Physical Exam (1) - Pulmonary Flashcards
parts of a physical examination
observation and inspection
palpation
auscultation
cough assessment
observation and inspection
general appearance
inspection of face, head and neck
inspection of unmoving chest
inspection of moving chest
general appearance includes
level of consciousness
body type and proportions
posture
extremities
equipment
level of consiousness
are they AxO
if there is a lack of O2 –> could have affect on A&O
body type and proportions
are they obese or cachectic
abnormal postures may indicate
MS anomalies
MS anomalies may contribute to
pulmonary dysfxn or result from pulmonary problems
what could anomalies of the spine and rib cage interfere with
normal excursion
result in restrictive patterns
commonly include scoliosis, kyphosis and ankylosing spondylitis
extremities
inspect for signs of local cyanosis or digital clubbing
look for painful, swollen joints
edema
equipment
take note of any equipment used in managing the pt
cardiac monitor, vent, oxygen, etc.
where is a good area to detect color changes
face
head
neck
color changes
cyanosis
pallor
redness
what should we observe about breathing
pursed lip breathing
nasal flaring
what should we look for on the neck
jugular vein distension
hypertrophy of the SCM
use of other neck muscular hypertrophy
what does the use of other neck muscles indicate
use of accessory muscles
what should we look for in the face
signs of distress
inspection of the unmoving chest
static components
what should we look for on the unmoving chest
conditions of the skin
shape and symmetry of the chest
rib angles
intercostal spaces
musculature around the chest
conditions of the skin
incisions
scars
trauma
inspection of the moving chest
moving components
what should we determine –> moving chest
rate of respiration
inspiration and expiration ratio, in time
normal rate of respiration
12-20 breaths per min
inspiration and expiration ratio normal
1:2
is there any… –> moving chest
noise w/ breathing
what should we look for –> moving chest
symmetry of ventilation
muscles of breathing
breathing pattern
symmetry of ventilation
are the left and right sides expanding the same amount
muscles of breathing
primary v. secondary muscles being used
breathing patterns
should be diaphragmatic
eupnea
normal breathing
dyspnea
SOB
orthopnea
SOB when laying down
characterized by the # of pillows a pt needs to not have SOB
tachypnea
persistent rate of >20 breaths/min
bradypnea
rate < 12 breaths/min
palpation is used to
either confirm or rule out a suspected abnormality
what do we palpate
thoracic musculature
skeleton
what are we feeling for
pulsations
tenderness
bulges
depressions
unusual movements
what should we locate
landmarks
thoracic excursion
specific lung segments
more objective measures
diaphragm motion
chest wall pain
specific lung segments
utilizing your hands to compare the extent of expansion and timing of movement in the upper, middle and lower lobes
upper segments
stand in front of pt
place you hands on their upper traps
middle segments
stand in front of pt
place hands around side of the pt
have thumbs line up right below the nipple line
lower segments
stand behind the pt
fingers facing down
more objective measures
tape measure
measure of sternal angle with goniometer
tape measure
placed at level of xiphoid process
measure at full inspiration and full expiration
what is a normal differentiation b/w full inspiration and expiration
2-4”
wide range
measure of sternal angle w/ goni
axis is at the xipho-sternal jxn
arms of the goni aligned w/ lower margin of the ribs
when do we measure of sternal angle w/ goni
full inspiration and expiration
diaphragm motion
place thumbs at sternal angle with fingers over lower margins or ribs
inspiration should cause ribs to separate
what should we have the pt do –> chest wall pain
describe the
-location
-type
-characteristics of pain
-point of painful area
how can we palpate chest wall pain
with firm pressure
what should we have the pt do –> chest wall pain
cough
take deep breaths
to see if these reproduce of exacerbate the sxs
what must we differentiate b/w –> chest wall pain
cardiogenic pain
nerve root pain
costal cartilages or ribs
musculature
cardiogenic pain –> chest wall pain
located substernally
w/ or w/o radiation to UE
described as pressure or a weight on the chest
how does nerve root pain happen
if inflamed or irritated
what will pain follow –> nerve root pain –> chest wall pain
dermatomal distribution
nerve root levels that involved the chest, back and abdoment
C2 (lower neck, shoulders and clavicular areas)
T2-T12
what are causes of nerve root pain
degenerative arthritis
neoplasms
OA
disc lesions
costal cartilages or ribs is d/t –> CWP
fx
subluxation
inflammation
infection
costal cartilages or ribs sxs –> CWP
well localized
tender to palpation
–> palpate ON the rib will cause pain
muscular CWP is d/t
spasm
strain
delayed muscle soreness following activity
how do we differentiate muscular CWP
history
deep palpation of muscle bellies
giving resistance to the action of suspect muscle in an attempt to reproduce the pain
where will palpation cause pain –> muscular CWP
intercostal space
when we use the area/stretch the area –> CWP
it will hurt
if needed our physical exam must be
expanded to rule out other MS problems
MS problems
thoracic outlet syndrome
cervical disc problems
shoulder girdle pathologies
