OMED 1401 - Advanced Patient Assessment (RESPIRATORY ASSESSMENT)

Question 1

What Occurs during Respiratory: End of Bed Assessment?

Answer 1

Is the Patient Time Critical?
What Signs and Symptoms would you expect to see from the End of Bed which would indicate a Time Critical Patient?
What other Environmental Clues are you Looking for?

Question 2

What History Taking do you need for a Respiratory Assessment?

Answer 2

What are they like when they are well?
Dyspnoea - What Causes it? How far can they walk? Orthopnoea? - Shortness of Breath that Occurs whilst Lying Flat and is Relieved by Sitting or Standing. Paroxysmal Nocturnal Dyspnoea (PND)? - a Sensation of Shortness of Breath that Awakens the Patient, Often after 1 or 2 hour of Sleep, and is usually Relieved in the Upright Position. (Symptom/Sign of Heart Failure).
Cough - Productive/Colour? Include Haemoptysis?
Breath sounds audible to Patient?
Trauma
Weight Loss? Night Sweats? (Cancer Red Flag)
TB and other Contagious Diseases (Eg MERS)
DVT and PE Risk Factors.

Question 3

What are the Red Flags to Recognise for Respiratory Failure?

Answer 3

Respiratory Rate Change >30 or <10 Breaths per Minute.
O2 Saturation Drops <90% (Non COPD)
Use of Multiple Accessory Muscle Groups (Visual in the Neck)
Inability to Lie Supine
Change in Mental Status (Act Aggressive when Starved of Oxygen or Infection/Hypovalaemia)
Cyanosis
Inability to Clear Mucus
Exhaustion

Question 4

What is the Pneumonia Curb?

Answer 4

Confusion - Mental Test Score, Disorientation in Person, Place or Time - 1 Point
Uremia - Blood Urea > 7mmol/L - 1 Point
Respiratory Rate - >30 Breaths per Minute - 1 Point
Blood Pressure: Systolic <90 mmHg or Diastolic <60mmHg - 1 Point
Age - >65 Years - 1 Point
DO NOT LEAVE A PT AT HOME IF THEY SCORE 3 OR MORE.

Question 5

What are the Risk Factors for DVT and Pulmonary Embolism?

Answer 5

Previous PE/DV
Active Cancer
Pregnancy/Postpartum (4 Weeks)
Long Haul Flights with in Last 4 Weeks
Resent Immobility (Bedridden for 3 Days or More)
Resent GA with in Four Weeks
Calf Swelling more than 3cm
Recent Immobilisation to Lower Leg
Unilateral Oedema
Tenderness to Deep Vein System in Calf
Intravenous Drug User (IVDU)
Oral Contraceptive Pill
Obesity
HIV

Question 6

Who are Included in the High Risk Groups?

Answer 6

Chronic Respiratory Diseases including Asthma and COPD
Chronic Heart / Renal / Liver Disease
Chronic Neurological Conditions
65 Years of Age or Above
Anyone Immunosuppressed
Diabetic
Pregnant Women

Question 7

What is Meant by the Enhanced Respiratory Assessment?

Answer 7

First Thing: End of Bed Assessment
1. Wash your Hands
Work in a Systematic Way:
- Hands
- Face
- Lymph
- Neck

Question 8

How to Access the Hands in a Respiratory Assessment?

Answer 8

Pulse
Rate, Rhythm, Character and Volume
A Bounding Pulse is a Sign of CO2 Retention
You may Count the Respiratory Rate at this Point of the Assessment.
Koilonychias (Inverted Nail Beds)
- Iron Deficiencies
- Anaemia
- Clubbing
- Loss of Nail Angle at the Base
- COPD
- Emphysema
- CHD
- Lung CA
Cyanosis
- Blue Discolouration of the Fingers
- Various Heart and Lung Conditions
- Poor Circulation
Nicotine Staining
- High Risk Respiratory Illness
Tremors / Flank
- Ask the Patient to Hold out Arms and Cock the Wrists Upwards
- Wait 30 Seconds
- Flapping (Tremor) is a Sign of CO2 Retention
- Sign of B2 Agonist Use.

Question 9

How to Access the Face is a Respiratory Assessment?

