respiratory exam Flashcards
what are the general principles of an exam (general resp, cardio)
inspection (including suroundings)
palpatations
percussion
auscultation
what is the normal respiratory rate
12- 15 breaths per minute
what things are looked for on inspection of the patient
respiratory rate respiratory rhythm use of accessory muscles (sternocleidomastoids, scalene - laboured breathing) sound chest movement - symmetrical?
chest shape
what chest shapes are to be looked out for
barrel chest
Pidgeon chest - sever child hood asthma
sternal depression - congenital - not clinically significant
`what are the types of percussive notes
hyper-resonant - more air than normal
dull or impaired - more solid ie pus
stony dullness - fluid/ puss
what are the type of sounds heard on auscultation
wheeze
crackles
pleural friction rub
bronchial breathing
what position should a patient be in the exam
45 degrees
what should be done first after introduction
initial assessment
what are you looking for in the initial assessment
immediate intervention
patient well enough for exam
check the environment around the patient - open pots
news chart
what are the time capillary refill is held for - how long is refill time normally
do in both hands
hold for 5 seconds
refill is normally 2 seconds or under
what shoud be looked at on the hands in the resp exam
tar staining
warmth of hands - compare
peripheral cyanosis or anaemia
finger clubbing
tremor
Muscle wasting
Capillary refill time
how do you check for peripheral cyanosis or anaemia in the hands
inter-lace your fingers and compare colour
what are you looking for on the arms
IV track marks
what tremors are we looking for - how long?
fine - hold arms out
flapping - hold and raise arms for 15 seconds
what must you do after the hand and arm examination
take the pulse and respiratory rate
what are the signs of finger clubbing
loss of nail bed angle
increased nail bed fluctuation
increases bulk of soft tissue over the terminal phalanges
how long should the pulse be taken for
15 seconds and multiplied by 4
how long should respiratory rate be taken for
a full minute
what should be looked at for the head
the conjunctivae of the eyes
tongue and lips
face in general
what are you looking for at the conjunctivae of the eyes
check for anaemia - normal conjunctivae are pink
what are you looking for in the tongue and lips
signs of central cyanosis - blue discolouration of the tongue/lips
what are you looking for in the face
no sing of redness, swollen tonsils or white patches
what things are you looking at in the neck for the respiratory exam
tracheal position
measure crico-sternal distance
check lymph nodes
how should tracheal position be measured
chin along mid line and neck slightly extended
warn patient about discomfort
place finger lightly in supra sternal notch and gently feel for the trachea
how do you measure the crico-sternal notch
it should be between 2 to 3 fingers wide
between the supra sternal notch and the cricoid cartilage
how should lymp nodes be examided
ask patient to sit forward
feel nodes –
sholders to neck
suprclavicular anterior cervical chain tonsillar nodes submandibular nodes sub mental - right to chin
pre and post auricular
post cervical chain
what should be done after lymph node exam - why
back of chest exam - to stop over-movement of patient
what is in the back of chest exam
inspection
palpitation
percussion
auscultation
what are you looking for when inspecting the back of the chest
are there any scars
looking for visual abnormalities - scoliosis/ kyphosis
what are you doing on palpation of the back of the chest - where
checking lung expansion - 3 times
apices, midway and bases
where on the back are you percussion
5 zones
aperies
upper
middle
lower
axilla (mid auxiliary line)
where do you auscultate
the 5 zones you’ve just done
for respiratory exam what part of the stethoscope do you use
the diaphragm
what should you be listening for on auscultation
breathing is vesicular or bronchial
intensity
added sounds
what added sounds might you hear on auscultation
crackles
wheeze
pleural rubs
what do you do after auscultating the 5 zones
check vocal resonance by getting the patient to say 99
what position should the patient be in for the front of chest respiratory exam
45 degrees
what is the only different procedure of the front of chest respiratory exam compared to the back
checking the position of the mediastinum
how is the position of the mediastinum checked
check tracheal position is correct
feel for the apex beat and see if it is the correct position
where should the apex beat be felt
the 5th intercostal space in the mid clavicular line
how should the consultation be closed
thank patient
tell them you’ve finished
get the patient comfortable again
