso yomveka.

1. Pachimake pa mtima - mitral valavu.
2. II intercostal danga kumanja kwa sternum wa - kung'ambika.

An chizindikiro chofunika cha matenda ndi mtima phokoso, kumene kungakhale zonse kapena zimachitika pambuyo katundu wina. Tiyenera kumamveka bwino ndi kumva zonse nthenda mtima mungoli. Nkofunika kudziwa osati phokoso komanso khalidwe ndi malo mapangidwe ake. Iwo angayambe systole ndi diastole.

Pathological, thupi, kapena mwina osati phokoso, komanso magawo ntchito. Mu matenda a auscultation mtima kumathandiza. auscultation mfundo zofanana ndi zimene tafotokozazi. Akhoza kupanga III ndi IV wa malankhulidwe zina wosawoneka zinthu zosiyana (nthawi imeneyi, choyamba wachiwiri kachigawo systole kapena diastole).

Small mtima - udindo waukulu

Ana auscultation - ili ndi gawo lofunika kwambiri ndi matenda. The mwana, makamaka ang'onoang'ono chifukwa cha msinkhu sangathe kukanena za mavuto awo. Dokotala ayenera khutu chidwi ndi digiri yapamwamba ya kulemba, monga malankhulidwe mtima mwanayo kusintha ndi kukula. Tiyeni titsimikize ndi phokoso zinchito kapena nthenda. Nkofunika kuchita kufotokoza poyerekeza pakati pa malankhulidwe loyamba ndi lachiwiri la mphamvu kapena kutsindika. Aliyense kuphwanya umboni za ambiri mwa njira pathological mu thupi la mwanayo.

Masiyanidwe matenda a matenda a mtima ana ntchito njira auscultation

mtima phokoso	zimagogomezera	The kudwala anaulula (Maphunziro Akakhalidwe Kazolengedwa)
choyamba	Pachimake pa mtima	Anachoka atrioventricular orifice mwapang'ono
chachiwiri	msempha	BP, kapena thupi khalidwe la kutha msinkhu
chachiwiri	mtsempha wamagazi m'mapapo mwanga	Maluso ductus arteriosus, stenosis, insufficiency bicuspid valavu, chilemacho interatrial kapena septum interventricular, m'mapapo mwanga mtsempha wamagazi sclerosis, pulmofibroz, myocarditis, congestive mu makope m'mapapo mwanga
Yoyamba ndi yachiwiri	Pa mfundo zonse	wathanzi mtima pambuyo zolimbitsa thupi (thupi kapena psycho-maganizo)

Kuwonjezera inagona, angafooketse malankhulidwe mtima kapena kugawanika awo. Auscultation ali bwinobwino zimaonetsa ngati dotolo adziwa kumvetsera.

Mimba ndi auscultation

Mtima pepala yaikidwa ndipo umayamba kuchepa kale lililonso Msabata lachitatu la mimba, ndipo sikisi ake adamva mu US. Matenda a mayi ndi mwana wosabadwayo chofunika mu akuti makamaka pobereka. Kuchuluka ndiponso zili zikusintha malankhulidwe mogwirizana chitukuko yoopsa.

Auscultation wosabadwa Motero njira ambiri kumodzi ndi zothandiza kudziwa viability ake. Kuchita sitepe imeneyi imafunika obstetric stethoscope (onani chithunzi m'munsimu). Ngati ndi kotheka, ntchito stethoscope.

Iwo akhoza kugawidwa nyengo yonse ya mimba nthawi zingapo (kwa mlingo yoopsa mtima yachibadwa, komanso chikhalidwe cha chidzalo awo).

N'zochititsa chidwi kuti pa sabata 6 mayi atatenga pathupi, kugunda kwa mtima wa mwana chikugwirizana ndi kholo la. kusiyana mwina pini 3 m'mwamba kapena pansi n'kubereka. kuchepetsedwa Komanso chiwerengero cha kumayamba kukula. Popeza kuti kumawonjezera mlingo mtima tsiku lililonse mwa akatemera 3, ndi chovomerezeka kudziwa m'badwo wa histologically mwana wosabadwayo.

