pemfis anak bhs inggris individu tulis tangan besok

PHYSICAL EXAMINATION

1.         DEGREES OF CONSCIOUSNESS

a.          Compos mentis is normal consciousness, fully conscious, able to answer all questions about his surroundings.

b.          Apathy is a state of consciousness are reluctant to get in touch with the surroundings, indifferent manner.

c.          Somnolence (Obtundasi, Lethargy) is decreased consciousness, psychomotor responses are slow, easily fall asleep, but awareness can be recovered when stimulated (easily aroused) but fell asleep again, able to give a verbal answer.

d.         Stupor is a spontaneous movement, responding reflexively to stimuli pain, hearing loud and strong vision. Verbalization may occur but is limited to one or two words. Non-verbally by using the head.

e.          Semi-coma that there is no verbal response, reaction to stimuli rough and there is a dodge (eg avoiding puncture).

f.           Commas are not reacting to the stimulus.

2.         SIGNS - VITAL SIGNS

a.        Blood pressure

The number of normal blood pressure based on a person's age is:

-             Infants aged under 1 month: 85/15 mmHg

-             Age 1-6 months: 90/60 mmHg

-             Age 6-12 months: 96/65 mmHg

-             Age 1-4 years: 99/65 mmHg

-             Age 4-6 years: 100/60 mmHg

-             Age 6-8 years: 105/60 mmHg

-             Age 80-10 years: 110/60 mmHg

-             Age 10-12 years: 115/60 mmHg

-             Age 12-14 years: 118/60 mmHg

-             Age 14-16 years: 120/65 mmHg

-             Age 16 years and over: 130/75 mmHg

-             Elderly: 130-139/85-89 mmHg

Place to measure a person's blood pressure is:

-             Upper arm

-             Ankle

b.       Pulse

Places where the pulse count is:

-             Ateri radalis: On the wrist

-             Temporal artery: In the temple bone

-             Carotid artery: the neck

-             Femoral Artery: In the groin

-             Dorsalis pedis artery: On the back foot

-             Popliteal artery: in the crease of the knee

-             Artery bracialis: In the folds of the elbow

The number of normal pulse rate based on a person's age is:

-             Newborns: 110-180 times per minute

-             Adults: 60 - 100 times per minute

-             Elderly: 60 -70 times per minute

c.          Breathing

One-time respiration = one + one-time inspiration expiratory

The number of normal breathing is:

-             Infants: 30-40 breaths per minute

-             Child: 20 - 50 times per minute

-             Adults: 16-24 breaths per minute

d.         Body temperature

Place to measure a person's body temperature is:

-             Armpit / axilea, in this area is silenced thermometer around 10-15 minutes.

-             Anus / anal / rectal, thermometer left in place in this area about 3-5 minutes.

-             Mouth / oral thermometer is silenced in this area about 2-3 minutes

Someone said the normal body temperature, if temperature is at 36 º C - 37.5 º C.

3.         Cardiovascular SYSTEM

INSPECTION
Heart, a topographic heart was in the front cavity of the mediastinum.

Inspection performed on patients with precordial lying supine or in left lateral decubitus position for a little stale sometimes hard to find for example in mitral stenosis. and the examiner standing on the right patient. This pulsation is located in accordance with the apex of the heart. Pulse diameter approximately 2 cm, with punctum maximum in the middle of the area. Pulses occur at sistolis ventricle. When ictus cardiac shifted to the left and widened, the possibility of enlargement of the left ventricle.

Palpation

Apex of the heart beats (cardiac iktus)

In normal circumstances, the attitude of sitting, sleeping supine or standing iktus seen in the V intercostal space medial left side rather than the left midclavicularis linea. In children iktus appear on IV intercostal space.

Throbbing pulse of the chest

If in the upper chest there beats it must be suspicious abnormalities in the aorta.

Ascending aortic aneurysm can cause pulsations in the right second intercostal space, while the throbbing chest on the left second intercostal space areas indicate the presence of dilatation a. descenden pulmonary and aortic aneurysm.

Vibration / Trhill

The presence of vibration often indicate the presence of congenital valve abnormalities or congenital heart disease. Weak vibration will be easier if the person is palpable doing physical work because of the frequency of the heart and blood will flow faster. With the palpable vibration will be heard on auscultation of heart sounds.

Percussion

We make percussion to set the boundaries of the heart.

Percussion heart has meaning to the two kinds of heart disease is pleural
pericardium and aortic aneurysm.

The left border of heart

·       We make percussion from lateral to medial direction.

