Respiratory Exam Flashcards
What are the main steps in a respiratory exam?
Prepare the patient Hand hygiene General inspection Hands Wrist Head and neck Anterior and lateral chest wall Posterior chest wall Measure peak flow Conclude and close assessment
How should you prepare the patient?
Introduction and consent
Explanation
Exposure: undress to waist; provide gown
Position: examine from right; 90 degrees
What should you generally inspect?
Environment and patient
What should you look at in the hands?
Nails
Fingers
What should you check at the head and neck?
Conjunctivae Lips, tongue, and palate Trachea - One finger - Feel either side - Midline or deviated
What should you check at the anterior and lateral chest wall?
Inspection - including axillar Expansion - Lower and upper - Hands anteriorly over lower rib cage - Thumbs opposed to each other and off chest wall - Ask patient to take deep breath - Degree of expansion - Symmetry of movement - Upper anterior chest using flat of your hands Percussion - Down midclavicular line every 2nd intercostal space - 2 on axillar - Alternate right and left sides to compare Auscultation - Same places as percussion - Listen for one complete breath cycle - Patient breaths in and out through open mouth Vocal resonance - Same places as percussion - Patient says 99
What should you check at the posterior chest wall?
Move patient to edge of bed Inspection Expansion - Hands over posterior lower rib cage - over lung bases - Thumbs opposed to each other and off chest wall - Patient takes deep breath - Degree of expansion and symmetry Percussion - Rotate scapulae - patient hugs themselves - 2 positions in upper zone - 2 positions in lower zone Auscultation - Same sites as percussion - Breathe in and out through mouth Vocal resonance - Same sites as percussion
When is peak flow useful?
Small proportion of patients with asthma
Where is peak flow recorded?
On peak flow chart
What should you check at the wrist?
Radial pulse
Respiratory rate
What is peak flow used for?
Monitoring degree of airflow obstruction
What might you find on a general inspection?
General mental state - high CO2 makes you drowsy Alertness Respiratory effort - use of accessory respiratory muscles Coughing Wheezing Stridor Supplemental oxygen Sputum in a cup
What might the nails show?
Peripheral effects of respiratory disease
Clubbing
How long should you measure PR and RR for?
15 sec each
What do you look for in the conjunctivae?
Anaemia