Answer 9

Conjunctiva of the Face
- Gently Pull down the Eyelids
- Pale is a Sign of Anaemia
Central Cyanosis
- Ask the Patient to Stick out their Tongue
- Check for Central Cyanosis
- Can be a Sign of Various Respiratory Illnesses such as Asthma, Bronchitis, PE, COPD.
Horner’s Syndrome
- Constricted Pupil
- Droopy Eyelids on one side of the Face
- Caused by the Compression of the Sympathetic Chain in the Chest Cavity
- Sign of a Tumour

Question 10

How to Access the Lymph Nodes and Drainage System in a Respiratory Assessment?

Answer 10

Swollen Lymph Nodes have Drained from Facial and Thoracic Ducts
Most Swollen Nodes are Signs of Infection
Can be Linked to Infection Caused by Injury
Enlarged Nodes can Sometimes be Suggestion of Metastatic Cancer E.g. Lung or Abdominal (Rare)

Question 11

How to Perform a IPPA Assessment on the Chest?

Answer 11

Inspect - Look
Palpate - Feel
Percuss - Tap
Auscultate - Listen

Question 12

How to Inspect the Chest in a Respiratory Assessment?

Answer 12

Able to Speak in Full Sentences?
Type of Breathing?
Chest Wall Abnormalities - Kyphosis, Scoliosis, Pectus Excavatum/Carinatum
Scars, Masses, Lesions and Bruising
Chest Expansion
Chest Wall - Width is Double Depth
Blue Bloater / Pink Puffer / Barrel Chest.

Question 13

How to Palpate the Chest in a Respiratory Assessment?

Answer 13

Assess for Masses, Tenderness or Crepitus
- Subcutaneous Emphysema Air Escapes from the Lungs into Subcutaneous Tissue.
Assess Chest Expansion
- Posteriorly Place Thumbs at Level of 10th Rib and Place Palms on Posterolateral Chest.
- Approx 2 Inches Apart before Inspiration. Feel Thoracic Expansion during Quiet and Deep Inspiration. Look for Symmetry.
- Chest Expansion Symmetrical
- No Masses or Tenderness.

Question 14

How to Palpate the Chest (FREMITUS) in a Respiratory Assessment?

Answer 14

Why? - Assesses the Function of the Lungs and State of the Pleura.
How? - Noise Vibrations Pass through the Bronchi and Lungs and Transmit off Chest Wall. Check for Increased or Decreased Frequency (Sound) of Vibrations.
What For? - Another Check for Respiratory Conditions:
Increased - Consolidation, Bronchus Collapse, Pneumonia, Tumour, Pulmonary Fibrosis.
Decreased - Pleural Effusion, Pneumothorax, COPD.
TACTILE VOCAL FREMITUS
1. Palpate with Ulnar Border of your Hand
2. Ask the Patient to Repeat ‘Ninety - Nine’
3. Assess all Zones in Zig-Zag Manner
4. Note if:
- Increased
- Decreased
- Absent

Question 15

How to Percuss the Chest in a Respiratory Assessment?

Answer 15

1. Palm over Chest Wall
2. Middle Finger Strikes 2nd Phalanx
3. Movement comes from Wrist
   Percuss from Side to Side and Top to Bottom.
   Compare the Sides looking for Asymmetry.
   Note the Location and Quality of the Percussion Sounds you Hear.

Question 16

How to Auscultate the Chest in a Respiratory Assessment?

Answer 16

Normal - Regular and Comfortable at 12-20 Breaths/Minute
Tachypnoea - 20 Breaths/Minute
Bradypnoea - <12 Breath/Minute
Hyperventilation - Rapid, Deep Respiration >20 Breath/Minute
Apneustic - Neurological: Sustained Inspiratory Effort
Cheyenne-Stokes - Neurological: Alternating Pattern of Depth Separated by Brief Sounds of Apnea.
Kussmaul’s - Rapid, Deep and Laboured - Common in DKA
Air Trapping - Difficulty during Expiration - Emphysema.

Question 17

What is the Difference in Vesicular Sounds and Bronchial Sounds?

Answer 17

Bronchial are Heard over the Trachea, Vesicular is Heard over the Thorax.
If Bronchial Breath Sounds are Heard over the Peripheral Lung Fields, this is Abnormal (E.g. Pleural Effusion and Pneumonia)
VESICULAR SOUNDS:
- Lower Pitched, Rustling
- Softer Relatively
- Inspiration Longer and Expiration Shorter
- No Gap Between Insp and Exp Sounds
- Normally Heard in Lung Parenchymal Region (Peripheral Thorax)
Bronchial Sounds
- Higher Pitched, Hollow or Blowing Quality
- Louder Relatively
- Inspiration and Expiration Equal
- Gap Between Insp and Exp Sounds
- Normally Heard along Tracheobronchial Tree (Central Thorax).

