Denyut Nadi Normal Manusia

June 3rd, 2010
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Denyut Nadi Normal Manusia

Salah satu indikator kesehatan jantung adalah terjadinya peningkatan denyut nadi pada saat
beristirahat. Waktu yang tepat untuk mengecek denyut nadi adalah saat kita bangun pagi dan
sebelum melakukan aktivitas apapun. Pada saat itu kita masih relaks dan tubuh masih terbebas
dari zat-zat pengganggu seperti nikotin dan kaIein. Kita dapat mengecek sendiri dengan
merasakan denyut nadi kita di bagian tubuh tertentu.
Cara mengukur denyut nadi :

Denyut Nadi
Dengan menggunakan 2 jari yaitu telunjuk dan jari tengah, atau 3 jari, telunjuk, jari tengah dan
jari manis jika kita kesulitan menggunakan 2 jari.
Temukan titik nadi ( daerah yang denyutannya paling keras ), yaitu nadi karotis di cekungan
bagian pinggir leher kira-kira 2 cm di kiri/kanan garis tengah leher ( kira-kira 2 cm disamping
jakun pada laki-laki ), nadi radialis di pergelangan tangan di sisi ibu jari.
Setelah menemukan denyut nadi, tekan perlahan kemudian hitunglah jumlah denyutannya
selama 15 detik, setelah itu kalikan 4, ini merupakan denyut nadi dalam 1 menit.
Denyut nadi pada orang yang sedang beristirahat adalah
60 80 kali permenit untuk orang dewasa,
80 100 kali permenit untuk anak-anak,
100 140 kali permenit pada bayi.
Bila Anda semakin bugar, denyut nadi Anda sewaktu istirahat akan makin menurun, kuat dan
lebih teratur.
Namun denyut nadi bisa lebih cepat jika seseorang dalam keadaan ketakutan, habis berolah raga,
atau demam. Umumnya denyut nadi akan meningkat sekitar 20 kali permenit untuk setiap satu
derajat celcius penderita demam.
Sedangkan untuk mengetahui kekuatan denyut jantung maksimal yaitu dengan rumus:
Nadi Max ÷ 80° x (220 umur )
Misalkan anda sekarang berusia 40 tahun maka kekuatan maksimal jantung anda adalah 80 ° X
180 ÷ 144 kali/menit.
Yang perlu diperhatikan adalah, denyut nadi yang terlalu cepat, terlalu lambat, atau tidak
beraturan dapat berarti gangguan pada jantung. Segeralah periksakan diri ke instansi kesehatan
terdekat.

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!ysical Examination of te Abdomen

