Respiratopry Examination Flashcards
Observation
Observation -
Pale
Clubbing of digit = CHronic fibrosis
Pectus excavatum - associated w marfans
Pectus carnatum
Barrel chest - COPD, Over inflated lungs
DIfficulty breathing - Asthma, copd
Breathing rate and rhythm
Not using accessory muscles - asthma, fibrosis,
make sure it is controlled and consistent
Normal relaxation and expansion of the chest
Normal = 12-20
>20 = Asthma, copd, Pneumonia
“Get pulse (fake) and check their breathing rate”
General:
* Cyanosis- COPD (chronic bronchitis)
* Nasal flaring, pursed lips, accessory muscle breathing- asthma, pulmonary edema, fibrosis, PE
* Wheeze- asthma, COPD
* Productive cough- COPD, CF, pneumonia
* Pink puffer (emphysema)- pursed lips, barrel chest and use of accessory muscles to breathe.
* Clubbing of digits- Chronic Fibrosis, interstitial lung disease
* Blue bloater (CB)- purulent sputum, obese, wheeze, chest tightness, smoking
* Cachexia- lung cancer, late COPD
* Stridor- foreign object obstruction
* Pallor- anemia, CHF
* Tracheal deviation:
o Away: pneumothorax
o Towards: Pneumonectomy
Hands:
* Peripheral Cyanosis
* Cold hands- Raynaud’s, poor perfusion
* Clubbing of digits- Chronic Fibrosis, interstitial lung disease
* Joint Swelling- RA–> linked with pleural effusion, fibrosis
Face:
* Ptosis/ miosis/exophthalmos (Horner’s)- Pancoast tumor
* Conjunctival pallor
Breathing rate
* Respiratory rate:
* Going to inspect rhythm
* Controlled and consistent rate
* Normal expansion & relaxation of the chest
* And that they are not using accessory muscles at rest
o 12-20= normal
o <12= intoxication, raised ICP
o >20= asthma, copd, pneumonia
Chest:
* Barrel chest- COPD, Overinflated chest
* Pectus excavatum – Associated with Marfans, Rickets and Scoliosis
* Pectus Carnatum – Pigeons chest
Palpation
Tracheal deviation, Chest expansion and Tactile fermitus
Tracheal deviation
Make sure i am palpating the trachea, note the distance between the two SCMs
I can ask the patient to swallow and see for any noticable deviations
-Away: pneumothorax, pleural effusion
-Towards: Pneumonectomy, pleural fibrosis
- Crico-sternal distance:
-<3 fingers- hyperinflation- d/t asthma or COPD
Chest expansion:
-Ask patient to cross their hands and with youre thumbs grab aorund the back of patient
-Ask patient to breathe in and out
-Healthy- upwards/symmetrical bilaterally
- It should be 3-5cm symmetrically
-Asymmetrical with decreased expansion- pneumothorax, pneumonia, pleural effusion
Tactile Fermitus
-Ask patient to cross their arms and tell them when i apply pressure could you repeat the phrase “99” for me
- Increased fremitus: increased tissue density
o Tumor
o Pulmonary fibrosis
o Atelectasis
o Pneumonia - Decreased fremitus: fluid and air outside lung space
o Pulmonary effusion
o Pneumothorax
o Emphysema d/t hyperinflation
o Asthma
Percussion: 14 times
Percussion Posterior part of back ask patient to cross their arms
Trying to listen for dull, resonant or hyperresonant sounds
Then say you would repeat this for the anterior part
Resonant sounds -
Heard over normal lung tissue
Dullness:
Solid areas like bone
o D/t Consolidation or Mass
Pleural effusion
Tumor
Pneumonia
Emesis
Hyperresonant sounds
Heard in hyperinflated lungs,
COPD , Emphysema
and can be heard in children or thin adults
Tympanic sounds
Hollow, high, drumlike
In the chest – indicates excessive air e.g. pneumothorax
Percussion
Diaphragm border
Ask patient to exhale completely and hold it as you percuss down for dullness to determine the location of the diaphragm.
-Mark this are
- Now ask patient to take a deep breathe in and hold it
-Keep percussing down for the other level of dullness
-This distanc between the two should be no greater than 3-5cm
-Note liver dullness
- A lung affected by COPD often displaces the upper border of the liver downward
-It also lowers the level of diaphragmatic dullness posteriorly
Asucultation
Auscultation:
-Ask patient to cross their arms and breathe in and out through their mouths
-Listen to each point through inspiraiton and expiration
-Assess volume /quality on both lobes
Start with Trachea
Quality
Normal breathe sounds:
Vesicula; Good soft and low pitched sound
Bronchial - consolidation/fibrosis (loud or harsh)
Volume:
-Quiet/reduced- Indicates airway obstruction / reduced air entry
d/t pleural effusion, pneumothorax, pneumonia
- Other sounds:
Fine Crackles = Pneumonia, Pulmonary edema
Coarse crackles- Bronchiectasis
Wheeze - Associated with airway narrowing, COPD, Asthma
Pleural rub- Discontinous creaking in phase with breathing
pleural effusion, CHF, Pulmonary embolism
Stridor (trachea auscultation) - Loud, high pitched musical sound, Can indicate upper respiratory tract obstruction
Auscultation
Vocal Fermitus
Voice Sounds
* Ask patient to say “99” should be just audible but in consolidate lung will become louder e.g. Pneumonia
- Increased fremitus: increased tissue density
o Tumor
o Pulmonary fibrosis
o Atelectasis
o Pneumonia - Decreased fremitus: fluid and air outside lung space
o Pulmonary effusion
o Pneumothorax
o Emphysema d/t hyperinflation
o Asthma