Question 18

What are the Different Vesicular Sounds?

Answer 18

Bronchial - Loud Abnormal Lung Sounds
Wheeze - High Pitch Musical Sounds
Crackles - Course or Fine. Air Passing through Fluid.
Rhonchi - Loud Gurgling Noise.

Question 19

What is Peripheral Edema?

Answer 19

Swelling in your Arms and Legs. This Happens when Fluid gathers in your Tissues and Causes a Heavy, Swollen and even Painful area in the Body.
SIGNS AND SYMPTOMS
- Full or Heavy Feeling in Arm or Leg
- Swelling and Puffiness, Leaving a Dent with your Finger when you press on the Area (Pitting)
- Skin that Feels Tight and Warm
- Immobility or Difficulty Moving Joints around the Affected Area
- Pain and Tension around the Affected Area
- Feeling of Pressure around the Affected Area, which can be Related to Pressure on the Veins in your Legs.
- When Shoes, Clothing or Jewellery becomes tight around the swollen area.

Question 20

What is the Normal CO2 Range?

Answer 20

4.6 - 6

Question 21

What is Pulmonary Oedema?

Answer 21

WHAT IS IT?
Caused by too much Fluid in the Lungs. This Fluid collects in the Many Air Sacs in the Lungs, Making it Difficult to Breathe. Often Caused by Congestive Heart Failure. When the Heart is not Able to Pump Efficiently, Blood can back up into the Veins that takes Blood to the Lungs.
SIGNS AND SYMPTOMS?
- Dyspnoea (Especially During Movement or Lying Down - Have a Drowning Sensation)
- Coughing up Blood (Haemoptysis)
- Wheezing
- Gasping for Air
- Chest Tightness
- Fatigue
- Swelling in the Legs (Pitting)
- Cyanosis
- Orthopnoea
- Paroxysmal Nocturnal Dyspnoea
AFFECT ON VITAL SIGNS?
- Increased or Decreased Heart Rate or Blood Pressure.
- Increased Respiratory Rate
- Low Oxygen Saturation (<94)
ENHANCED ASSESSMENT FINDINGS
Hands and Face - Cyanosis with Bluish or Grey Skin
Legs - Swelling on the Ankles/Calf’s due to Fluid Build up. Pitting Expected.
IPPA SPECIFIC
Inspection - Struggling to Complete Sentences due to Dyspnoea. Hyperventilating and Use of Accessory Muscles in Later Stages due to Fluid Build up.
Percussion - Similar Sounds on Both Sides.
Palpation - No Palpable Masses.
Auscultation - Crackling or Wheezing/Whistling Sounds in the Lungs.
IS A COUGH OR SPUTUM PRESENT?
- Begins with a Dry Cough. Later, a Cough that Produces Frothy Sputum that may look Pink or have Blood in it. (Haemoptysis)

Question 22

What is a Pulmonary Embolism?

Answer 22

WHAT IS IT?
A Blood Clot that Blocks and Stops Blood Flow to an Artery in the Lung. In Most Cases, the Blood Clot Starts in a Deep vein in the Leg and Travels to the Lung. When a Blood Clot Forms in one or More of the Deep Veins in the Body, It’s called Deep Vein Thrombosis (DVT).
SIGNS AND SYMPTOMS?
- Dyspnoea (Appears Suddenly)
- Chest Pain (Sharp and Felt when you Breathe Deeply. Pain can Stop the PT from being able to take a Deep Breath.)
- Fainting (Syncope - When your Heart Rate or Blood Pressure Drops Suddenly)
- Lightheadedness
- Excessive Sweating
- Leg Pain or Swelling (Usually in the Back of the Lower Leg)
- Cyanosis
AFFECT ON VITAL SIGNS
- High Temperature or Fever
- Rapid or Irregular Heartbeat
- Low Oxygen Saturation
- Tachycardic
- Tachypnoea (High RR)
- Severe Cases: Hypertension
ENHANCED ASSESSMENT FINDINGS
Hands and Face - Central Cyanosis
Legs - Swelling in the Back of the Lower Leg
IPPA SPECIFIC?
Inspect - Hyperventilating (Use of Accessory Muscles), Tachypnoea. Unable to Complete Sentences, Large Chest Expansion.
Palpate - No Masses or Tenderness
Percuss - Symmetrical Sounds
Auscultate - Coarse Crackles or Wheezing.
IS A COUGH OR SPUTUM PRESENT?
Cough that may Include Bloody or Blood-Streaked Mucus.