Inspection consists oI visual examination oI the abdomen with note made oI the shape oI the
abdomen, skin abnormalities, abdominal masses, and the movement oI the abdominal wall with
respiration. Abnormalities detected on inspection provide clues to intra-abdominal pathology;
these are Iurther investigated with auscultation and palpation.
Auscultation oI the abdomen is perIormed Ior detection oI altered bowel sounds, rubs, or
vascular bruits. Normal peristalsis creates bowel sounds that may be altered or absent by disease.
Irritation oI serosal surIaces may produce a sound (rub) as an organ moves against the serosal
surIace. Atherosclerosis may alter arterial blood Ilow so that a bruit is produced.
!alpation is the examination oI the abdomen Ior crepitus oI the abdominal wall, Ior any
abdominal tenderness, or Ior abdominal masses. The liver and kidneys may be palpable in
normal individuals, but any other masses are abnormal.
Tecnique
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The abdomen is inspected by positioning the patient supine on an examining table or bed. The
head and knees should be supported with small pillows or Iolded sheets Ior comIort and to relax
the abdominal wall musculature. The entire abdominal wall must be examined and drapes should
be positioned accordingly. The patient`s arms should be at the sides and not Iolded behind the
head, as this tenses the abdominal wall. Good lighting is essential, and it is helpIul to have
tangential lighting available, Ior this can create subtle shadows oI abdominal wall masses.
First, the general contour oI the entire abdominal wall is observed. The contour should be
checked careIully Ior distention and note made as to whether any distention is generalized or
localized to a portion oI the abdomen. Similarly, the Ilanks should be checked Ior any bulging.
The abdominal wall skin should be inspected careIully Ior abnormalities. Any areas oI
discoloration should be noted, such as the bluish discoloration oI the umbilicus (Cullen`s sign) or
Ilanks (Grey Turner`s sign). The skin should be inspected Ior striae, or 'stretch marks,¨ and
surgical scars. CareIul note oI surgical scars should be made and correlated with the patient`s
recollection oI previous operations. The skin oI the abdomen should also be checked careIully
Ior engorged veins in the abdominal wall and the direction oI blood Ilow in these veins. This is
perIormed by placing the tips oI the index Iingers together, compressing a visible vein. The
Iingertips are then slid apart, maintaining compression, producing an empty venous segment
between the Iingers. A Iinger is removed Irom one end and the vein is watched Ior Iilling. The
procedure is then repeated, but the opposite Iinger is removed and the vein again checked Ior
Iilling. Above the umbilicus, blood Ilow is normally upward; below the umbilicus, it is normally
downward. Obstruction oI the inIerior vena cava will cause reversal oI Ilow in the lower
abdomen. In addition to these large dilated veins, note should be made oI any spider angiomas oI
the abdominal wall skin.
Next, the abdomen should be inspected Ior masses. This should be perIormed Irom several
angles. It is important to diIIerentiate abdominal wall Irom intra-abdominal masses. A mass oI
the abdominal wall will become more prominent with tensing oI the abdominal wall
musculature, whereas an intra-abdominal mass will become less prominent or disappear. UseIul
maneuvers are to have the patient hold his head unsupported oII the examining table, to hold his
nose and blow, or to raise his Ieet oII the table. Abdominal wall masses are most commonly
hernias (either umbilical, epigastric, incisional, or spigelian), neoplasms (benign and malignant),
inIections, and hematomas.

Once a mass is determined to be intra-abdominal, its location should be described in relation to
the abdominal quadrants The relationship oI intra-abdominal organs to these quadrants should be
considered in attempting to determine the cause oI the mass. The mass should be examined Ior
movement with respiration or Ior pulsation with each heartbeat. Also, the mass should be
observed Ior peristalsis, as it may well represent dilated bowel.
Lastly, the abdominal wall should be observed Ior motion with respiration. Normally, the
abdominal wall moves posteriorly in a symmetrical Iashion with inspiration. With peritonitis,
there may be localized or generalized rigidity oI the abdominal wall so that this motion is absent.
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The patient is positioned comIortably in the supine position as described in Inspection. The
stethoscope is used to listen over several areas oI the abdomen Ior several minutes Ior the
presence oI bowel sounds. The diaphragm oI the stethoscope should be applied to the abdominal
wall with Iirm but gentle pressure. It is oIten helpIul to warm the diaphragm in the examiner`s
hands beIore application, particularly in ticklish patients. When bowel sounds are not present,
one should listen Ior a Iull 3 minutes beIore determining that bowel sounds are, in Iact, absent.
Auscultation Ior abdominal bruits is the next phase oI abdominal examination. Bruits are
'swishing¨ sounds heard over major arteries during systole or, less commonly, systole and
diastole. The area over the aorta, both renal arteries. and the iliac arteries should be examined
careIully Ior bruits.
Rubs are inIrequently Iound on abdominal examination but can occur over the liver, spleen, or an
abdominal mass.
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The patient is positioned supine with head and knees supported, as Ior Inspection and
Auscultation. Take the history and perIorm inspection and auscultation beIore palpation, as this
tends to put the patient at ease and increases cooperation. In addition, palpation may stimulate
bowel activity and thus Ialsely increase bowel sounds iI perIormed beIore auscultation. Ask
patients with abdominal pain to point to the area oI greatest pain. Then reassure them that you
will try to minimize their discomIort and examine that point last.
In palpating the abdomen, one should Iirst gently examine the abdominal wall with the
Iingertips. This will demonstrate the crunching Ieeling oI crepitus oI the abdominal wall, a sign
oI gas or Iluid within the subcutaneous tissues. In addition, it will demonstrate any irregularities
oI the abdominal wall (such as lipomas or hernias) and give some idea as to areas oI tenderness.