·       Changes between the resonant sound of the lungs to the relatively dim as we set the left heart border.

·       Normal: Above: ICS II left in linea parastrenalis left (heart waist)

Bottom: ICS V left a little to the left medial linea midklavikularis

(Place iktus)

Limits Right Heart

·       Percussion also performed from lateral to medial direction.

·       Here is rather difficult to determine the extent of heart since it was located far from the front wall of the thoracic

·       Normal: The lower limit of the heart is right around the intercostal space

III-IV right, in linea parasternalis right.

While the upper limit of the right second intercostal space linea

parasternalis right.

Auscultation

Auscultation of heart sounds made ​​at the following places:

Listen to BJ I in:

·       ICS left sternal line IV (BJ I Tricuspidalis)

·       V line midclavicula ICS / ICS right sternal linea III (BJ I Mitral)

Listen to the BJ II on:

·       ICS right sternal II lines (BJ II Aorta)

·       ICS left sternal linea II / III linea ICS right sternal (BJ II pulmonary)

Listen to BJ III (if any)

·       Heard in the mitral area

·       BJ III came after BJ II with a considerable distance, but not exceeding half of the diastolic phase, low tone

·       In children and young adults, BJ III is normal

·       In adults / parents are accompanied by signs of edema / dipneu, BJ III is an abnormal sign.

·       BJ III in decomp. called Gallop Rhythm.

Of the normal heart can be heard Lub-dub, Lub-dub, Lub-dub. Lub is the sound of closing the mitral valve and tricuspid valve , which marks the beginning of systole . Dub is the sound of the aortic valve and the pulmonary valve as a sign of early diastole . In the dub sound, if the patient's breathing sound will be divided.

4.         DIGESTION SYSTEM

INSPECTION

a.          Patients lay supine with both arms at your sides.

b.          Inspection of the cavum oris, tongue to see whether there is abnormality.

c.          Put a small pillow under your knees and back of the head to stretch / relaxation of abdominal muscles.

d.         Note the presence or absence of abdominal tension.

e.          Examiner stood on the right side of the patient and note the color of skin and abdomen, belly shape, simetrisitas, scarring, wounds, vein patterns, and striae and the shadow of the veins and abnormal movement.

f.           Note the position, shape, color, and inflammation of the umbilicus.

g.          Note also the movement of the surface, mass, enlargement or tension.When the stiffened abdomen, ask the patient to turn aside and inspection of the presence or absence of enlargement of the area between the ribs, ribs and pelvis, ask the patient whether the abdomen was more tense than usual.

h.          If there is tension in the abdomen, measure the circumference of the abdomen by placing a strap / bandage around the abdomen through the umbilicus. Make a knot on both sides of the rope / bandages to mark the boundary where the abdominal circumference, perform monitoring, if there is an increase in stretching the abdomen, then the distance of two nodes farther away.

i.            Inspection of the abdomen for breathing movements are normal.

j.            Have the patient lift his head and notice the presence of peristalsis or aortic pulsation.

Palpation

Abdomen

a.        Position the patient lying supine and the examiner on his right.

b.       Perform light palpation in each quadrant of the abdomen and avoid areas that had been known previously as the point of trouble, such as appendicitis.

c.        Place the examiner's hand on the abdomen is flat, with fingers extension and maintain parallel surfaces coincide and abdomen.

d.       Palpation begins slowly and carefully from the superficial depth of 1 cm to detect areas of pain, tension or the presence of abnormal masses.

e.        When muscles are weak deep palpation can be performed from 2.5 to 7.5 cm, to know the circumstances of organs and detect any less obvious palpable mass during palpation

f.        Note the characteristics of each mass at the location, including size, location, shape, consistency, tenderness, pulsation and movement

g.        Note the patient's face during palpation to look for signs / discomfort.

h.       If the pain is found, the test will be the pain off, then press the quick release to detect whether the pain incurred by releasing the pressure.

i.         Ask the patient to lift his head from the examining table to see the contraction of abdominal muscles

Liver

a.          Position the patient supine sleeping.

b.          Examiners in addition to the right and facing the patient.

c.          Place the examiner's left hand below the piston / posterior right chest of patients in the eleventh and twelfth ribs and tekananlah towards the top.

d.         Put your right palm on the abdomen, the fingers point to the head / superior patient and thus ekstensikan fingertips klavikular located in the line below the lower limit of the liver.

e.          Then press gently inward and upward.

f.           Ask the patient to breathe and try to feel the edge of the liver while deflating the abdomen.

