1) Health Status
Need to review the level of consciousness, how the patient's general appearance, facial expressions during the examination, the patient's attitude and behavior toward nurses, how the mood of patients to determine the level of patient anxiety and tension. There should also be measured height and weight of patients.
2) Respiratory System
Inspection in patients with pleural effusion, a sick form of convex hemithorax, horizontal ribs, widened space between the ribs, decreased respiratory movement. Furtherance of the mediastinum toward the contra lateral hemithorax is known from the position of tracheal and cardiac ictus. Respiratory rate tended to increase and examination usually dyspneu.
Vocal Fremitus decreased primarily for the amount of pleural effusion fluid> 250 cc. In addition to palpation of the chest wall movements were also found on the left chest pain.
Percussive sound dim to be sensitive depending on the amount of liquid. If the liquid does not fill the pleural cavity, there is the upper limit of the liquid form of curved lines with the lateral end of the medical patient in a sitting position. This line is called the line "Ellis-Damoiseaux". The line is most obvious in the front of the chest, is less clear in the back.
Sound Auscultation of breath decreases until it disappears. In the sitting position more liquid upwards thinner, and behind it there is compression atelectasis of the lung parenchyma, may be found auscultation signs of compression atelectasis around the upper limit of the liquid. Coupled with the sign "i - e" that is, if the person is asked to utter the words "i", then it will sound "e" nasal, called egofoni.
3) Cardiovascular System
On inspection to note the location of ictus Cordis, normally located in the ICS - 5 on linea medio clavicularis left border of 1 cm. This examination aims to determine the presence or absence of cardiac enlargement. Palpation to calculate the frequency of the heart (health rate) and be aware of the depth and irregular heart beat or not, should also examine the thrill of vibration ictus Cordis. Percussion to determine the limit of the heart where the cardiac region sounded dull. It aims to determine is there any heart or left ventricular enlargement. Auscultation of heart sounds to determine I and II single or gallops and is there a third heart sound that may be symptoms of heart trouble and is there any murmurs that indicate the presence of increased blood flow turbulence.
4) Digestive System
At the inspection need to be considered, whether the abdominal bulge or flat, edge protruding belly or not, the umbilicus prominent or not, but it also needs to be in inspection whether or not there lumps or masses.
Auscultation to listen to the voice in which intestinal peristalsis normal values 5-35 times per minute. On palpation should also be noted, is there any abdominal tenderness, is there a mass (tumor, feces), abdominal skin turgor to determine the degree of hydration of the patient, whether the liver is palpable, whether the lien is also palpable. Tympanik normal abdominal percussion, the mass of solid or liquid will cause a dull sound (liver, ascites, vesika urinarta, tumors).
5) Neurological System
On inspection of the level of awareness needs to be studied, In addition to GCS examination is also required. Is there composmentis or somnolence or comma. Pathological reflexes, and how the physiological reflex. Additionally sensory functions also need to be studied such as hearing, sight, smell, touch and taste.
6) Musculoskeletal System
At the inspection should be noted there peritibial edema, palpation at both extremities to determine the level of peripheral perfusion and capillary refil time with a survey. By inspection and palpation examination of muscle strength were compared between the left and right.
7) Integumentary System
Inspection of the general condition of skin hygiene, presence or absence of color in the skin lesions, on examination with pleural effusion will usually be visible cyanosis as a result of failure of oxygen transport system. On palpation should be checked on the warmth of the skin (cold, warm, fever). Then the skin texture (smooth-rough-soft) as well as skin turgor to determine the degree of hydration of a person.
Physical Examination of Pleural Effusion