Deep palpation oI the abdomen is perIormed by placing the Ilat oI the hand on the abdominal
wall and applying Iirm, steady pressure. It may be helpIul to use two-handed palpation,
particularly in evaluating a mass. Here the upper hand is used to exert pressure, while the lower
hand is used to Ieel. One should start deep palpation in the quadrant directly opposite any area oI
pain and careIully examine each quadrant. At each costal margin it is helpIul to have the patient
inspire deeply to aid in palpation oI the liver, gallbladder, and spleen.
In the Ilanks it is oIten helpIul to elevate the Ilank to be examined slightly and place one hand on
the lower ribs oI that Ilank to 'push¨ the retroperitoneal contents up to the examining hand. In
this way, small renal masses that would otherwise be missed may be appreciated.
Abdominal tenderness is the objective expression oI pain Irom palpation. When elicited, it
should be described as to its location (quadrant), depth oI palpation required to elicit it
(superIicial or deep), and the patient`s response (mild or severe). Spasm or rigidity is the
involuntary tightening oI the abdominal musculature that occurs in response to underlying
inIlammation. Guarding, in contrast, is a voluntary contraction oI the abdominal wall
musculature to avoid pain. Thus, guarding tends to be generalized over the entire abdomen,
whereas rigidity involves only the inIlamed area. Guarding can oIten be overcome by having the
patient purposely relax the muscles; rigidity cannot be. Rigidity is thus a clear-cut sign oI
peritoneal inIlammation.
Rebound tenderness is the elicitation oI tenderness by rapidly removing the examining hand.
Again, this is a diIIicult sign Ior the beginning examiner to master. The most common error is to
remove the hand very quickly with an exaggerated motion and thus startle the patient. All that
needs to be done is smoothly but quickly to liIt the palpating hand oII the abdomen and observe
Ior pain, Iacial grimace, or spasm oI the abdominal wall. Both tenderness and rebound
tenderness may be elicited by palpation in a diIIerent quadrant. Thus, palpation oI the leIt lower
quadrant may produce tenderness and rebound tenderness in the right lower quadrant in
appendicitis (Rovsing`s sign). This is called reIerred tenderness and reIerred rebound.
When abdominal masses are palpated, the Iirst consideration is whether the mass is intra-
abdominal or within the abdominal wall. This can be determined by having the patient raise his
or her head or Ieet Irom the examining table. This will tense the abdominal muscles, thus
shielding an intra-abdominal mass while making an abdominal wall mass more prominent. II the
mass is intra-abdominal, important points are its size, location, tenderness, and mobility.
Palpation and percussion are used to evaluate ascites. A rounded, symmetrical contour oI the
abdomen with bulging Ilanks is oIten the Iirst clue. Palpation oI the abdomen in the patient with
ascites will oIten demonstrate a doughy, almost Iluctuant sensation. In advanced cases the
abdominal wall will be tense due to distention Irom the contained Iluid. Gas-Iilled intestines will
Iloat to the top oI the Iluid-Iilled abdomen. Thus, in the supine patient with ascites there should
be periumbilical tympany with dullness in the Ilanks. One should mark the level oI dullness on
the skin and then turn the patient on one side Ior a Iull minute. A change in the level oI dullness
is termed shiIting dullness and usually indicates more than 500 ml oI ascitic Iluid. Another
physical sign oI ascites is demonstration oI a transmitted Iluid wave. The patient or an assistant
presses a hand Iirmly against the abdominal wall in the umbilical region. The examiner places
the Ilat oI the leIt hand on the right Ilank and then taps the leIt Ilank with his right hand. In the
presence oI ascites, a sharp tap will generate a pressure wave that will be transmitted to the leIt
hand. UnIortunately, Iat will also transmit a Iluid wave, and there are Irequent Ialse-positives
with this test.
In addition to detection oI ascites, percussion can be used to help deIine the nature oI an
abdominal mass. Tympany oI an abdominal mass implies that it is gas Iilled (i.e., intestine).
Percussion is also used to deIine liver size.
Normal peristalsis oI the intestine produces bowel sounds as gas and Iluid are passed through the
intestinal lumen. Normally, the bowel sounds are intermittent, low-pitched, chuckling sounds.
Bowel sounds may be decreased or increased in disease states.