Gall bladder

a.          Position the patient supine sleeping.

b.          Examiners in addition to the right and facing the patient.

c.          Place the palm of the examiner's left hand under the patient's chest on the right posterior ribs XI and XII and tekananlah towards the top.

d.         Put your right palm on the abdomen, the fingers point to the head / superior patient and thus ekstensikan fingertips klavikular located in the line below the lower limit of the liver.

e.          Then press gently inward and upward.

f.           Ask the patient to breathe and try to feel the edge of the liver while deflating the abdomen.

g.          Palpation below the liver edge at the lateral side of the rectus muscle.

h.          When gallbladder disease is suspected, ask the patient to breathe deeply during palpation.

Spleen

a.          Position the patient supine sleeping

b.          Right beside the examiner and patient face

c.          Put it crosses the palm of your left hand below the waist inspectors left the patient and press upwards.

d.         Put your right palm with the fingers under the edge of the extension above the left abdominal kostal.

e.          Press your fingertips toward the spleen and then ask the patient to take a deep breath.

f.           Palpasilah edge of the spleen when spleen moves downward toward the examiner's hand

g.          If in the supine position can not be touched, then the position of the patient lying on her side to right with both lower limbs flexed.

h.          In certain circumstances test required Schuffner

Aorta

a.          Position the patient supine sleeping

b.          Right beside the examiner and patient face

c.          Use your thumb and index finger right hand.

d.         Palpasilah slowly but in the direction of right upper abdominal midline.

Examination Ascites

a.          Position the patient supine sleeping.

b.          Examiners in addition to the right and facing the patient.

c.          This procedure requires three hands.

d.         Ask the patient or an assistant to squeeze the stomach of patients with ulnar side of the hand and upper right arm along the midline in the vertical direction.

e.          Place your hands on both sides of the abdomen and the examiner with a sharp knock one side with the examiner's fingertips.

f.           Feel the impulse / vibration waves of liquid with your fingertips or the other can also use the ulnar side of hand to feel the vibration of the fluid wave.

Plug it in rectum

Abdominal examination may be terminated with a digital rectal (its less fun so placed at the end). This examination can be performed on patients in a slanting position (symposisi), lithotomi, or knee-chest. Checks can be done with one hand or two hands (bimanual, one hand on the pelvis). Digital rectal need to be careful because of the sensitive nature of the anus, easy contractions.Therefore performed digital rectal serileks may use lubrication. We recommend that people with diabetes first. At the position where the abnormality diagnosis lithotomi use at 3 o'clock position that is right, the left 9 o'clock, 6 o'clock to 12 o'clock direction and the sacrum toward the pubis.

Auscultation

a.          Patients lay supine with hands on both sides.

b.         Put a small pillow under the knees and behind the head.

c.          Place the stethoscope head side of the diaphragm in the lower left quadrant. Give light pressure, ask the patient not to talk. If it may take 5 minutes continuously to hear before the examination to determine the absence of bowel sounds.

d.         Listen to what a normal bowel sounds, hyperactive, hipoaktif, no bowel sounds and note the frequency / character.

e.          When bowel sounds are not easily heard, proceed with the systematic examination and listen to each quadrant of the abdomen.

f.           Then use the stethoscope bell, to listen to the sound of rustling section in each quadrant and epigastric artery above the aortic, renal, iliac, femoral and thoracic aorta. In thin people may be able to look bowel peristalsis or pulsation of the aorta.

Percussion

Abdomen

Do a percussionist in the four quadrants and note the sound that comes about when to do it and distinguish the limits of the organ under the skin. Hollow organs such as stomach, intestines, bladder tympanic ring, while the sounds are deaf to the liver, spleen, pancreas, kidneys.

Percussion Limit Heart

a.          Position the patient sleep supine and the examiner stood on the right patient.

b.          Perform percussion on the right line as high as the umbilicus midklavikular, sliding slowly upwards, until there is change in the sound of timpani become deaf, mark the lower limit of the heart.

c.          Measure the distance between subcostae kebatas right under the liver.

d.         Lower limit of the liver edge is the lower limit of the right ribs.

e.          Upper limit of the liver is located between the ribs into the gap 5 to the gap to 7 ribs.

f.           Distance below the upper limit of the liver ranging from 6-12 cm and the movement of the bottom of the heart is breathing at about 2-3 cm.

