Inspection is the first objective method of examining the patient, its effectiveness is determined by a number of factors, among which the most important are the doctor's observation, pedantry and, of course, personal experience. That is why during the training it is necessary to see the maximum number of patients with the most different external signs of the disease. An important condition for a successful examination is, as already mentioned, the creation of maximum comfort for the patient - a sufficiently warm room where it is examined, exclusion of prolonged exposure to the body, uncomfortable position, etc.
General inspection includes evaluation of the following elements:
- state of consciousness;
- position of the patient;
- constitution (constitution);
- facial expression;
- body temperature;
- anthropometric data.
Almost simultaneously with this , skin integuments are examined and studied in various parts of the body (head, neck, trunk, limbs), but in the case history this information is presented in different departments.
The digital evaluation of external morphological features involves measuring growth and body weight. To determine the growth is a well-known rostomer, and most people know their growth. To measure body weight use a conventional floor scales.
Measurement of growth in adults is important to establish its relationship with the mass. In rare cases, with repeated measurement of growth over several years, its significant decrease is noted in connection with the disease - deformation of the spine - due to ankylosing spondylitis (Marie-Strumpell-Bechterew disease).
Regular measurement of body weight is more important. The increase in mass is noted with the accumulation of fluid in the body with the formation of edema as a result of heart disease, kidneys, liver, as well as with excessive nutrition, metabolic disorders, disorders of the endocrine system ( obesity ).
Weight loss is observed in the following cases:
- impaired absorption - diarrhea (diarrhea);
- endocrine-metabolic disorders ( diabetes mellitus, thyrotoxicosis );
- convergence of edema;
- malignant tumors;
- diseases that occur with heart failure, less often pulmonary;
- chronic infections ( tuberculosis, bronchiectasis, chronic inflammatory processes - systemic connective tissue diseases (eg, systemic lupus erythematosus ).
When measuring body weight in comparison with growth, both the deficit and its excess are detected. A simple formula is useful: body height (cm) should be 100 plus body weight (kg). If the amount received is higher than the growth rate, body weight is excessive, if significantly lower, is inadequate. Many recommend to specify the mass of the patient at the age of 18, with which the maximum weight of an adult is compared. Excess weight is a risk factor for coronary heart disease.
To detect persons with increased body weight with the purpose of further correction, the body mass index (BMI) - the Quetelet index is used. This indicator is especially convenient for conducting epidemiological (population) studies, with massive preventive examinations. The Quetelet index (BMI) is the ratio of body weight (kg) to square of height (m 2 ). With normal body weight, BMI is 20-25 kg / m 2, with the initial form of obesity - 25-30 kg / m 2. If the index exceeds 30 kg / m, this condition corresponds to obesity, which requires a number of corrective measures (strict restriction of caloric content of food - up to 1200-1600 kcal / day, 1-2 days of shipment per week), because such excess body weight is a factor risk of serious diseases (primarily atherosclerosis and hypertension with a threat of heart failure).
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