Respiratory Assessment

Question 1

Inspection Topics

Answer 1

• Resoiratlry Effort Rate
• Hands/Feet
• Face
• Thorax
• Cough

Question 2

Hands/Feet Inspection

Answer 2

• Colour of hands - pallor/erythema
• Warm to touch? Clammy?
• Peripheral cyanosis?
• Tremours? (overuse of B2 agonist inhalers)
• Asterixes (hand flap) = CO2 pretension/liver failure
• Clubbing? Loss of shamroths window? = increased CO2 pretension/liver failure

Question 3

Assessment Respiratory Effort and Rate

Answer 3

• do full real rate for 1 minute
• normal rhythm? = regular/irregular (Cheyenne Stokes)
• depth = deep/shallow (Kausmauls)
• effort = relaxed, tripoding
• speaking in full sentences?
• diaphragamit breathing?
• intercostal reccession
• use of accessory muscles?
• paradoxical breathing? Flail chest

Question 4

Thorax Inspection

Answer 4

• change in shape/symmetry
• scarring?
• barrel chest?
• Kyphosis? Scoliosis?
• Pectus excavatum, carinatum
• rashes or masses?
• swelling or redness?

Question 5

Cough Inspection

Answer 5

• can you cough for me?
• what is the strength of this cough?
  Would this cough be enough to clear secretions?

Question 6

Face Inspection

Answer 6

• obvious swelling?
  Mucuous membrane should be pink
• dehydrated, furry tongue
  Nostrils flaring?
  Central syanosis? Lips and nostrils
• pale conjunctiva (anaemia)

Question 7

Palpation Topics

Answer 7

• Bony structures
• Tracheal deviation
• Tactile fremitus
• Respiratory excursion
• Masses

Question 8

Palpating Bony Structures

Answer 8

• palate along the bony structures (sternum, clavicle, shoulders, shoulder blades,)
• Looking for symmetry, abnormality, crepitus
  Flail segemtns?
• Signs of surgical emphysema? (popping under the skin = puncture and infection)
• any tenderness upon palpation?

Question 9

Tracheal Deviation

Answer 9

• any tracheal deviation, late sign of tension pneumothorax

Question 10

Tactile Fremitus Assessment

Answer 10

• palate ant/post/lat
• feel for equal vibrations when pt says ‘blue balloons’
  Increase means inflammation and decreased means decreased density eg COPD

Question 11

Respiratory Expansion

Answer 11

• Hands ant/post while pt takes deep breath (equal)
• ankylosing spondylitis (inflammation sphere)

Question 12

Percussion Technique

Answer 12

• Percuss and (6th), Lat (8th), Post (10th)
• Consider cardiac dullness
  Resonance = normal
  Hyperesonance = space (pneumothorax)
  Hyporesslnan e = mass, consolidation, effusion (fluid, blood, puss, mucous)
  Dull/Flat = bone, organ egdiapghrapm

Question 13

Diaphragmatic Excursion

Answer 13

• palate from below scapula when holding breath out until dull
• Palate down again when breath holding out until dull
  Normal = 3-6cm
• changes can indicate COPD, nerve dmg, pneumothorax and pleurisy

Question 14

Auscultation Technique

Answer 14

• Looking for presence and quality of sounds
• auscultate ant/lat/post
• listen to all lobes (left 2, right 3)
  -use Bell to listen to apex of the lungs (just above the clavicle)
• compare both sides
• ladder technique

Question 15

Chest Sounds

Answer 15

Fine Crackles = pulmonary fibrosis/oedema
Course Crackles = pulmonary oedema/infection
Inspiratory Stridor = upper airway obstruction
Wheeze = asthma, ,COPD (narrowing of upper airway)
Snore = fluid, mucous
Abscent = tension pneumorX, life threatening asthma

Question 16

Respiratory Handover

Answer 16

• thank pt for their time
• I believe the pt is fit and healthy
• I have found no inspecplapation
• on percussion the lungs were resonant
• I heard no adventitious sounds
• I would do a systems review to conclude my assessment history or abnormalities on inspection