Mtima yokha pambuyo miyezi iwiri mimba lagawidwa ndi partitions mu zipinda zinayi - ndi atria ndi ventricles. Kapangidwe Izi zili thupi wamkulu. Kumayambiriro kwa sabata 9 mtima yoopsa akuchita 175 kumenyedwa pa mphindi. Kenako, pafupipafupi amachepetsa kuchokera trimester chachiwiri, mwana wosabadwayo yachibadwa amakhala 140-160 a nkhonya. kupatuka aliyense kuchokera limasonyeza hypoxia ndi tachycardia amadziwika mlingo woyambilira wa akusowa mpweya, ndi bradycardia - sitepe lolemera, napempha alowererepo mwamsanga.

yoopsa palpation

Palpable mu theka lachiwiri la mimba akhoza kudziwa malo a mwana wosabadwayo ndi ziwalo munthu mu chiberekero. Komanso, anatsimikiza zaka gestational mayi kutalika kwa atayima pansi, komanso mutu wa mwanayo ngati mwamphamvu mbamuikha otsegulira beseni kakang'ono - izi ndi harbingers loyamba la kubadwa. Mu obstetrics Leopold ntchito njira chomwe njira zinayi chachikulu.

Auscultation ndi kubereka

Opanda kugunda kwa mtima zikhoza kukhala chiwonetsero cha kudwala ndi maziko vuto lakumva. Izi zimachitika pamene akuchikazi m'mimba khoma thickening (kunenepa), yoopsa cholakwika malo (mwachitsanzo, ndi kumbuyo Tikaganizira za occipital kapena breech) polyhydramnios ndi T. D. Nthawi zambiri Aletsedwa mlingo malankhulidwe mtima kumachitika mu nthawi generic. Matenda a thupi yoopsa pa nthawi ino ndiyofunikila.

Imodzi mwa njira Kupenda mkazi wapakati - palpation. Zimathandiza kudziwa malo a mwana wosabadwayo ndi ulaliki wake. Koma chifukwa chomwecho akhoza zimatheka pamene kwa matenda a yoopsa Kukula kwa auscultation mtima ntchito. auscultation mfundo za khalidwe la. Ngati kugunda kwa mtima limanenedwa bwino pamwamba Mchombo mayi, mwana wosabadwayo ndi breech ulaliki, ngati pansipa - mutu. mwana angakhale hyperactive, kutembenuzira "uku," nthawi yonse ya mimba. Kumvetsera kamvekedwe bwino pa mlingo wa m'michombo limasonyeza udindo yopingasa.

Auscultation ku matenda a matenda a m'mapapo

Auscultation - pali njira akusewera kwambiri kupanga matenda matenda a m'mapapo. Kusiyanitsa mitundu zolondola (kapena vesicular) ndipo zosiyanasiyana za kuvutika kupuma. Komanso, mbali khalidwe zosiyanasiyana matenda zauma kapena lonyowa rales ali ndi ziwalo zina auscultation. Auscultation mfundo anakonza symmetrically.

kusintha thupi vesicular kupuma

Ngati munthu wabwino kapena, Tikawonetsetsa bwino anayamba minofu misa, ali hypertrophied adipose minofu, kusintha kupuma akhoza kukhala mwina motsogozedwa kufooka, ndi phindu lake. Auscultation ntchito ndi stethoscope lapansi.

Kulimbikitsa vesicular kupuma ndi khalidwe ana. Wina dzina lake, sipangakhalenso anamva m'deralo mankhwala - puerile. Pali wina wapadera Mbali - mpweya chomwecho pa mbali ofananira ya chabwino ndi mbali kumanzere.

Matenda a chifuwa ndi auscultation

Auscultation matenda ikuchitika m'njira ochiritsira. Akamalankhula khalidwe la siteji wokonda vesicular mpweya molimba mtundu. A anachita kutupa ndi kuchepetsa wa machubu bronchial. Against limakhala mpweya stiffness anatsimikiza wheezing youma, ndipo iwo angakhale osiyana mu kamvekedwe, komanso kukumbutsa ikulira ndi kuimba mluzu. Izo zimatengera kukula kwa bronchi ndi mlingo wa chidzalo cha chinsinsi chawo. Iwo bwino anamva mu magawo onse kupuma.

Ndi chitukuko cha matenda, ntchofu kupanga mu Airways ukuwonjezeka, ndi auscultation anaulula sing'anga kuonekeratu rale.

Kuti amve mmene mapapo ndi bwino pamene wodwala ali chilili. M'pofunika yerekezerani phokoso mpweya ndi wheezing mfundo womwewo wa lamanja ndi thupi kumanzere. Pali ndondomeko zina lomvetsera - mfundo auscultation - mapapo.