Percussion Stomach

a.          Position the patient supine sleeping.

b.          Examiners in addition to the right and facing the patient.

c.          Perform percussion at the bottom of the anterior ribs and the left epigastrium.

d.         Gastric air bubble in the percussion will sound when the tympanic 

5.         ASSESSMENT SYSTEM BREATH

a.       Inspection

1)         Chest examination starts from the posterior thorax, the client in a seated position.

2)         Chest observed by comparing one side to another.

3)         Inspection of the thorax poterior on skin color and condition, lesion, mass, spinal disorders such as kyphosis, scoliosis and lordosis, the amount of rhythm, depth of breathing, and chest movement symmetry.

4)         Observation of respiratory type, such as: respiratory nasal or respiratory diaphragm, and the use of auxiliary respiratory muscles.

5)         When observing respiration, record the duration of the phase of inspiration (I) and expiratory phase (E). ratio in this phase is normally 1: 2. Prolonged expiratory phase indicate the presence of airway obstruction and is often found on the client Chronic Airflow Limitation (CAL) / COPD.

6)         Review and compare configuration chest anteroposterior diameter (AP) diameter lateral / tranversal (T). this ratio normally ranges from 1:2 to 5:7, depending on the client's body fluids.

7)         Abnormalities in the form of the chest:

a)         Barrel Chest, arises due to the occurrence of lung overinflation.An increase in AP diameter: T (1:1), often occurs on the client emphysema.

b)         Funnel Chest (Pectus Excavatum), arises if there is depression of the bottom of the sternum. This will suppress the heart and large blood vessels, resulting in murmurs. This condition can occur in rickets, Marfan's syndrome or due to workplace accidents.

c)         Pigeon Chest (Pectus carinatum), arises as a result of inaccuracy sternum, where there is an increase in AP diameter.Arise in clients with severe kyphoscoliosis.

d)        Kyphoscoliosis, seen with the elevation of scapula. This deformity would interfere with the movement of the lungs, can occur in clients with osteoporosis and other musculoskeletal disorders affecting the thorax.

e)         Kiposis, increasing the normal curvature of the thoracic vertebral column causes the client looks hunchback.

f)          Scoliosis: thoracic vertebrae curved laterally, accompanied by vertebral rotation.

8)         Observation of chest movement symmetry. Movement disorder or indicates an inadequate chest expansion on pulmonary or pleural disease.

9)         Observation of abnormal retractions intercostal spaces during inspiration, which can indicate airway obstruction.

b.       Palpation

1)         Conducted to assess the symmetry and observe chest movement abnormalities, skin condition and learn to identify the vocal premitus (vibration).

2)         Palpation of thoracic abnormalities terkaji to know when inspections such as: mass, lesion, swollen.

3)         Kaji also the softness of the skin, especially if the client complains of pain.

4)         Vocal premitus: chest wall vibrations produced when speaking. 

c.        Percussion

1)         Nurses to assess the resonance pulmonary percussion, the organ that is around and development (excursion) of the diaphragm.

2)         This type of percussive sound:

Normal percussion sound resonant (resonant): generated to determine the boundary between the heart and lungs.

d.       Auscultation

1.       Assessment is very meaningful, include listening to a normal breath sounds, extra sounds (abnormal), and sound.

2.       Normal breath sounds from the vibrations generated when the air through the airway from the larynx to the alveoli, the nature of the net.

3.       Normal breath sounds:

a)       Bronchial: Normal audible above the trachea or the suprasternal notch. Ekspirasinya phase is longer than inspiration, and there is no stopping between the two phases.

b)       Vesicular: sounds soft, smooth, like a breeze. Inspiration is longer than the expiratory, expiratory sounds like a blast.

c)       Bronchovesikular: a combination of bronchial and vesicular breath sounds. His voice was loud and the intensity of being.Inspiration equal in length to expiration. This voice was heard in the thoracic region where the bronchi is covered by the chest wall.

6.         Musculoskeletal system

a.          Inspection

1)         At the time of inspection of the spine, open the patient's clothes to reveal the entire body.

2)         Inspection muscle size, compare one side with the other side and observe for atrophy or hypertrophy. Straightness of the spine, was examined with the patient standing upright and bending forward.

3)         If you found any difference between the two sides, measured both by using the meter.

4)         Observe the presence of muscle and tendon contractures to determine the possibility indicated by malposition of a body part.

5)         Observe normalcy bone structure and the presence of deformity.

6)         Kulvatura scoliosis is characterized by abnormal lateral spine, which is not the same shoulder height, waist line is not symmetrical, and the scapula is prominent, will become clearer with forward bending test.