Question 23

What is Pleurisy?

Answer 23

WHAT IS IT?
Inflammation of the Sheet-like Layers that Cover the Lungs (THE PLEURA). The Pleura is Two Large, Thin Layers of Tissue that Separate your Lungs from Your Chest Wall. The Two Layers rub Against Each other like Sandpaper. Usually caused by a Virus.
SIGNS AND SYMPTOMS?
- Chest Pain that Worsens when you Breathe, Cough or Sneeze due to the Layers Rubbing together. (Sharp or Stabbing Pain)
- Dyspnoea
- Pain may Spread to your Shoulders or Back
AFFECT ON VITAL SIGNS
- Fever
- High RR with Rapid or Shallow Breathing
ENHANCED ASSESSMENT FINDINGS
Hands and Face - Cyanosis
Lymph Nodes - Inflamed due to the Infection.
IPPA SPECIFIC?
Inspect - Use of Accessory Muscles due to Rapid Breathing, Unable to Complete Sentences due to the Pain and Breathlessness.
Palpate - Tenderness on Palpation due to the Pain. No Palpable Masses.
Percuss - Symmetry in Sounds
Auscultate - Audible Raspy Breathing Sounds.
IS A COUGH OR SPUTUM PRESENT?
There is a Cough.

Question 24

What is Emphysema?

Answer 24

WHAT IS IT?
The Air Sacs in the Lungs (Alveoli) are Damaged. Over time, the Inner Walls of the Air Sacs Weaken and Rupture - Creating Larger Air Spaces inside the Small Ones. This Reduces the Surface Area of the Lungs and in turn, the Amount of Oxygen that Reaches your Bloodstream.
SIGNS AND SYMPTOMS?
- Dyspnoea beginning Gradually
- Unable to Complete most Daily Tasks
- Eventually Causes Dyspnoea when at Rest.
AFFECT ON VITAL SIGNS
- Low Oxygen Saturation as the Surface Area has Decreased so the Amount of Oxygen being Transported has been Reduced.
- High Respiratory Rate as the PT is trying to Catch there Breathe however this will Begin to Drop as the PT begins to get Tired.
ENHANCED ASSESSMENT FINDINGS?
Hands and Face - Cyanosis due to Lack of Oxygen being Transported. Fingernails turn Blue or Grey with Exertion. The Fingers experience Clubbing. Check Rate, Rhythm, Character and Volume of Pulse.
Nicotine Staining due to Smoking being a Risk Factor for Emphysema.
IPPA SPECIFIC?
Inspect - Unable to Complete Full Sentences, Rapid Breathing and Use of Accessory Muscles as the Body Attempts to Transport Enough Oxygen for Organs and Cells.
Palpate - Difficulty to Palpate Apex Beat due to Hyperinflation.
Percuss - Increased Percussion Notes
Auscultation - Decreased Breath Sounds and an Audible Expiratory Wheeze.
IS A COUGH OR SPUTUM PRESENT?
Chronic Cough caused by the Irritation of the Airways due to Inflammation or Blockage caused by Mucus Build up. Yellow Sputum is Present.

Question 25

What is Pneumonia?

Answer 25

WHAT IS IT?
Infection that Inflames the Air Sacs in one or Both Lungs. The Air Sacs may fill with Fluid or Pus.
SIGNS AND SYMPTOMS?
- Chest Pain when you Breathe or Cough
- Confusion or Changes in Mental Awareness
- Fatigue
- Nausea, Vomiting, Diarrhoea and Shaking Chills
- Dyspnoea
AFFECT ON VITAL SIGNS?
- Low Temperature (Especially those older than 65 and Immunocompromised)
- High Temperature causing Sweating
- Increased RR
- Increased Pulse Rate
ENHANCED ASSESSMENT FINDINGS
Hands and Face - Central Cyanosis. Check Pulses - Fast, Regular Rhythm.
Lymph Nodes - Inflamed and Swollen due to the Infection.
IPPA SPECIFIC?
Inspect - Guarding and Lag on Expansion on Affected Side. Children may have Nasal Flaring and/or Intercostal and Sternal Retractions.
Palpate - Tactile Fremitus is Increased
Percuss - Dull Over Affected Area
Auscultation - Breath Sounds Louder than Normal, Crackles Present.
IS A COUGH OR SPUTUM PRESENT?
Dry Cough that may Produce Thick, Yellow, Green, Brown or Blood Stained Mucus.

Question 26

What is a General Chest Infection?

