Respiratory Exam

Question 1

What sections are in a respiratory exam?

Answer 1

Initial Assessment
Introduction and Consent
General Overview
Hands
Head
Neck
Front of Chest
Back of Chest
Closure

Question 2

What do you do in the initial assessment and introduction of a respiratory exam?

Answer 2

Initial assessment

• does patient need life-saving intervention?
• are they well enough to proceed with examination?
• inspect environment (oxygen, vomit, sputum, medication)

Introduction

• Clean hands
• My full and role
• Check patient’s full name and date of birth
• Confirm with wristband
• Explain procedure and obtain informed consent
• Position bed at appropriate height and patient at 45deg
• Check charts if available

Question 3

What are you looking for in the hands during a respiratory exam?

Answer 3

Tar staining
Peripheral cyanosis
Clubbing
CO2 retention
- flapping tremor
- warmth/pinkness

Pulse and respiratory rate

Question 4

What are you looking for in the head and neck during a respiratory exam?

Answer 4

Central cyanosis in tongue
Conjuctivae for pallor

Assess tracheal position
Nodes if asked
Distance from laryngeal prominence to sternal notch

Question 5

What is the procedure for inspecting the front of the chest during a respiratory exam?

Answer 5

Inspection
Palpation
Percussion
Auscultation

Inspection

• scars
• abnormalities
• lesions, dilated veins

Palpation

• Apex beat
• expansion (upper and lower)

Percussion
- clavicle + 3 + axilla

Auscultation

• breathing in same areas as percussion
• deep breaths through mouth
• vocal resonance in same areas
• listening for vesicular vs bronchial
• sound intensity
• added sounds (rub, wheeze, crackles)
• inspiratory or expiratory sounds?

Question 6

What is the procedure for inspecting the back during a respiratory exam?

Answer 6

Same as front

• scars
• upper and lower expansion on palpation
• percuss/auscultate each lobe