Respiratory

Question 1

Structure of a Resp assessment

Answer 1

1. Observe from the end of the bed:
   a. Scars.
   b. Chest shape,
   c. asymmetry.
2. Pattern of breathing:
   a. Respiratory rate.
   b. Time spent in inspiration and expiration.
   c. Pursed-lip breathing.
3. Chest wall movement, paradoxical rib movement, intercostal indrawing.
4. Accessory muscle use.
5. Examine the hands:
   a. Clubbing,
   b. nicotine staining,
   c. muscle wasting.
   d. Check for tremor and flap.
6. Examine the face:
   a. Check for anaemia,
   b. cyanosis,
   c. signs of superior vena cava obstruction.
7. Examine the neck:
   a. Jugular venous pressure,
   b. tracheal deviation and
   c. cricosternal distance.
8. Examine the anterior chest wall: PPA
   a. Palpate: apex beat,
   b. right ventricular heave,
   c. expansion of upper and lower chest.

a. Percuss: compare right with left, from top to bottom, then axillae.

a. Auscultate: deep breaths; compare right with left, from top to bottom, then axillae. Repeat positions, asking the patient to say ‘one, one, one’ for vocal resonance.
9. Examine the posterior chest wall:

Question 2

When examining the Hands what are you looking for? (8)

Answer 2

1- finger clubbing
2- nicotine staining
3- muscle wasting
4- tremors (Co2 retainers/ beta agonist use)
5. asterixis
6. Temperature
7. Cyanosis
8. Pulse

Question 3

When examining the Face what are you looking for? (3)

Answer 3

1. Cyanosis
2. Anaemia
3. Superior vena cava obstruction

Question 4

What do you palpate for? (3)

Answer 4

1- Apex beat
2- Ventricular heave
3- Pain

Question 5

Causes of dyspnea

Answer 5

Resp infection
MI
Asthma
COPD
Resp Failure

Question 6

Stages of assessment

Answer 6

End of bed
Inspect
Palpate
auscultate
Percuss

Question 7

What to check on face and neck during Inspection

Answer 7

Eyes- pallor- eyelids/ jaundice
JVP- distended?
Tracheal deviation
Surgical emphysema

Question 8

What to Palpate

Answer 8

Mediastilum
Trachea central
Equal chest rise
Anterior posterior expansion
Thumbs central- 5cm expansion normal range
Tactile fremitus

Question 9

Causes of Tactile fremitus

Answer 9

Causes of increased vocal fremitus: pneumonia, lung abscess.
Causes of decreased vocal fremitus: pleural effusion, pneumothorax, emphysema.

Question 10

Casues of different resonance

Answer 10

Hyporesonance (Consolidation)
Hyperresonance (Pneumothorax)