Saturday, June 19, 2004

Egophony

In some ways, we are being trained "bush" nursing i.e. lots of seldom-more-like-never used diagnostic procedures and do-it-yourself tricks to detect all sorts of pathologies when things like stethoscopes or X-rays are unavailable. My favorite is "egophony" coming from the latin "to sound like a donkey" (or so my nursing textbooks tell me but I don't really think it's true). If you suspect pleural consolidation (lots of awful fluid building up in your lungs from pneumonia or other bad news), you can place your ear to a person's back and ask them to say "eeeeee". If this "eeee" sounds more like "aaaaah", it means you have some consolidation going one. There is also the somewhat whimsically named "Whispered Petroloquy" test where you ask the same patient to whisper "one, two, three" while you listen. If you hear "one, two, three" louder than you would expect with your ear plastered against someone's back, it's more bad news for them.

The most difficult test for me to perform is percussion. Percussion consists of rapping a finger of one hand on the finger of the other hand pressed against someone's chest or belly area (look it up here: http://home.cogeco.ca/~nursingprocess/perc.htm - it's too difficult to explain well and this link has a picture which looks a little bit naughty frankly). One percusses a chest or a belly to map our area/things/organs beneath the skin. It's technically possible to percuss the belly area in order to record someone's liver span - you percuss from the lungs down and when the sound shifts from "resonance" to "dullness" you have hit the liver. When the sounds return to "resonance" you have returned to lung. If you keep going far enough, you get "tympany" which is what the stomach is supposed to sound like. Have you ever had anyone percuss you? Ever? NO. No one does it. However, when I move to Utah and live in an off-the-grid trailer and all the radiologists are dead, I will be able to know just how enlarged your liver is. However, at this stage, I have not perfected this technique and everything sounds like "dullness" to me.

My favorite part of the assessment process so far is old fashioned palpation i.e. touching. I happen to have an easily palpable aorta (yes, it is possible to feel you aorta - suck in your stomach and feel just to the left of your bellybutton - you'll know you're there when you feel a strong outward pulse coming from something the diameter of a hot dog) and last Thursday I had several classmates palpate my easily palpable aorta. We all get pretty close pretty fast.
Speaking of nursing school friendships, I forgot to mention a really wonderful thing that I noticed in orientation. The dean's welcome address included a brief section about the friendships that were made in this program due to the experiences we share and the intensity of the courses and time involved. Could you imagine a dean of any other school/program talking about friendships? I don't think at Dentistry or law convocations, the dean waxes on about the lifelong friendships his or her students will make. I imagine some would say it's unprofessional but I think it's wonderful: speaks well of nursing in my mind.

Thanks Nate and Ilan!

54 Comments:

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