胸部診察のバックアップソース(No.71)

#contents

胸部診察は、肺の診察と心臓の診察に分けられる。打診、聴診の際の声掛けを忘れないようにする。
試験時間は5分間である。
*肺の診察 [#c3697e75]
視診→打診→聴診の順で行われる。また、前胸部と肺部の診察を行う。
**前胸部 [#m2e4d9de]
***視診 [#n3505cbd]
① 解剖学的部位、皮膚所見を確認する。：胸骨角、剣状突起の確認
② 呼吸数の測定：30秒数えて2倍する。

***打診 [#ld39c35f]
8か所以上打診する。
最初の打診（右鎖骨窩）は親指を当てて叩く。それ以外は中指のDIP関節を叩く。
左右交互に上から下へと打診する。

***聴診 [#a2326e78]
深呼吸の声掛け
吸気と呼気での聴診
鎖骨窩はベル型で聞く。
8か所以上左右交互に聞く

**背部 [#ra8cc7b1]
***視診 [#xb4d4752]
解剖学的部位（隆椎、肩甲骨下角）、皮膚所見の確認。
***打診 [#k2b73b47]
8か所以上左右交互に打診
両側の肺底部の清音と濁音の境界を確認する

***聴診 [#kdb3c479]
深呼吸の声掛け
8か所以上左右交互に聞く
吸気と呼気で聞く

*心臓の診察 [#md8345ce]
視診→触診→聴診の順で行われる。
**視診 [#m147cc73]
心尖拍動の確認（正常ではあり、掌）
胸壁拍動の確認（正常ではなし、手の近位部）

**触診 [#cef1c7a2]
心尖拍動→第5肋間鎖骨中線にて、指先と手掌で確認
胸壁拍動→手掌近位部（3か所ぐらい）
スリル→手掌遠位部（4領域）

**聴診 [#n10634ce]
膜型で4領域聴診
心尖部はベル型でも聞く。その際に左側臥位になってもらう。

*胸部診察のセリフ [#tacf8e61]
（胸骨角・剣状突起を確認しました）
皮疹・着色班・手術痕ありません。
胸郭に変形や左右差を認めません。
呼吸の型は胸腹式呼吸で、リズム・速さ・深さに異常はありません。
呼吸数は○○です。
胸壁運動の左右差ありません。
大きく息を吸ってもらえますか？鎖骨上窩・肋間の吸気時の陥凹ありません。

これから胸を叩いていきますので、手が冷たかったら言ってください。
これから聴診器で胸の音を聞いていきます。大きく深呼吸を繰り返してください。

それでは背中の診察をしていくので後ろを向いてください。
（隆椎を確認しました。肩甲骨下角を確認しました）
皮疹・着色班・手術痕ありません。
胸郭に変形や左右差を認めません。
背中を叩いていくので痛かったら教えてください。

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胸部診察 のバックアップソース(No.71)

胸部診察のバックアップソース(No.71)