Ileus is a Iailure oI peristalsis and is the normal physiologic response oI the intestine to
laparotomy or peritoneal inIlammation. In addition, ileus is seen in a number oI disease states
that do not aIIect the peritoneum directly, including pneumonia, congestive heart Iailure, and
uremia. Bowel sounds will be markedly diminished or absent in ileus as the intestine distends
with gas in its paralyzed state.
Early mechanical bowel obstruction produces hyperactive peristaltic waves proximal to the
mechanical obstruction. These waves are increased in Irequency and Iorce and produce a
concomitant increase in bowel sounds with characteristic 'rushes.¨ As the bowel gradually
dilates with gas and Iluid, the bowel sounds become high pitched and tinkling, and there may be
periods oI hypoactive bowel sounds that alternate with hyperperistaltic rushes. These rushes
correlate with the increased peristaltic activity. Finally, in late intestinal obstruction there may be
loss oI all bowel sounds due to loss oI peristaltic activity Irom vascular compromise.
Vascular bruits are the audible maniIestation oI turbulent blood Ilow. They are Iound normally in
thin patients, but in heavier individuals will be muIIled because oI the surrounding Iat. Loud
systolic bruits are due to atherosclerotic plaques within arteries, producing turbulent Ilow. These
plaques are common in the aorta and iliac arteries and less common in the renal arteries. In
addition, turbulent Ilow within an abdominal aortic aneurysm may create a bruit. Bruits that are
present in both systole and diastole are strongly suggestive oI an arteriovenous communication.
Rubs are uncommon on abdominal auscultation but, when Iound, are the result oI inIlamed
peritoneal surIaces grating on each other during respiration. This can be the result oI a neoplastic
or inIectious process that destroys the normally smooth peritoneal surIaces.
Crepitus is produced by gas (air) and/or Iluid within tissues. In the abdominal wall, it either is
due to traumatic introduction oI air or is secondary to inIection (gas gangrene). Subcutaneous
emphysema can occur Irom rupture oI a pulmonary bleb or penetrating chest injury with
dissection oI air into the subcutaneous spaces. In addition, penetrating abdominal trauma may
introduce enough air into the abdominal wall to produce crepitus. Gas gangrene can occur as a
complication oI intra-abdominal surgery and produce crepitus oI the abdominal wall. The gas is
produced by anaerobic bacteria (usually clostridia species) and is a very speciIic clinical sign
when Iound in the patient with wound inIection.
Abdominal tenderness occurs as a result oI irritation oI the parietal peritoneum. While
inIlammation or irritation oI the visceral peritoneum will cause abdominal discomIort, anorexia,
and poorly localized pain, it will not cause tenderness and rigidity oI the abdominal wall.
Irritation or inIlammation oI the parietal peritoneum will stimulate the pain Iibers oI the parietal
peritoneum and abdominal wall, creating the symptoms oI localized pain and the signs oI
tenderness, rigidity, and rebound tenderness. Thus, iI there is diIIuse irritation oI the peritoneum,
as in diIIuse peritonitis, there will be diIIuse tenderness and rigidity.
Abdominal masses arise Irom the surrounding structures, thus the importance oI topographic
relationships. The presence or absence oI tenderness oI a mass gives important inIormation as to
its etiology. An appendiceal abscess will be tender as it inIlames the parietal peritoneum,
whereas carcinoma oI the cecum will be nontender because there is no inIlammation involved.
Tympany over a mass implies it is gas Iilled. In the abdomen, this usually signiIies the mass is
dilated bowel, as only rarely will there be enough gas in any other mass to produce tympany.
Ascites is the presence oI intra-abdominal Iluid and occurs because oI overproduction oI intra-
abdominal Iluid or lack oI absorption. It is most commonly seen in cirrhosis in which there is an
increase in portal pressure and hypoalbuminemia. The increased portal pressure hydrostatically
increases transudation oI Iluid through capillaries, whereas the hypoalbuminemia hydrostatically
Iavors ascites Iormation. Thus, there is accumulation oI Iluid in the peritoneal space, which
signiIies severe liver disease. Other common causes oI ascites include carcinomatosis in which
there is both an increase in Iluid Iormation and diIIiculties in clearing intraperitoneal Iluid, and
congestive heart Iailure in which there is a hydrostatic increase in venous pressure.

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