Respiratory Exam Flashcards
What position is the patient in when examining the anterior chest wall?
You will want the patient to be lying on the couch, at a 45 degree angle
What position is the patient in when examining the posterior chest wall?
Ask the patient to lean forwards
What position is the patient in when examining the cervical lymph nodes?
You will ask the patient to sit across the couch with their legs dangling off the sides.
How should the patient be exposed during a respiratory examination?
The patient will need to be exposed from the waist upwards, however if possible you should offer the patient a blanket so they will only be exposed when appropriate, and if relevant patients do not need to remove their bras.
Where do you perform general inspection from?
The end of the bed
How do you assess respiratory rate? duration, position, exposure, awareness
Your will measure the rate of breathing visually observing the anterior chest wall (and abdominal walls) movements for 30 seconds while the subject breaths quietly. The subject lies on the couch with the chest and abdominal area exposed. You will count the respiratory movements without the subject being aware (you may pretend measuring their pulse).
How do you express breathing rate?
As breaths/minute
Where does the trachea bifurcate? (carina)
The level of the sternal angle (T5)
Where does the trachea lie?
It lies in the midline of the neck and suprasternal (jugular) notch of the manubrium
From where to where is the trachea palpable?
Larynx to the suprasternal notch.
What position is the patient for palpation of the trachea?
Ask the patient to lean back and lower their neck slightly so their neck is relaxed
If the trachea is not in the midline what will your fingers feel during the palpation of the trachea?
If it is displaced to one side then your finger will feel one side of the trachea instead of its middle.
If the trachea is in the midline what will your fingers feel during the palpation of the trachea?
If the trachea is in the midline, your finger will not be able to progress further.
Where should the trachea be in normal healthy individuals? [but]
In normal healthy individuals should be in the midline but there may be a slight displacement of the trachea to the right
What does any significant displacement of the trachea at the suprasternal notch suggest?
Disease of the upper lobes of the lung
Common causes of tracheal displacement [Displacement towards the side of lung lesion] 3
Displacement towards the side of lung lesion
- Upper lobe collapse
- Upper lobe fibrosis
- Pneumonectomy
Common causes of tracheal displacement [Displacement away from the side of lung lesion] 3
Displacement away from the side of lung lesion
- Extensive pleural effusion
- Tension pneumothorax
- Chest Expansion
Where are your hands placed in assessment of chest expansion (anterior)? Male
Anterior chest wall (just below 5th or 6th ribs) with fingers extended around the sides of the chest. The thumbs should just meet in the anterior midline (mid-sternal line), resting lightly on the chest wall, to allow its movement during respiration.
Where are your hands placed in assessment of chest expansion (anterior)? Female
In female subjects,the examiner’s hands lie beneath the breasts.
How much should the tips of your thumbs move apart in a normal patient in assessment of chest expansion?
> 5 cm
Where do your thumbs meet in chest expansion examination - posterior?
Repeat this examination on the posterior chest wall with thumbs meeting in the posterior midline
At what level do your thumbs meet in chest expansion examination - posterior?
:evel of 10th thoracic vertebra (T10).
What are you observing in examination of chest expansion - posterior?
Any asymmetry between right and left sides
What does movement of the anterior chest wall give some indication of?
Expansion of upper and middle lobes
What does movement in the posterior chest wall indicate?
Expansion of lower lobes
How does the chest expand during inspiration?
Symmetrically
What does reduced expansion of the chest wall on one side indicate?
A lesion on that side
The common causes are of unilateral decreased expansion are; [4]
The common causes are of unilateral decreased expansion are;
Pneumothorax
Pleural effusion
Collapsed lung
Consolidation
When would you see a bilateral decrease in expansion? is it difficult to detect?
Bilateral decrease in expansion, as seen in asthma or COPD, can difficult to detect.
What type of sounds are produced during percussion of air-filled spaces e.g. the lung?
A hollow, drum-like sound
What type of sounds are produced during percussion over solid organs e.g. heart, liver or over fluid collection?
A dull sound
Which chest wall should be percussed?
Both the anterior and posterior chest wall should be percussed
Is percussion performed over breast tissue in females?
In females, percussion is not performed over the breast tissue.
What may you have to ask females to do to allow percussion?
You may have to ask them to move the breasts laterally to allow percussion.
In what locations do you percuss the chest? [3]
You should percuss symmetrically all areas of the anterior, posterior, and apical areas of the chest.
