Resp

Question 1

1

Answer 1

inspect

Question 2

2

Answer 2

isnpect hands - inspect front and then turn them over

Question 3

3

Answer 3

clubbing - bring nails together

Question 4

4

Answer 4

tremor !! hands “if you could bring your hands back out for me and keep them there”

and cock your wrists back

fine tremor = salbutamol

astetrixis = co2 retention

Question 5

and relax…

5

Answer 5

“id like to feel your pulses in your wrist”

2 PARTS:

1. palpate the radial
2. bring up to the chest and asses RESPIRATORY RATE

Question 6

6

Answer 6

check blood pressure

“at this point i would check your blood pressure?”

Question 7

7

Answer 7

“Could you turn your head to the right for me”

just look for signs of a phat JVP

Question 8

8

Answer 8

“and bring your head back for me. im just going to look at your face and eyes, ok? if you could just look straight ahead for me”

inspect for hypoxia

anaemia in eyes - pull eyelids down

inspect mouth - if you could open your mouth for me, and lift your tongue to the roof of the mouth

Question 9

9

Answer 9

INSPECT THE CHEST -

expose the chest at this point -

have a good look, also get them to pull up both arms

barrel chest, scars, muscle wasting…

Question 10

10

Answer 10

TRACHEAL POSITION!!!!!!!

REMEMBER FACE THEN INSPECT THEN GO TO NECK BEFORE YOU START DOING ANYTHING WITH THE CHEST

im now going to feel the position of your windpipe. let me know if its too uncomfortable

wiggle finger on the middle of trachea and then wiggle finger to side. then put 3 fingers like a gun pointing to the neck

Question 11

11

Answer 11

palape apex beat

5th ICS

Question 12

12

Answer 12

ASSESS CHEST EXPANSION

“I’m now going to asses the expansion of your chest. this will jsut involve me placing my hands around the chest, quite tihgtly. then asking you to take a deep breath in.”

“deep breath”

“and out”

clasp hands around the chest. put thumbs together in centre of the sternum.

Question 13

13

Answer 13

Tactile vocal fremitus

(palpation still)

have edge of the hand on the chest and go down 3 times on each side getting the patient to say 99

http://www.imperialendo.co.uk/Newskills/resp6.html

Question 14

14

Answer 14

percuss the lung fields

start at top above clavicle

2 above nipples

1 on/slightly below nipples

1 under arms below nipples

Question 15

15

Answer 15

“im now going to listen to your chest, if you just take some deep breaths in and out through your mouth”

listen above clavicle with bell

then 3 on chest to just below nipple

then 1 again on side

(Starting at the apices, auscultate from side to side anteriorly and laterally with open mouthed breathing (clavicle to 6th rib, mid-clavicular line; Axilla to 8th rib, mid-axillary line)).

Question 16

16

Answer 16

Assess for vocal resonance

“this time james every time i place my stethescope on the chest, could you say 99 for me”

Question 17

16

Answer 17

palpate lymph nodes

“can you now sit foward for me, id like to examine the glands in your neck”

start under chin, work way out under jaw, then down the neck centrally, then along collarbone to traps, then back up side of neck

Question 18

17

Answer 18

inspect posterior wall

“im just going to more closely look at your back

Question 19

18

Answer 19

assess for chest expansion

Question 20

19

Answer 20

Assess tactile vocal fremitus (“say ninety-nine”).

Question 21

20

Answer 21

percuss back

“im now going to tap on your back,” “if you could just fold your arms for me?”

percuss 4 times, quite centrally

Question 22

21

Answer 22

aucultate back

5 times. working way down and out from central position

vesicular breathing = normal

inspiratory stridor = upper airway obstruction

wheeze = asthma / copd!!!!

crackles = pulmonary oedmea. if fine then pulmoulmoary fibrosis

Question 23

22

Answer 23

and now if you could say 99 for me

Question 24

22

Answer 24

oedema

“im just going to press on your ankles”

Question 25

complete

Answer 25

that complete the examination, thank you v much, you can now get dressed for me

in summary i performed a respiratory exam on …

they had no peripheral stigmata or respiratory disease, his pulse was regular, and he had a normal respiratory rate. they had a normal and symmetrical percussion note on the front and back of the chest.

on ascultation they had normal vesicular breathing with no added sounds.

to complete the respiratory exam id like to

assess peak flow!!!

measure oxygen levels and send off a sputum sample!!!