Laboratory On Surface Anatomy
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Transcript of Laboratory On Surface Anatomy
Laboratory Work No. ____
SURFACE ANATOMY
Objectives: To be able to be familiar with the surface anatomy of the Chest, Upper Back
and Abdomen; To be able to perform the basic skills in physical examination of a normal
patient.
General Considerations:
1. The patient must be properly undressed and gowned for this examination.
2. Ideally the patient should be sitting on the end of an exam table.
3. The examination room must be quiet to perform adequate percussion and
auscultation.
4. Try to visualize the underlying anatomy as you examine the patient.
I. Inspection: Chest
1. Observe the rate, rhythm, depth, and effort of breathing. ___________
breaths/min
2. Listen for obvious abnormal sounds with breathing such as wheezes.
3. Observe for retractions and use of accessory muscles (sternomastoids,
abdominals).
4. Observe the chest for asymmetry, deformity, or increased anterior-posterior (AP)
diameter. Measure the AP diameter in cms. _______________.
5. Confirm that the trachea is near the midline
6. Take note of the following on your patient: sternal angle, point of maximum
impulse (PMI), sternal notch, costal margin, scapular area. Identify where the
triangle of auscultation is located.
Inspection: Abdomen
1. The patient should have an empty bladder. Make the patient comfortable in a
supine position. Have the patient keep arms at the sides or folded across the chest.
Observe the contour of the abdomen (is it flat? Rounded? Protuberant?
Symmetric?)
2. Note the quadrants of the abdomen. Label with markers.
3. Measure the abdominal girth in cms. __________________________.
II. Palpation: Chest
1. Identify any areas of tenderness or deformity by palpating the ribs and sternum.
2. Assess expansion and symmetry of the chest by placing your hands on the
patient's back, thumbs together at the midline, and ask them to breath deeply.
3. Check for tactile fremitus. Ask the patient to say "ninety-nine" several times in a
normal voice. Palpate using the ball of your hand. You should feel the vibrations
transmitted through the airways to the lung. What does increased tactile fremitus
indicate? ________________________________________________________
________________________________________________________________
Palpation: Abdomen
1. Usually, after inspection of the abdomen, auscultation is done afterwards, then
followed by percussion and then palpation. Palpating the abdomen is the last
procedure when examining this area.
2. When palpating the abdomen, keep your hand and forearm on a horizontal
plane, with fingers together and flat on the abdominal surface. Palpate the
abdomen with a light, gentle and dipping motion. Feel on all four quadrants.
3. Describe findings for each quadrant.
4. What is voluntary guarding? How will you differentiate if the resistance
that you are feeling while palpating the abdomen is voluntary guarding or
involuntary muscle spasms?
III. Percussion: Chest
Proper Technique
1. Hyperextend the middle finger of one hand and place the distal interphalangeal
joint firmly against the patient's chest.
2. With the end (not the pad) of the opposite middle finger, use a quick flick of the
wrist to strike first finger.
3. Categorize what you hear as normal, dull, or hyperresonant.
4. Practice your technique until you can consistantly produce a "normal" percussion
note on your (presumably normal) partner.
5. Draw an anterior chest and posterior chest and plot out which of the areas are dull
or resonant.
Percussion: Abdomen
1. Percussion of the abdomen follows directly after auscultation of the abdomen.
2. Percuss the abdomen lightly in all four quadrants to assess distribution of
tympany and dullness. Draw the abdomen and label the areas of tympany and
dullness.
3. Briefly percuss the lower anterior chest between the lungs above and costal
margin below, on both left and right sides. Compare your findings.
IV. Auscultation – will not be performed during this particular laboratory work. Your
laboratory professor will however discuss the parts of the stethoscope in preparation for
your upcoming laboratory work.
Detail all of your findings for each step of the physical examination. Submit your results
via email. If you have taken pictures, attach them and properly label.