问题 问答题 简答题

心脏触诊(内容、方法、顺序)(18分)

答案

参考答案:

(1)触诊手法正确(3分);被检查者卧位,检查者在其右侧,先用右手掌自心尖部开始检查,触诊压力适当。

(2)触诊顺序正确(3分);从心尖部开始,逐渐触诊肺动脉瓣区、主动脉瓣区、第二主动脉瓣区及三尖瓣区。

(3)在心尖搏动区触诊(可用单一示指指腹)确认心尖搏动最强点,并能表达被检查者心尖搏动所在体表位置(6分);

①能够正确指出心尖搏动最强点在第几肋间。(3分)

②能够正确指出在锁骨中线内、外。(3分)

(4)触诊震颤、心包摩擦感(4分);

①震颤:用手掌或手掌尺侧小鱼际肌平贴于心前区各个部位,以触知有无微细的震动感(2分)。

②心包摩擦感:用上述触诊手法在心前区胸骨左缘第4肋间触诊。或说出如何能使触诊满意的条件(前倾位、收缩期、呼气末、摒住呼吸(1分)。)

(5)提问(5个)(2分)

①心尖搏动最强点在第4肋间锁骨中线外,考虑什么情况?(1分)答:右心室增大

②心尖搏动触不到,有什么可能?(1分)答:胸壁过厚。

③如何辨别收缩期震颤和舒张期震颤?(1分)答:可通过心尖搏动触及胸壁的时间确认为收缩期的开始。

④心前区触到舒张期震颤即肯定有器质性心脏病,对不对?(1分)答:对。

⑤心尖搏动增强见于哪些情况?答:心尖搏动增强见于左室肥大、甲状腺功能亢进、发热、贫血时,心尖搏动增强,范围大于直径2cm,尤其是左室肥大,心尖搏动明显增强。

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Although problems are a part of our lives, it certainly doesn’t mean that we let them rule our lives forever. One day or the other, you’ll have to stand up and say – problem, I don’t want you in my life.

  小题1:   Problems with friends, parents, girlfriends, husbands, and children – the list goes on. Apart from these, the inner conflicts within ourselves work, too. These keep adding to our problems. Problems come in different shapes and colors and feelings.

But good news is that all problems can be dealt with. Now read on to know how to solve your problems.

Talk, it really helps. What most of us think is that our problem can be understood only by us and that no talking is going to help.    小题2:  Talking helps you move on and let go.

Write your problems.    小题3:   When you write down your problems, you are setting free all the tension from your system. You can try throwing away the paper on which you wrote your problems. By doing this, imagine yourself throwing away the problems from your life.

Don’t lose faith and hope. No matter what you lose in life, don’t lose faith and hope. Even if you lose all your money, family… you should still have faith.    小题4:   

Your problems aren’t the worst. No matter what problem you get in life, there’re another one million people whose problems are huger than yours.    小题5:   Your problems might just seem big and worse, but in reality they can be removed.

Go about and solve your problems because every problem, however big or small, always has a way out.

A.But the truth is that when you talk about it, you’re setting free the negative energies that have been gathering within you.

B.When we have a problem, a pressing, critical, urgent, life-threatening problem, how do we try and solve it?

C.Tell yourself: when they can deal with them, why can’t I?

D.Of course, we’ve been fighting troubles ever since we were born.E. We can often overcome the problem and achieve the goal by making a direct attack.

F. Having a personal diary can also be of huge help if you don’t want a real person to talk with.

G. With faith and hope, you can rebuild everything that you lose.

解答题