Resp Flashcards
1
inspect
2
isnpect hands - inspect front and then turn them over
3
clubbing - bring nails together
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
and relax…
5
“id like to feel your pulses in your wrist”
2 PARTS:
- palpate the radial
- bring up to the chest and asses RESPIRATORY RATE
6
check blood pressure
“at this point i would check your blood pressure?”
7
“Could you turn your head to the right for me”
just look for signs of a phat JVP
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
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…
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
11
palape apex beat
5th ICS
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.
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
14
percuss the lung fields
start at top above clavicle
2 above nipples
1 on/slightly below nipples
1 under arms below nipples
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)).
16
Assess for vocal resonance
“this time james every time i place my stethescope on the chest, could you say 99 for me”
16
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
17
inspect posterior wall
“im just going to more closely look at your back
18
assess for chest expansion
19
Assess tactile vocal fremitus (“say ninety-nine”).
20
percuss back
“im now going to tap on your back,” “if you could just fold your arms for me?”
percuss 4 times, quite centrally
21
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
22
and now if you could say 99 for me
22
oedema
“im just going to press on your ankles”
complete
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!!!
