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Practical skill “Palpation of thyroid gland”
ALGORITHM for “Palpation of thyroid gland”
1. To greet and name itself.
2. Friendly behavour.
3. To explain to the patient a purpose of the visit, duration of conversation and to get his agreement.
4. Correct and quiet conversation with a patient.
5. To get the agreement of patient for the performance of the examination.To take complaints Correct and quiet conversation with a patient.A patient is in vertical position persons to the doctor, neck and shoulders of patient is maximally weakened
6. The external examination of patient includes the configuration of neck, its thickness, deformation and presence of additional formations
7. A doctor fixes the back of the head of patient by left arm and by the first finger of right arm, displacing laterally sterno-cleido-mastoid muscle gently performs the palpation of right lobe by finger from below to upward.
8. A doctor fixes the back of the head of patient by right arm and by the first finger of the left arm, displacing laterally sterno-cleido-mastoid muscle gently performs the palpation of the left lobe by finger from below to upward.
9. Laying on the front surface of neck the large fingers of both hands and fixing the back of the head of patient performed the palpation of the whole gland and its isthmus in the state of rest and at swallowing
10. The last stage of inspection of thyroid gland is the palpation of lymph nodes.
Practical skill “Verification of Ortner’s and Merphy’s signs”
ALGORITHM for “Verification of Ortner’s and Merphy’s signs”
1. To greet and name itself.
2. Friendly behavour.
3. To explain to the patient a purpose of the visit, duration of conversation and to get his agreement.
4. Correct and quiet conversation with a patient.
5. To get the agreement of patient for the performance of the examination.To take complaints Correct and quiet conversation with a patient.To ask a patient to lie down on the back and relax the muscles of front abdominal wall
6. The external examination of abdomen is performed, the doctor marks the
7. symmetry, presence of outpouching and participation of front abdominal wall in the act of breathing
8. Before the palpation the point of projection of gallbladder bottom on a front abdominal wall is determined (site of the crossing of external edge of right rectus muscle with costal arch)
9. By a rib of the right hand a doctor performs the dosed shots of the right costal arch in the site of gallbladder projection (Ortner’s sign)
10. Fixing by left hand the right costal arch the doctor performs the deep palpation by right arm on the height of breathing in the site of gallbladder projection (Merphy’s sign)
Practical skill “Determination of the symptoms of peritoneal irritation”
ALGORITHM for “Determination of the symptoms of peritoneal irritation”
1. To greet and name itself.
2. Friendly behavour.
3. To explain to the patient a purpose of the visit, duration of conversation and to get his agreement.
4. Correct and quiet conversation with a patient.
5. To get the agreement of patient for the performance of the examination.To take complaints To ask a patient to lie down on the back and relax the muscles of front abdominal wall
6. The external examination of abdomen is performed, the doctor marks the
7. symmetry, presence of outpouching and participation of front abdominal wall in the act of breathing
8. The right arm of the doctor on the front abdominal wall (any area) slowly presses by 4 fingers of doctor (to estimate the degree of pain)
9. All hand is quickly taken off from abdominal wall to estimate the increase of pain degree (Schotkin Blumberg’s sign)
10. By the fingers tips of right arm the doctor performs dosed percussion of front abdominal wall (Rozdolsky’s sign).
Practical skill “To be able to perform pleural punction“
ALGORITHM for “To be able to perform pleural punction“
1. To greet and name itself.
2. Friendly behavour.
3. To explain to the patient a purpose of the visit, duration of conversation and to get his agreement.
4. Correct and quiet conversation with a patient.
5. To get the agreement of patient for the performance of the examination.To take complaints Location puncture.
6. Washing of the operating field.
7. Local anaesthesia of skin and soft tissues.
8. Puncture of skin and soft tissues on the upper edge of underlying rib by an aspiratioeedle, entrance in a pleural cavity.
9. Aspirating to receive and estimate the contents of pleural cavity/
10. Evacuation of contents of pleural cavity.
11. Extraction of needle.
12. Aseptic bandage.
Practical scill “To perform digital examination of rectum”
ALGORITHM for “To perform digital examination of rectum”
1. To greet and name itself.
2. Friendly behavour.
3. To explain to the patient a purpose of the visit, duration of conversation and to get his agreement.
4. Correct and quiet conversation with a patient.
5. To get the agreement of patient for the performance of the examination.To take complaints Examination of perianal area in knee-elbow position or in position of patient on a side with the flexed knees.
6. The index finger, dressed into the glove and smeared by solution of lubricant enters the rectum.
7. Estimated: tonus of anal sphincter, wall of the rectum, presence of compressions, excrescences, overhanging, pain syndrome, pathological maintenance.
8. After rectal examination the character of maintenance is estimated on a glove.
