临床诊断学肾脏科.PPTVIP

Skin / Nails Testing skin turgor Special nails pattern Terrys nails (left) Seen in liver cirrhosis. White proximal nail, reddened distal nail Half-and-half nails (right) Seen in renal failure. White proximal nail, brown distal nail Examination for arterio-venous fistula AV Graft (Gortex) AV Fistula (native) Tunneled cuffed catheter (Hickman, Permcath) Double lumen catheter Peritoneal dialysis (Tenckhoff) catheter Renal Transplant * Kussmaul respirations are marked by a deep, rapid breathing rate that is a corrective mechanism against conditions such as diabetic ketoacidosis or CNS problem.? Typically this is the body’s way of expelling excess CO2 during metabolic acidosis. * Place one hand under the paitent’s right flank, and the other hand at the right costal margin. Ask patient to take a deep breath, at the height of inspiration, press the fingers of both hands together to try to capture the kidney. Ask the patient to exhale, and slow release the pressure, to feel the kidney to slide between the fingers. It may not be palpable. * Examine the left kidney in the same way, the left kidney is less likely to be palpable. If the kidneys are palpable, they should be smooth, firm and non-tender. 臨床診斷學 腎臟科 2010 共同教材 Outline History taking Occupation, Name, Age… Chief complaint Present illness Past history Family history Drug history Review of systems Physical examinations History Taking問診 Before start history taking Identification data Name Sex Age Race Marrital status Occupation 範例 Date of admission: 2009-Aug-28 General Data: Name: 胡xx Sex: male Age: 65 y/o Occupation: Farmer Ethnic origin: Taiwanese Martial status: Married Place of residence: Tao-Yuan Travel history: Denied Source of Information: Patient Chief complaints 腰痛… 尿尿有泡泡、混濁、顏色異常… 腳或身體水腫… 喘… 尿量減少… 尿尿時不舒服，頻尿, 發燒… Present illness (1) 腰痛 ( Flank pain ) Anatomy Questions about pain LQQOPERA 1. 位置 (Location): 局部性 (localized)、瀰漫性 (diffuse) 、移位性 (migratory) 、