Muyenera kuyamba ndi nsonga ndiyeno kuyendera kutsogolo padziko, ndiyeno mbali ndi kumbuyo. Mu matenda protracted mwina agwirizane phokoso zina Mwachitsanzo, crepitus, zimene zikusonyeza kusintha kutupa mu Airways m'munsi.

Auscultation a m'mapapo ikuchitika mu magawo angapo: pa akuya mwachizolowezi ndi mpweya pambuyo kutsokomola. Makamaka mwatsatanetsatane tione mfundo ya auscultation, ndiwo ambiri "Muzisamala" kwa dokotala.

Matenda a chifuwa nawonso anamanga pa kafukufuku auscultation ndi maphunziro zasayansi zipangizo kwachilengedwenso. Akamalankhula m'mapapo vesicular mpweya mtundu anatsimikiza pamaso pa nthawi okhwima kapena mpweya monga gawo pachimake. Nthawi zina, chifuwa amakwiya chitukuko cha matenda kwambiri - ndiko kumayambitsa. "Thonje" Choncho, amakhala mpweya. Pa wheezing pachimake amamva lonse pamwamba m'mapapo.

percussion kuwala

Percussion kafukufuku akhoza kuchitika njira zitatu ndi mwachindunji pogogoda m'dera kafukufuku mwa mbale kapena chala pa chala. Panopa kwambiri applicable womaliza. Njira sikutanthauza zida zina pa dokotala, ndi kuona mapapo ndi nkhani ndithu.

Percussion mwina lathu poyerekeza kapena mtunda. Wotchuka kwambiri chimake choyamba, ponena kuti kuzindikira zotupa. Izo ndi chisindikizo, kotero percussion phokoso pamwamba pawo kuzimiririka kuposa abwinobwino m'mapapo minofu.

Pali mithunzi ambiri ndi malankhulidwe yotengedwa, tikafuna phokoso. Mwachibadwa, izo ziyenera kukhala akulu, shrill ndi yaitali. Ngati panali afiira, afiira kamvekedwe, zachitsulo hue, boxed kapena thympanitis - umasonyeza pamaso pa wodwala, kapena njira zina yotupa mu mapapo, napempha alowererepo zachipatala.

Auscultation ku matenda a matenda a m'mimba thirakiti

Kumvetsera ntchito ngati njira matenda angapo a matenda a m'mimba thirakiti. Kafukufuku yemwe ndi dokotala ntchito stethoscope, kapena kuika khutu lake khoma m'mimba. Kudzera njira imeneyi anatsimikiza ndi kukhalapo (pakalibe) wa peristalsis mu intestine kapena m'mimba.

Auscultation amachitidwa pa mfundo poyerekeza, ndiko kupeza chithunzi chokwanira lomvetsera chofunika pa mfundo zosiyanasiyana. Muyenera kuchita kafukufuku chete ndipo ngati n'kotheka, popanda wakulimbira savutitsa pamimba.

palpation wa pamimba

Kuphunzira pamimba amanyamula pazipita informativeness palpation njira. Iwo anachita kukakamizidwa waulemu pa pamimba. Tiyenera kuyamba ndi kumanzere groin manja ofunda, kuti chifukwa kusapeza la wodwalayo. Izi ndi zofunika kuti achotse ndi reflex m'mimba khoma mavuto.

Kasamalidwe imadutsa kusanthula poyerekeza cha kumanja ndi kumanzere theka pansi mmwamba. Kukakamiza dera epigastric - komaliza. Ndi soreness izi anatsimikiza ziwalo zosiyanasiyana za mavuto m'mimba khoma, pamaso pa madzimadzi pamimba (fluctuation syndrome).

percussion m'mimba

percussion njira kudziwa malire a chiwindi ndi ndulu, monga iwo m'molema kwathunthu phokoso (m'chiuno). Komanso, akuyerekeza muzituluka ndi matumbo thympanitis, adokotala akhoza kupanga matenda a kutsekeka kwa aliyense m'madi- lapansi.

Mtheradi chiwindi afiira bwinobwino kumatanthauza kumanja mu IV intercostal danga mawu a pafupifupi nipple mzere. Ngati pa Kupenda malowa phokoso tympanic ndi wapezeka, amasonyeza perforation ziwalo, mwachitsanzo M'mimbamo pali madzi.

Percussing ndulu kulibe tanthauzo zothandiza: m'mphepete ake pansi poschupyvaetsya mosavuta palpable.