Resp examination

Question 1

overview

Answer 1

1. general observations
2. intro
3. general inspection
4. inspection, palpation, percusion and auscultation of chest

Question 2

1.general observations x13
3 groups

Answer 2

usual:
* immediate intervention
* concious, distressed

patient state:
1. cough, dyspnea?
2. sweaty or cyanosed?
3. accessory muscles?
4. Is breathing labored?
5. Is chest movement symmetrical*?

enviroment:
* any medications (e.g. inhalers/nebuliser)
* oxygen
* sputum pot
* note the presence and readings on any monitors
* Look for the presence of chest drains.
* CHECK CHARTS

Question 3

3.general inspection overview

Answer 3

hands and arms
face
neck

Question 4

3.general inspection: hands and arms x8

Answer 4

Hands:
* Tar staining of fingers
* Warmth of hands
* Peripheral cyanosis or anaemia - (interlace your fingers
with patient’s to compare colour)
* finger clubbing
* cappilary refill should be under 2 secs

Tremours:
* fine and flapping

Measuring:
* pulse and resp

Arms:
* track marks of IV drug abuse

Question 5

3.General inspection: head x3

Answer 5

• conjunctivae- pallor/anaemia by gently pulling down the lower
  eyelid.
• tongue and lips Look for central cyanosis – blue discolouration of tongue and/or lips
• face Look- redness or swollen tonsils, or white patches
  indication infection.**

Question 6

3.general inspection: neck x3

Answer 6

tracheal position

Measure crico - sternal
distance

Lymph Nodes

tracheal position: Place the index/middle finger in the
suprasternal notch and gently feel for the trachea which
should be central. Movement to one side or the other
indicates that the mediastinum has shifted to that side

crico-sternal distance: 2 to 3 patient finger widths can be inserted
between the suprasternal notch and the cricoid cartilage

lymph:
* supraclavicular
* anterior cervical chain
* tonsillar nodes
* submandibular nodes
* submental nodes
* pre and post auricular nodes
* posterior cervical nodes.

Question 7

4.(a)back of chest: Inspection x3

Answer 7

1. get to lean forward over a pillow while legs are over bed

• asymmetry
• spinal deformities- kyphosis and scoliosis.
• skin lesions or dilated veins evident?

Question 8

4.Back of chest: palpation

Answer 8

expansion:
hands on each side of the chest symmetrically
stretch the skin with the fingers, with the thumbs extended to try to touch each other in the midline.

breath in

repeat at three levels; the bases,vthe apices, and midway between.

Question 9

4.back of chest: percussion

Answer 9

Percuss 5 areas: Apices, upper, middle and lower zones,
and axilla (mid-axillary line)

comparing both sides

Question 10

4.back of chest: auscultation

Answer 10

Use diaphragm

Apices, upper, middle and lower zones,
and axilla (mid-axillary line)

breath sounds:
“no wheezes, crackles or rubs”
“vesicular breath sounds”
“any pain?”

Vocal resonance:
“ninety nine”

Question 11

4.(b) front of chest: inspection

Answer 11

patient at 45 degrees

• scars
• Are there any visible abnormalities of the sternum or the
  chest wall?
• Are any skin lesions or dilated veins evident?
• barrel chest, even movemnt?

Question 12

4.Front of chest palpation

Answer 12

tracheal position
apex

expansion:
upper lobe or apices, and bases

Question 13

4. front of chest percussion and auscultation

Answer 13

same as back

Question 14

areas for percussion and auscultation

Answer 14