7)         Observe the state of the bones to determine the presence of swelling joints.

8)         Joint inspection for the presence of joint abnormalities.

9)         Inspection of movement joints.

b.       Palpation

1)       Palpation of the muscles at rest and during muscle move actively and passively to detect weaknesses (flasiditas), a sudden contraction is involuntary (spasticity)

2)       Test muscle strength by having the client pull or push the hands of the examiner, the right limb muscle strength compared with the left limb.

3)       Palpation for the presence of edema or tenderness.

4)       Palpation of the joint while the joint is moved passively will provide information about the integrity of the joints. Normally, the joints move smoothly. Gemletuk voice can indicate a ligament that slips in between the bony prominence. The surface is less flat, bleak on the state of arthritis, resulting in crepitus due to uneven surfaces which rub against one another mutually.

5)       Check for lumps, rheumatoid arthritis, gout, and osteoarthritis cause the typical bumps. Lumps under the skin in rheumatoid arthritis and there are soft inside and along the tendons that provide extensions to the joint function normally, the involvement of the joints possessed a symmetrical pattern. Hard lump on gout and precise and is located in the adjacent joint capsule itself.

6)       Use the quick determination of muscle strength with Lovett's scale (score 0 - 5)

0 = No contraction at all.
1 = Movement contraction.
2 = ability to move, but not strong when fighting

custody or gravity.
3 = Strong enough to overcome gravity.
4 = Quite strong but not full power.
5 = full strength of contraction.

c.     Percussion

1)         Patellar reflex, patellar tendon (the middle of the patella and tuberosity tibiae) was hit with a reflex hammer. The response of the quadriceps femoris muscle contraction that is an extension of the knee.

2)         Biceps reflex, the arm with the elbow flexed to 90 º angle, and supination of the forearm supported on a certain pedestal (desk check). Finger probe placed on the tendon of m. biceps (above the elbow crease), then hit with a reflex hammer. Normal if it arises biceps muscle contraction, increased slightly in case of partial flexion and pronation movements. If there will be a spread of hyperactive flexion movement of the arm and the fingers or the shoulder joint.

3)         Triceps reflex, the arm supported and flexed at an angle of 90 º, triceps tendon with a reflex hammer diketok (triceps tendon is at a distance of 1-2 cm above the olekranon). Normal response is contraction of the triceps muscle, a slight increase when mild extension and elbow extension hyperactive when it spread upwards until the muscles of the shoulder, or there may be a temporary klonus.

4)         Achilles reflex, the foot is dorsiflexed position, to facilitate the examination of this reflex can be placed under investigation foot / lower leg crossed over the contralateral.
Achilles tendon was hit with a reflex hammer, a normal response of plantar flexion movement of the foot.

5)         Abdominal reflex, performed by scratching the abdomen above and below the umbilicus. If scratched like that, umbilicus will move upward and toward the scratched area.

6)         Babinski reflex, a reflex of the most important. He only found in kortikospinal tract disease. To perform this test, goreslah tight lateral part of the heel of your foot towards the little finger and then across the heart of the foot. Babinski response occurs if the toes do dorsifleksi and other fingers spread. Normal response is plantar flexion of all toes.

7.         ENDOCRINE SYSTEM

Inspection

a.        (Skin color): Hyperpigmentation is found on the client or Cushing's syndrome Addison's desease. Hypopigmentation seen in clients with diabetes mellitus, hyperthyroidism, hypothyroidism.

b.       Faces: Variations, shape and structure of the face may be indicated by the eye disease acromegaly.

c.        Nails and Hair: Increased pigmentation of the nail is shown by a client with Addison's disease, dry, thick and brittle disease found in hypothyroidism, hipertyroidisme soft hair. Hirsutism found in Cushing's disease syndrome.

d.       Inspection of the size and proportionate body structure of the client: The tall, due to growth hormone insufficiency. The bones are very large, can be an indication of acromegaly.

e.        Signs and sign trousseaus chvoteks: Elevated levels of calcium hands and fingers clients contraction (carpal spasm).

Palpation

a.        Rough skin, dry was found on the client with hypothyroidism. Where softness and skin rinses can be a sign on a client with hyperthyroidism.Lesions on the lower extremities indicates DM.

b.       Palpation of the thyroid gland (place your hands on the other side of the trachea below the thyroid cartilage. Ask the client to tilt the head to the right Ask the client to swallow. After the client to swallow. Move on the left. During palpation in the lower left chest): Not enlarged on the client with Graves' disease or goiter.

