3 .

examination of respiratory rate

Breathing is an unconscious action , managed by
medulla oblongata and performed by the respiratory
muscles .when inspiring , diaphragm and
intercostalals are in contraction to give more space
to the thorax region and extend the lungs . the chest
wall moves up . lateral /in front and back ,while the
diaphragm moves down . after inspiration stops , the
lungs will be wrinkled , diaphragm rises passively and
chest wall will return to its former position . the
normal breathing rate 14-24 x/ minutes .
This examination begins by asking the patient to
take off his shirt . and then , in an inspectional way
,the examiner observe all breathing movements
thoroughly (do this step without affecting the
patients psychology ) .palpation is sometimes needed
to compare the right and left movement . in
inspiration , notice the movement beside . the rib ,
widening of epigastrum angle , the big chest
anteropo posterior . in expiration , also notice the
rib antrance and notice if there ais any use of
supporting breathing muscles . the last step is note
the rhythm rate , and movement disorder .
4 .examination af blood pressure
Blood pressure on aterial system is various
depending on cardiac cycle , that is ,systole when
reaching the peak and diastole when declining a bit .
the difference between systole and diastole is
called pulse pressure . when the ventricle is
contracted ,blood will be pumped to the whole body
. this condition is called systole and blood pressure
is called systole . when the ventricle is relaxed
,blood from the atrium enters ventricle , this blood
pressure is called diastole . the normal value of
blood pressure systole and diastole is 130/80
mmhg. The high blood pressure in influenced by some
factors such as physical activity , emotion ,pain ,
surrounding temperature , coffe , consumption ,etc.
The examination can be done when the patient is
sitting down or lying down , the arm is free from
pressure such as clothes and other things and
relaxed .wrap the cuff around the patients arm
neatly and do not be too tight about 2.5-5 cm above
the antecubital area (the inner aspect of the eblow) .
place the patient arn flexi . find brachial
arterybeside the biceps tendon . with one figher , fell
brachialis artery , pump the cuff fast up to 30 mmhg
above the pressure when pulsasi brachialis artery is
disappeared . slower down thepressure of the cuff
until the beat is felt again . it is call systolic
palpation pressured . take stethoscope ,and put
earpieces at brachial artery . pump the cuff again
until more and l3ss 30 mmgh . above systolic
palpation pressure slowly ,decrease the pressure of
the cuff around 2-3 mmgh per second . notice until
the brachial artery beat is heard .
It is called systolicpressure . continenue the
decreasing of cuff pressure until the beat is
weakenibg and eventually not heard . the peessure in
this condition is called diastolic pressure . if using a
glass mercury thermometer , it must be exactly in one
line horizontally with mercury . the repeated
measurement is done after several minutes from the
first examination .