Written by Dr.Md.Redwanul Huq (Masum)

Monday, 20 June 2011 12:23

Pre-requisites of Clinical Examination(Physical examination):

•  The room should be quiet and warm.
• There should be a couch, two or more chairs in the room.
• Well lighting of the room is a must.
• The examiner should have following equipments with him/her-

A thermometer, few pins, a hammer, a tuning fork, few cotton,a stethoscope, a sphygmomanometer, a soap/flower/any thing having smell,a Ishihara compatible color vision test plate/book, a fundoscope,few glass slides, a test tube, a test tube holder, a burner/candle.

•  The examiner should maintain proper hygiene for clinical examination.
• The examiner should observe all the events & objects surrounding the patient.
• Firstly the examiner should introduce himself/herself to the patient and take permission of examination from him/her.
• Patient should have proper position for examination.
• Patient should be asked to undress accordingly.
• Examination should always be performed from the right side of the patient.
• Patient should be asked about having tenderness in any part of the body, if present- that part should be examined at last with care.

Instruments used in medicine practice:

I) Use of bell of the stethoscope-

1) Mitral stenosis

2) To hear 3^rd & 4^th heart sounds

3) To hear fetal heart sound

4) To auscultate the apex of the lung.

II) Catheters:

Types of Catheters and use of Catheters:

Catheters are of following types-

1. Condom catheter: It is used when the patient can micturate voluntarily but disoriented &  cannot move.

2. Foley’s bi channel self retaining catheter (Indwelling catheter):

Channels:

Foley catheters have two channels, one is straight for passage of urine for storage .The other is oblique for introduction of fluid to inflate the balloon.

Use of catheters:

i) For continuous drainage of urinary bladder in cases of- unconscious patients with urinary retention or incontinence.

ii) Post operative patients who have undergone major abdominal, pelvic & perineal surgery.

iii) Patients with paraplegia, quadriplegia with urinary retention are also in need of use of catheters.

3. Plain rubber catheter:

Ends: One end is closed with eyes, the other end is open.

Uses:

i) Catheterization for temporary drainage in cases of retention of urine, unconscious patients,  hemiplegia, neurogenic bladder etc

ii) Urinary incontinence.

III) Naso-gastric tube (Ryle’s tube):

Ends:

It Has two ends- one close end with a weight inside & few lateral eyes, the other end is open.

Uses:

1) Therapeutic uses:

a) Nasogastric feeding & medication in unconscious/ old debilitated/ poisoned/ CVD / myopathic patients.

b) Nasogastric suction in cases of acute abdomen.

2) Diagnostic uses:- Gastric Juice analysis.

IV) Sphygmomanometer:

Use of Sphygmomanometer:

1. Measurement of Blood Pressure.

2. Examination for latent purpura- by Tourniquet test.

3. Examination for latent tetany (Trousseau’s sign).