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1、A. GENERAL EXAMINATION/VITAL SIGNS（一般检查） 1. Introduce yourself to patient, usually last name and title and have a little conversation to relax the patient and to judge mental state. 2. Wash hands before starting examinationPreferably, this should be done in view of the patient. 3. Patient is seated
2、in a chair 4. Palpate radial (wrist) Pulses for at least 30 seconds and recordThe examiner places the pad of his index, middle and ring fingers over the radial artery. If properly done, the examiner should be able to feel the artery pulsating under the examiners fingertips. The radial pulse may be m
3、easured for 30 seconds, then the pulse perminute can be found by multiplying by two. Attention should also be paid to the rhythm. The examiner should not use his thumb to palpate any pulse. 5. Palpate both radial (wrist) pulses simultaneously for symmetry for at least 30 seconds 6. Measure respirato
4、ry rate for 30 seconds and recordThe examiner unobtrusively measures patients respiratory rate. This may be accomplished by the examiner leaving his hands on the patients wrists for another 30 seconds after measuring the radial pulses so the patient does not realize that the examiner is watching him
5、 breathe. The depth and rhythm should also be noticed. The respiratory rate can also be measured during the back exam. 7. Measure blood pressure on right armBlood pressure may be measured with the patient in a sitting or lying position. In each position, the artery in which the blood pressure is to
6、be measured should be at the level of the heart (at the level of the fourth intercostal space in the sitting position; at the level of the middle axillary line in the lying position). The patients arm should be resting on a smooth table or supported by the examiner, and slightly flexed at the elbow.
7、 8. Place cuff in correct location 2-3 cm above the atecubital creaseThe examiner secures the blood pressure cuff snugly over the upper, arm so that one finger can be admitted under the cuff. The cuff should be positioned 23 cm above the antecubital crease or elbow joint. Put the middle of the cuff
8、over the brachial artery. 9. Palpate brachial arteryThe examiner can locate the brachial artery which lies slightly medial to the tendon of the biceps muscle in the antecubital fossa. The mercury column on the manometer dial should be properly calibrated with the pointer at “0” before the cuff is in
9、flated (i. e. , all the air should be pressed out of the cuff before it is inflated).The stethoscope is placed firmly over the brachial artery. The examiners inflates the cuff slowly but steadily. Until the brachial artery pulse disappears. Then he continues to inflate cuff 2.64.0kPa (2030 mmHg high
10、er, generally to about 21.3kPa (160mmHg). 10. Measure blood pressure over brachial artery twice and record the lower readingDeflate the cuff slowly at the rate of about 0.26kPa (2mmHg) Per second. The number where the examiner hears the first pulse sound is the systolic pressure. The pulse sound wil
11、l waken and then disappear. The number where the pulse sound disappears is the diastolic pressure. If the difference between weakening of the sound and its disappearance is 2.6kPa (20mmHg) or greater, the examiner should record these two numbers. The cuff must be completely emptied with the pointer
12、at “0” before it is reinflated. The same procedure may be followed for a second measurement of B. P. in the same or opposite arm. The lower pressure is recorded as the patients blood pressure. After finishing the measurement, the examiner deflates and rolls up the cuff, leans the manometer over a li
13、ttle so the mercury column disappears, closes the mercury column switch, puts the balloon in order, and closes the manometer.B. HEAD AND NECK（头颈部）Skull 11. Palpate and observe scalp (parting hair, and observing hair density, color, lustre and distribution)The examiner palpates the entire skull using
14、 both hands and simultaneously examines symmetrical areas. The examiner parts the hair to observe the scalp, noting any scaliness, deformities, lumps, tenderness, lesions or scars. The examiner also observes the density, color, lustre and distribution of the hair.Eyes 12. Visual screening:（omitted）
15、13.Observe cornea, sclera, conjunctiva and lacrimal puncta by gently moving lower eyelids down.Cornea Examination-With oblique lighting inspect the cornea for opacities, foreign bodies etc. Inspect lower palpebral, fornical, bulbar conjunctiva and sclera. Ask the patient to look up as you depress lo
16、wer eyelid with your thumb exposing lower palpebral, fornical, bulbar conjunctiva and sclera. Inspect the conjunctiva and sclera for color, and note the vascular pattern against the white scleral background.Lacrimal sac examination by digital compression for nasolacrimal duct obstruction-Ask the patient to look up. Press on the lower lid close to the medial c
