Head to toe- Respiratory

Question 1

End of bed assessment

Answer 1

• Clinical signs- Cyanosis, SOB, Cough, Stridor
• Object- O2, Sputum pot, cigarettes

Question 2

Hands

Answer 2

• Cyanosis
• Tar staining
• Finger clubbing- associated with CF, ILD, Ca
• Fine tremor (B-2-agonist)
• CO2 flap
• Temperature

Question 3

Radial pulse

Answer 3

• Bounding pulse= underlying CO2 retention (T2RF)
• Pulses paradoxus: pulse wave volume decreases significantly during the inspiratory phase. late sign of cardiac tamponade, severe asthma/COPD exacerbations

Question 4

JVP in context of respiratory

Answer 4

• Measured at 45’ angle, looking left measure the distance between top of the IJV and sternal edge
• A raised JVP denotes venous hypertension- pulmonary hypertension is Associated with COPD + ILD

Question 5

Eyes

Answer 5

• Conjunctival pallor
  *

Question 6

Mouth

Answer 6

• Central cyanosis

Question 7

Inspection

Answer 7

• Scars-
• Chest wall deformities: Asymmetry (Lung Ca), Hyperexpansion (COPD/asthma)

Question 8

Palpate

Answer 8

• Trachial deviation- deviates away from tension pneumothorax and large pleural effusion
• Trachial deviation- towards lobar collapse
• Apex beat- displaced due to RV hypertrophy (COPD, Pulm HTN, ILD), large pleural effusion, tension pneumothorax
• Chest expainsion- reduced symmetrically in pulmonary fibrosis and asymmetrially in pneumothorax, pneumonia, pulural effusion

Question 9

Percuss- types of percussion note

Answer 9

• Resonant= normal
• Dullness: Increased tissue density due to consolidation, tumour and lobar collapse
• Stony dullness: Pleural effusion
• Hyper-resonance- Pneumothroax

Question 10

Tactile fremitus

Answer 10

• Increased vibration= increased tissue density e.g. pneumonia, tumour, lobar collapse
• Decreased vibration= pneumothorax and pleural effusoin

Question 11

Auscultation breath sounds

Answer 11

• Bronchial- harsh-sounding, inspiration and expiration are equal= associated with consolidation
• Quiet= reduced air entry
• Wheeze= continuous, whilsting sound (asthma, COPD, Bronchiectasis)
• Stridor= high pitched extra-throacic from turbulent air flow shows upper airway obstruction
• Coarse crackles- poping lung sound= pneumonia, pulmonary oedema
• Fine end-inspiratory crackles: sounds like velco= pulmonary fibrosis

Question 12

Lymph nodes + resp causes of lymphoedema

Answer 12

• check lymph nodes
• Lung Ca
• TB
• Sarcoidosis