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 : Kesadaran Penuh Verbal : Panggilan, Suar Pain : Rangsangan Nyeri Unrespon : Tidak ada reaksi rangsangan apapun GCS (Glascow Coma Scale) Eye Score 4 Verbal Score 5 Motorik Score 6

GLASCOW COMA SCALE (GCS) SCORE Eye (Mata) Spontan 4 Suara 3 Nyeri 2 Unrespon 1 Verbal (Suara) Dapat komunikasi dengan baik (tdk disorietasi) 5 Komunikasi berupa kalimat (Bingung) 4 Komunikasi berupa kata “sepenggal” & tidak beraturan 3 Suara, tanpa ada kata, merintih (Garbled sound) 2 Unrespon 1 Motorik (Pergerakan) Tidak ada kelainan motorik,sadar (Obey to comment) 6 Dapat mengisolasi rangsangan (dengan suara) 5 Dapat mengisolasi rangsangan dengan nyeri 4 Abnormal flexi (decorticasi) 3 Abnormal Extensi (decerebrasi) 2

KEPALA DAN LEHER WAJAH MATA HIDUNG BIBIR dan RONGGA MULUT TELINGA 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?

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

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

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 Data—Health History Questions Objective Data—Physical Exam Abnormal Findings

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

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

Abnormal Findings (cont.) Pediatric Facial Abnormalities Fetal alcohol syndrome Congenital hypothyroidism Down syndrome Atopic (allergic) facies Allergic salute and crease © Pat Thomas, 2006.

Abnormal Findings (cont Abnormal Findings (cont.) Abnormal Facial Appearances With Chronic Illnesses Parkinson’s syndrome Cushing’s syndrome Graves’ disease Hyperthyroidism Myxedema (hypothyroidism) Bell’s palsy Brain attack or cerebrovascular accident Cachectic appearance Scleroderma

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 (Doll’s 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 Hearing tests Whispered voice, Weber, Rinne 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 Palpate or Percuss Sinuses Outer Nose Nasal Cavity Sinuses Palpate or Percuss 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 Grave’s disease Adenopathy Neck masses

Objective Data—Physical Exam (cont.) Neck–Inspect and palpate Symmetry Range of motion Lymph nodes

Return to Head and Neck Slide

Objective Data—Physical Exam (cont.) Neck–Inspect and palpate (cont.) Trachea Thyroid gland Posterior approach Anterior approach Auscultate

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Measuring JVD