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
What do you look for in the lips and tongue?
Cyanosis
What does a deviated trachea mean?
Away from lung - tension pneumothorax
Towards lung - collapsed lung
Where is the trachea?
Behind the manubrium
Where does the trachea bifurcate?
At the manubriosternal joint
Where are the apex of the lungs?
2.5 cm above medial 3rd of clavicles
Where are the borders of the lungs?
Line starts at sternoclavicular joint
Continues along lateral border of sternum to 4th costal cartilage
Border of right lung arcs down to
- 6th rib in midclavicular line
- 8th rib in midaxillary line
- 10th rib adjacent to vertebral column posteriorly
Border of left lung similar but deviate laterally at 4th costal cartilage to form cardiac notch
Posterior border from C7 to T10 4 cm from midline
Where is the oblique fissure?
line between spinous process of T2 to 6th costal cartilage anteriorly
What does the oblique fissure coincide with?
Medial border of scapula when hands behind head
Where is the horizontal fissure?
On right side
From 4th costal cartilage back to intersect with oblique fissure
Where do the inferior borders of the pleura extend to?
8th rib in midclavicular line
10th rib in midaxillary line
12th rib in paravertebral line