Answer 26

WHAT IS IT?
Infection of the Lungs or Airways. The Main Types are Pneumonia or Bronchitis. Most Cases of Bronchitis are caused by Viruses where as Pneumonia is mostly Caused by Bacteria.
SIGNS AND SYMPTOMS?
- Dyspnoea
- Chest Pain or Discomfort
- Aching Muscles
- Tiredness
- Headache
AFFECT ON VITAL SIGNS?
- High Temperature
- High RR due to Shortness of Breath
- Oxygen Saturation less than 90%
- Raised Heart Rate due to Infection.
ENHANCED ASSESSMENT FINDINGS
Hands and Face - Cyanosis, May be Hypoxic, Measure RR and Pulse Rate (Expect both Levels to be Elevated).
Lymph Nodes - Inflamed due to Infection.
IPPA SPECIFIC?
Inspect - Unable to Speak in Full Sentences. Rapid Breathing and Shortness of Breath.
Palpate - No Palpable Masses or Tenderness. Increased Frequency of Vibrations (Fremitus).
Percuss - Hyper-resonance
Auscultate - Wheeze and Crackles Present.
IS A COUGH OR SPUTUM PRESENT?
There is a Chesty Cough with Green or Yellow Sputum.

Question 27

What is Asthma?

Answer 27

WHAT IS IT?
Condition where your Airways Narrow and Swell and may Produce Extra Mucus. This can Make Breathing Difficult and Trigger Coughing, a Whistling Sound (Wheezing) when you Breathe out and Shortness of Breath.
SIGNS AND SYMPTOMS?
- Dyspnoea
- Chest Tightness or Pain
- Wheezing when Exhaling
- Trouble Sleeping caused by Shortness of Breath, Coughing or Wheezing
- Coughing or Wheezing attacks that are Worsened by a Respiratory Virus, such as a Cold or Flu.
AFFECT ON VITAL SIGNS?
- High Respiratory Rate >30
- High Heart Rate >120
ENHANCED ASSESSMENT FINDINGS
Hands and Face - Clubbing, Peripheral Cyanosis, Inverted Nail Beds, Clammy or Cold. Check for any Tar Staining in between the Fingers to Suggest Tobacco Use. Check for Tremors. Conjunctiva Pallor - When the Eye lids are Pulled down are the Eyes Pale. Jaundice, Ask the Patient to Stick there Tongue out and Check for Cyanosis underneath it.
Lymph Nodes - Check all Lymph Nodes for any Inflammation to Suggest Infection.
Chest - Begin IPPA Assessment.
IPPA SPECIFIC?
Inspect - Look for any Masses, Scars to suggest Previous Surgeries. Equal Chest Rise and Rate.
Palpate - Feel for any Masses, if they are Pulsating. Check for any Tenderness.
Percuss - Percuss for any Hyper/Hypo Resonance. Do it in a Ladder of 8 and 2 on the Axilla. Listen for Different Sounds on Each Side.
Auscultate - Listen for Any Wheezing, Crepitations, Snoring in this Same Places as Percussion.
IS THERE A COUGH OR SPUTUM?
Do Have a Cough. Some Patients do Suffer from Phlegm.
HOW TO TREAT?
Salbutamol
Ipratropium Bromide
Oxygen
Magnesium

Question 28

What is COVID-19?

Answer 28

WHAT IS IT?
A Severe Acute Respiratory Syndrome. Causes Cold and Flu like Symptoms.
SIGNS AND SYMPTOMS?
- Fever
- Cold
- Tiredness
- Dyspnoea
- Muscle Aches
- Chills
- Sore Throat
- Runny Nose
- Vomiting, Diarrhoea and Nausea.
AFFECT ON VITAL SIGNS?
- Low Oxygen Saturations
- High Temperature due to Fever
- High Respiratory Rate
ENHANCED ASSESSMENT FINDINGS
Hand and Face - Check Hands for any Signs of Clubbing with the Schamroth Window Test. Koilonychia or Inverted Nail Beds is a Sign of Iron Deficiencies or Anaemia. Similar to this, Looking at the Conjunctiva for any Pallor is another way to Assess if a Patient is Anaemic. Due to the Low Oxygen Saturations, I Would Expect to See Peripheral Cyanosis on this Patients Extremities. I would Look for any Jaundice or Yellowing in Eyes.
Neck - Look for any Distention of the Internal Jugular Vein. Should be no more than 4cm in Visibility and should not be Bulging or Pulsating. This Suggest Right Sided Heart Failure.
Lymph Nodes - Check the Lymph Nodes for any Inflammation or Swelling that Suggests a Possible Infection.
Chest - Use IPPA to Access the Patients Chest.
Legs - Check for any Peripheral Oedema or Oedema in the Sacrum for those with Mobility Issues or if a Patient is Bed Bound.
IPPA SPECIFIC?
Inspect - Look for any Previous Scarring to Suggest Recent Surgeries. Look for Bilateral Chest Rise and the Rate the Patient is Breathing. Inspect for any Trauma or Lesions. Are there any Pulsating Masses Visible such as a AAA? Is there any Sign of Accessory Muscle use?
Palpate - Feel for any Pulsating Masses. Ask the Patient if they Feel any Tenderness on Palpation. Be Careful not to Rupture any Masses.
Percuss - Percuss in a 8 Ladder. Listen on Both Sides to assess if the Sounds are Similar. Is the Noise Hyper or Hypo Resonant.
Auscultate - Listen with a Stethoscope in the Same Way you Percussed. Listen for any Abnormal Chest Sounds such as Wheezing, Crackles or Snoring.

