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Health Assessment

FISIK DIAGNOSTIK

Dilakukan setelah anamnesa penderita


Listen to the patients, he will tell you the diagnosis (E. W. Salzman)

Yang Pertama : KEADAAN UMUM (Subyektif) Sebaiknya dilakukan secara sistematik, berurutan, dan tepat Dilakukan mulai dari kepala hingga kaki (head to toe) Diperlukan ketrampilan klinik dan pengalaman, sehingga harus tetap dilatih dan belajar Memerlukan sarana penunjang :

Senter, Stetoskop, Hammer Refleks, Otoscope, Opthalmoscope, Garputala, dll

KESADARAN PENDERITA

Kesadaran Penderita ada 2 : Kualitatif dan Kwantitatif


AVPU

Alert Verbal Pain Unrespon

: Kesadaran Penuh : Panggilan, Suar : Rangsangan Nyeri : Tidak ada reaksi rangsangan apapun

GCS (Glascow Coma Scale)


Eye Verbal Motorik

Score Score Score

4 5 6

GLASCOW COMA SCALE (GCS)


SCORE

Eye (Mata)

Spontan Suara Nyeri Unrespon

4 3 2 1

Verbal (Suara)

Dapat komunikasi dengan baik (tdk disorietasi) Komunikasi berupa kalimat (Bingung) Komunikasi berupa kata sepenggal & tidak beraturan Suara, tanpa ada kata, merintih (Garbled sound) Unrespon

5 4 3 2 1

Motorik (Pergerakan)

Tidak ada kelainan motorik,sadar (Obey to comment) Dapat mengisolasi rangsangan (dengan suara) Dapat mengisolasi rangsangan dengan nyeri Abnormal flexi (decorticasi) Abnormal Extensi (decerebrasi) Unrespon

6 5 4 3 2 1

KEPALA DAN LEHER

WAJAH

Simetris/tidak mencong, motorik sensoris wajah Jejas (hematome,vulnus,dll), pergerakan artikulasi,

MATA

Jejas, Oedem, Motorik, Exopthalmus,ptosis,dll Anemia, Ikterus, Hypermi /perdarahan konjungtiva, Hypema Reflek Cahaya, Refleks Kornea, Pergerakan bola mata, Retraksi, Buta warna

HIDUNG

Inspeksi : jejas, Anatomi hidung, Pernafasan cuping hidung Corpus alieum dalam lubang hidung, Polip, Rhinorea

BIBIR dan RONGGA MULUT


Inspeksi : Sianosis, Oedem, Leukoplakia, Vulnus, Corpus alineum Lidah : Anemis, Thypoid Keadaan Gigi : Caries, Hungtinton, warna, dll

TELINGA

Inspeksi : Keadaan anatomi, vulnus, Otorhoe Pemeriksaan ketulian : Garputala, Audiometer

REGIO COLI

Inspeksi : Pembesaran KGB, Thyroid, Jugular Vein Palpasi : Nadi carotis, konsistensi benjolan/tumor, ada tidaknya Kaku kuduk

Methods of Examination
Inspection Palpation

Light Deep

Percussion
flatness dullness resonance hyperresonance tympany

Auscultation
pitch intensity duration quality

Components of the General Physical Examination (cont.)

Be familiar with the components and the equipment used for a general physical examination. Ensure the patient is comfortable and his/her modesty is protected.

Can you name these pieces of examination equipment?


9

General Physical Examination Head, Neck, Eyes, Ears


Head - any abnormal conditions of scalp, skin, or growths Neck checks for symmetry and range of motion Eyes check for the presence of disease or abnormalities Ears checks for symmetry, presence of lesions, redness, or swelling

10

General Physical Examination Nose, Sinuses, Mouth and Throat


Nose- checks for presence of infection or allergy Sinuses checks for any discharge, lesions, obstructions, swelling or inflammation Mouth check general impression, condition of gums and teeth Throat checks for redness or swelling

11

Head and Neck


Inspect scalp and hair Facial Symmetry Palpate Sinuses Eyes Ears Inspect Nose Mouth

Neck

ROM Lymph Nodes Palpate trachea Palpate carotids Auscultate carotids

Assess for JVD

Structure and Function Subjective DataHealth History Questions Objective DataPhysical Exam Abnormal Findings

Slide 13-13

Head & Neck


Review Anatomy of head History

Headache Head Injury Dizziness Neck pain Lumps, swelling Surgery

Structure and Function


Head

Cranial bones Sutures Facial bones Facial muscles Salivary glands

Slide 13-15

Abnormal Findings
Abnormalities in Head Size and Contour
Hydrocephalus Pagets disease of bone (osteitis deformans) Acromegaly

Slide 13-16

Abnormal Findings
(cont.)

