General Chest Examination

i do not really know what should i wrote today. just try to summarised chest examination that i practise just now.

1. wash hand while introduce myself
2. ask the name and date of birth of the patient.
3. take letter of consent eg : " can i do chest examination to you today? "

inspection

1. make sure the patient sit 45 degree position in a comfortable way.
2. ask the patient to take out shirt
3. stand opposite of the patient (in front of the bed) and look for the the patient face( look ill or not) and scar( had accident or any surgery before)
4. ask the patient to breath deeply ( see the chest expansion - whether normal heart rate and ,symmetrical )
5. look for any ankle oedema
6. ask the patient to lift up hand and make it straight (show method)- see for any nicotine stain and clubbing + hypercarpnic termors* (eyes in same level of the patient hand)
7. check for palmar erythmia( tgn bwh ) and flapping (tgn 90 darjah)
8. check pulse rate *
   
9. ask patient to turn left- check for JVP raise ask patient to stick out tounge and lift it upward - (see any anemia or central cyanotic*)
10. look for the anemia(pale) and jaundice( yellow) when ask patient to look up and look down while streching it.

palpation

1. check trachea is central or not
   
2. check apex beat (normal- in 5th intercostal space at midclavicular line)
3. check for lymph node*
4. check chest expansion at upper and lower chest
   
5. ask patient to say "99" during palpation of both hand at 8 place of the body ( check vocal fremitus)

percussion

1. percussion the same place like to check vocal fremitus but add with both clavicle ( make it in sequece to compare between both side)

auscultation
1. ask patient to breath deeply through out the mouth when you are put the stethoscope to the patient while open the (6 places)
2. do the same step but ask the patient to say "99". (for bronchial vesicular breath sound, and vocal resonance)



ask patient to sit to the left and make her back of body facing opposite me

1. check for the scar, breathing rate, palpation,percussion, and auscultation again.

say thank you.

then summarise.

p/s: * = indicate (i am not really know what that , not familiar word)

i wrote in before sleeping ..if there are any comment or suggestion or additional information i will happy to hear that, thank you

time to sleep ..zzz , a buzy and adventure day tomorrow.
hope to keep strong ..and still smiling.