Auscultation

Auscultation in the neck area diata thyroid can identify the sound of "bruit".Beep who because of turbulence generated by the thyroid arteries. Normally there is no sound.

8.         Integumentary system

Inspection

a.        Assess the integrity of the skin color of flushing, cyanosis, jaundice, irregular pigmentation

b.       Assess the mucous membrane, turgor, and general condition, skin

c.        Assess the shape, integrity, nail color.

d.       Assess the wound, scar / scars, drain, pressure sores.

Palpation

a.        The existence of pain, edema, and decreased temperature.

b.       Skin texture.

c.        Skin turgor, normal <3 seconds

d.       Areas of edema palpated to determine consistency, temperature, shape, mobilization.

e.        Palpation capillary refill time: the color returned to normal after 3-5 seconds.

9.         Neurological

Inspection

a.        Assess LOC (level of consiousness) or level of consciousness: by doing a question about patient awareness of time, place and person.

b.       Assess mental status.

c.        Assess the presence of seizures or tremors.

Palpation

a.        Assess the level of comfort, the pain and even the location, duration, type and treatment.

b.       Assess sensory function and determine whether normal or impaired.Assess the lost flavor, burning / heat and numbness.

c.        Assess motor function such as: hand grip, muscle strength, movement and posture.

Percussion

a.        Patellar reflex, a knock on the patellar region (middle center of the patella).

b.       Achilles reflexes, struck with a reflex hammer, a normal response of plantar flexion movement of the foot.

10.     REPRODUCTIVE SYSTEM

Inspection

1.       General conditions, special obstetric examination, examination, and additional checks.

2.       Inspection of nutritional status: anemia, jaundice.

3.       Assess breathing patterns (cyanosis, dyspnea).

4.       Is there edema, how the shape and height, whether there are changes in pigmentation, chloasma gravidarum, striae alba, lividae striae, striae nigra, hyperpigmentation, and areola mamma.

Palpation

1.       palpation according to Leopold I-IV

2.       Cervix, which is to know the softening of the cervix and cervical dilation.

3.       Membranes, ie to find out whether it has been broken or not and whether there is tension membranes.

4.       The lowest part of the fetus, which is to find out whether the lowest part of the fetus, the lowest decline, whether there is a double position, whether there is a barrier at the bottom that could disrupt deliveries.

5.       Tactile fornix, which is to find out if there is bearing fornix and whether the fetus may still be pushed upwards.

Auscultation

Auscultation for bowel sounds find, the motion of the fetus in the uterus, fetal heart rate, the flow of the umbilical cord, abdominal aorta, and bleeding retroplasenter.

11.     SYSTEM urinal

Inspection

a.        Assess bladder habits, the output / amount of urine 24 hours, color, turbidity and the presence / absence of sediment.

b.       Kaji BAK frequency interference complaints, the presence of dysuria and hematuria, as well as a history of urinary tract infections.

c.        Inspection of the use of condom catheter, folleys catheter, silicone catheter or urostomy or supra pubic catheter.

d.       Reconsider treatment history and diagnostic assessment associated with urinary system.

Palpation

a.        Palpation of distesi bladder (bladder)

b.       To palpate kidneys Right: The position on the right patient. The left hand is placed behind the patient, parallel to the costa of the 12th, touching the tip of looking for costovertebral angle (lift to push the kidney to the front). The right hand is placed gently on the upper right quadrant in the lateral rectus muscle, ask the patient to breathe deeply, at the peak of inspiration right hand tap deep beneath the aortic arch to capture the kidney in between both hands (specify size, tenderness ga). Patients were asked to dispose of breath and stopped breathing, release your right hand, and feel how the kidneys back expiratory time.

c.        Followed by palpation Kidney Left: Move to the left of the patient, the right hand to hold and lift the rear. The left hand is placed gently on the upper left quadrant of the lateral rectus muscle, ask the patient to breathe deeply, at the peak of inspiration hit his left hand deep beneath the aortic arch to capture the kidney in between both hands (normally rarely palpable).

Percussion

For the examination of kidneys revealed additional procedure to invite the patient to sit facing one side, and the examiner standing behind the patient. One hand is placed at right angles as high kostovertebra thoracic vertebra 12 and lumbar 1 and hit with a fist ulnar side (right kidney). One hand is placed at right angles as high kostovertebra thoracic vertebra 12 and lumbar 1 and hit with a fist ulnar side (left kidney). Patients were asked to memberiksan response to inspections if there is pain.