Pediatric Facial Abnormalities


Fetal alcohol syndrome Congenital hypothyroidism Down syndrome Atopic (allergic) facies Allergic salute and crease
Pat Thomas, 2006.

Slide 13-17

Abnormal Findings
(cont.)

Abnormal Facial Appearances With Chronic Illnesses

Parkinsons syndrome
Cushings syndrome Graves disease Hyperthyroidism

Myxedema (hypothyroidism) Bells palsy Brain attack or cerebrovascular accident Cachectic appearance Scleroderma

Slide 13-18

Cardinal Fields of Gaze

Return to Head and Neck

Important to evaluated

Exopthalmus
Stellwag sign Von Graefe sign Mobius sign Joffroy sign Rosenbach sign Intracranial Aneurisma berdenyut Thrombosis sinus cavernosus odem + paralisa muscle

Enofthalmus dehidrasi/ sindrome horner Eye movement (N: III,IV,VI)

Saccade Pursuit Refleks okulosefalik (Dolls head manoevre)

Strabismus
Divergens Konvergens Hipertrofia hipotrofia

Nystagmus Palpebra Sekresi air mata

Arcus Senilis

Pterygium

Eye: Physical Exam


Visual acuity Test visual fields Extraocular muscle (EOM)

Corneal Light reflex Diagnostic Positions of gaze

Inspection of External structures


General Eyebrows Eyelids and lashes (lag, ptosis, closure)

Eye: Physical Exam

Eyeball Conjunctiva and Sclera Lacrimal status Cornea and lens Iris & Pupil

PERRLA

Ocular Fundus Findings: arcus senilis, conjunctival hemorrhage, ophthalmic herpes, ptosis

Ear

History Earache Infections Discharge Hearing Loss Environmental noise Tinnitus Vertigo Self-care

Ear: Physical Exam

Size and shape of Pinna Tenderness External meatus Otoscope pg 308 for normal with landmarks; 317 for serous otitis

EAC TM Whispered voice, Weber, Rinne

Hearing tests

Romberg

Nose, Mouth, Throat

History: Nose
Discharge Infections/Colds Sinus Pain Trauma Epistaxis Allergies

Nose, Mouth, Throat

History: Mouth & Throat Sores & Lesions Sore Throat Bleeding gums Toothache Hoarseness Dysphagia Altered Taste Smoking, ETOH Self-care

Nose: Physical Exam

Inspect
Outer Nose Nasal Cavity Sinuses

Palpate or Percuss Sinuses

Sinuses

Mouth & Throat: Physical Exam

Inspect Mouth & Throat


Lips Dentition Gums Buccal Mucosa Tongue Palate Pharynx

Uvula, pillars, tonsils, laryngeal wall

Palpate tongue, sublingual

Mouth & Throat Abnormal


Herpes simplex Gingival hypertrophy in a phenytoin patient Oral Candidiasis (Thrush) Enlarged tonsils

Neck Exam

Abnormal findings,
Goiter Graves disease Adenopathy Neck masses

Objective DataPhysical Exam


(cont.)
NeckInspect and palpate

Symmetry Range of motion Lymph nodes

Slide 13-51

Return to Head and Neck Slide

Objective DataPhysical Exam


(cont.)
NeckInspect and palpate (cont.)

Trachea Thyroid gland


Posterior approach
Anterior approach Auscultate

Slide 13-53

http://www.utdol.com/online/content/image.do?imageKey=onco_pix/lymph_8.htm&title=Lymph%20nodes%20head%20and%20neck

Measuring JVD