General inspection

The patient should be undressed; the examination room should be warm and well lit. An anthropometric caliper and a measuring tape are used to do anthropometry.

The appearanceof the patient is described: general condition, carriage, gait, position in bed, consciousness, expression of the face, constitution, nourishment, stature, chest circumference at calm breathing, skin, visible mucosa, and conjunctiva, subcutaneous fat, edemas, muscles, bones, joints.

General patient's condition may be good, satisfactory, moderate grave, grave, extremely grave. The criteria's of patient's condition are the following clinical features: consciousness, posture, gait, the facial expression, weight, and mental condition.

Good patient's condition is characterized by clear consciousness, ac­tive posture, free gait, sensible facial expression, sufficient weight, and good mood. This condition occurs in patients with remission of chronic disease favorable course of a disease, or during recovery.

Satisfactory patient's condition (status morboacili) is characterized by clear consciousness, active or active with restriction posture, free or partial deranged (specific) gait, sensible facial expression, and adequate mental reaction. This condition occurs in patients with remission of prolong chronic disease, or during recovery from acute disease.

Moderate condition (status ingravescens) is characterized by deranged consciousness, alteration of facial expression and posture (forced), uncertain gait, partial deranged mental state and may be observed in patients with recurrence of chronic disease, acute diseases, or due to the traumas and poisoning.

Grave condition (status morbogravi) is characterized by disorders of practically all clinical features: deranged consciousness, changed facial expression (fear, suffer, hopelessness, indifference). The patients have forced or passive posture, loss of weight, edema, and inadequate mental state. Grave condition is observed in patients with infections and oncologic diseases, heart failure, disorders of renal, liver functions, abnormalities of nervous and endocrine systems, after operations, traumas.

Extremely grave condition (status gravissimus) is characterized by unconsciousness, passive posture, and indifferent facial expression and observes in the patient with coma, shock, and agony.

The general condition of the patient is characterized by his/her position in bed and the state of the consciousness.

Consciousness (sensorium) may be clear or deranged. The criteria's of consciousness condition are the following features: orientation to the surroundings, adequate answers, concentrated attention, reflexes, and pupil reaction on light.

Clear consciousness(sensorium lucidum) is characterized by adequate behavior, correct orientation to the surroundings, timely answer to the question, and preservation of all reflexes.

The deranged consciousness develops due to the different causes: disorders of cerebral or cardiac circulation; endogenic and exogenic intoxication; infectious affections; hormonal, mineral, metabolic abnormalities; and traumas of the brain.

The deranged consciousness is divided into two groups - depressed (stupor, sopor, coma) and excited consciousness (irritative disorder, delirium).

Attention should be paid to gait and carriage. In healthy persons the carriage is straight, the gait is steady.

Position in bed. Three types of the patient's position are distinguished: active, passive, forced.

An active position is that which the patient can change as he needs.

A passive position is taken due to exclusively the law of gravity; this is the sign of poor condition of the patient.

A forced position is taken instinctively or consciously to elicit the suffering.

These positions can be specific and an experienced physician may determine the character of the disease seeing the patient's position.

In dry pleurisy, lung abscess, bronchiectasis, the patient prefers to lie on the affected side. In dry pleurisy, this position relieves the pain because it limits pleura movement; in abscess, it relieves coughing because the content of the cavity does not get to the bronchial tree.

During an attack of bronchial asthma the patient sits upright or resting the hands on the edge of the table of chair, this position allows mobilizing accessory respiratory muscles.

Дата добавления: 2015-10-30