Question 29

What is Tuberculosis?

Answer 29

WHAT IS IT?
Mainly Affects the Lungs. Germs that can cause Tuberculosis are a Type of Bacteria. Can Spread when a Person with the Illness Coughs, Sneezes or Sings. Can put Tiny Droplets with the Germs into the Air. Another Person can then Breathe in the Droplets and the Germs enter the Lungs.
SIGNS AND SYMPTOMS?
- Low Fever
- Tiredness
- Cough
- Chest Pain
- Pain when Breathing or Coughing
- Chills
- Night Sweats
- Weight Loss
- Not Wanting to Eat
AFFECT ON VITAL SIGNS?
- Low Temperature (Fever and Chills)
- Hypertension
- Tachycardia

Question 30

What is Atelectasis?

Answer 30

WHAT IS IT?
This is a Complete or Partial Collapse of the Entire Lung or Area (Lobe) of the Lung. Occurs when the Tiny Air Sacs (Alveoli) within the Lung become Deflated or Possible Filled with Alveolar Fluid.
SIGNS AND SYMPTOMS?
- Dyspnoea
- Rapid, Shallow Breathing
- Wheezing
- Cough
RISK FACTORS
- Older Age
- Conditions that Make it Difficult to Swallow
- Lung Diseases
- Bed Bound
- Recent Abdominal Surgery
- Smoking
AFFECT ON VITAL SIGNS
- Low Oxygen Saturation (Hypoxemia)
- Hypotension
- Tachycardia
- Fever
ENHANCED ASSESSMENT FINDINGS?
Hands and Face - Check Hands for any Signs of Clubbing with the Schamroth Window Test. Koilonychia or Inverted Nail Beds is a Sign of Iron Deficiencies or Anaemia. Similar to this, Looking at the Conjunctiva for any Pallor is another way to Assess if a Patient is Anaemic. Due to the Low Oxygen Saturations, I Would Expect to See Peripheral Cyanosis on this Patients Extremities. I would Look for any Jaundice or Yellowing in Eyes.
Neck - Look for any Distention of the Internal Jugular Vein. Should be no more than 4cm in Visibility and should not be Bulging or Pulsating. This Suggest Right Sided Heart Failure.
Lymph Nodes - Check the Lymph Nodes for any Inflammation or Swelling that Suggests a Possible Infection.
Chest - Use IPPA to Access the Patients Chest.
Legs - Check for any Peripheral Oedema or Oedema in the Sacrum for those with Mobility Issues or if a Patient is Bed Bound.
IPPA SPECIFIC?
Inspect - Look for any Previous Scarring to Suggest Recent Surgeries. Look for Bilateral Chest Rise and the Rate the Patient is Breathing. Inspect for any Trauma or Lesions. Are there any Pulsating Masses Visible such as a AAA? Is there any Sign of Accessory Muscle use?
Palpate - Feel for any Pulsating Masses. Ask the Patient if they Feel any Tenderness on Palpation. Be Careful not to Rupture any Masses.
Percuss - Percuss in a 8 Ladder. Listen on Both Sides to assess if the Sounds are Similar. Is the Noise Hyper or Hypo Resonant.
Auscultate - Listen with a Stethoscope in the Same Way you Percussed. Listen for any Abnormal Chest Sounds such as Wheezing, Crackles or Snoring. A Wheeze would be Expected on Auscultation due to the Fluid Build up.