Respiratory Examination Flashcards
What are the steps before examination?
Introduce yourself
Confirm name and DOB
Gain consent
Adjust bed to 45 degree angle
Ask patient to expose chest
Ask if patient is in any pain
What are you looking for in a general inspection?
Cyanosis or Pallor
Shortness of Breath
Cough or Wheeze
Stridor
Oedema
Cachexia
What does cyanosis indicate?
Poor circulation or inadequate oxygenation of blood
What does shortness of breath look like?
Use of accessory muscles
Nasal flaring
What is stridor and what does it indicate?
A high pitched breath sound
Indicates turbulent flow
What does pallor indicate?
Anaemia or poor perfusion
What does peripheral oedema or Ascites indicate?
Right ventricular failure
What does pulmonary oedema indicate ?
Left Ventricular Failure
What does Cachexia indicate?
End stage lung diseases ( COPD, lung cancer )
What objects/ equipment should you look out for?
Oxygen
ECGs leads
Medications
Catheters
IV
Mobility aids
What do you look out for on the hands?
Tar staining
Clubbing
Cyanosis
Bruised/thinned skins
Joint swelling/deformity
How do you assess finger clubbing?
Schamroth’s Window ( diamond test)
What else do you assess for on hands?
Fine temor
Asterixis
Symmetrical temperature
Radial pulse
What does skin thinning/bruising indicate?
Long term steroid use
What does joint swelling/ deformity indicate?
Rheumatoid Arthritis
( happens in pleural effusion / pulmonary fibrosis)
What does finger clubbing indicate?
Chronic Low Oxygen :
Lung cancer
Interstitial lung disease
CF
Bronchiectasis
What does a fine tremor indicate?
Beta-2-agonist usage ( e.g salbutamol )
What does asterixis indicate?
CO2 retention ( e.g type 2 reps failure)
What does the temperature of the hands indicate ?
Cold hands - poor peripheral perfusion
Excessively warm hands - CO2 retention
Where is the radial pulse palpated?
The radial ( lateral ) side under wrist
What do you assess of the radial pulse ?
Heart Rate
Regular Rhythm
What does a bounding pulse indicate?
CO2 Retention
What do you assess after inspecting the hands?
Respiratory Rate
What do you assess after hands/resp rate ?
Jugular venous pressure
How do you assess Jugular Venous Pressure?
Ask patient to lie at 45 degree angle
Ask patient to turn their head slightly to the left
Look for IJV between two sternocleidomastoid heads
Measure distance between sternal angle and pulsation point
What is the sternal angle?
The articulation between the sternum and the 2nd rib costal cartilages
What should the JVP height be?
3cm
What is the hepatojugular reflux?
Press down on the patients liver (right side) and see if IJV rises
What general inspection of the face should you do?
For plethora - associated with CO2 retention
What do you inspect the eyes for?
Conjunctival pallor - indicates anaemia
Ptosis , meiosis and exophthalmos
- indicate Horners Syndrome could be due to Pancoast Tumour
What do you inspect the mouth for?
Central cyanosis
Oral candidiasis - associated with steroid inhaler use
What do you inspect the chest for?
Scars
Asymmetry
Caved in chest
Protrusion of chest
Barrel Chest
How do you assess tracheal position?
Gently palpate tracheal borders , should be central
What does tracheal deviation indicate?
Tension pneumothorax
Late pleural effusion
How do you asses cricosternal distance?
Measure distance between suprasternal notch and cricoid cartilage - should be 3-4 fingers
What do you palpate on the chest?
Apex - 5th ICS, midclavicular line
Place hand horizontally
How do you assess chest expansion?
Place hands on patients chest inferior to nipples and bring thumbs together in the midline so that they touch.
Ask patient to take a deep breath
Where do you percuss on the chest wall?
Supraclavicular
Infraclavicular
Chest wall ( 4 areas bilaterally)
Axilla
What does a dull percussion indicate ?
Increased tissue density
What does hyper resonance indicate?
Decreased tissue density ( e.g pneumothorax)
Where do you auscultate the chest?
Supraclavicular
Infraclavicular
3-4 areas bilaterally on chest wall
Axilla
What do you assess on auscultation ?
Quality ( crackles , wheeze, stridor, )
Volume
What does wheeze indicate?
Asthma
COPD
Brochiecstasis
What does coarse crackles indicate ?
Pneumonia
Bronchiectasis
Pulmonary Oedema
What do fine end-inspiratory crackles indicate ?
Pulmonary fibrosis
What do you do after auscultation?
Assess vocal resonance , repeat auscultation but get patient to say 99 each time.
Which lymph nodes do you palpate?
Submental
Submandibular
Superficial Cervical
Deep Cervical
Posterior Cervical
Supra clavicular
Pre-auricular
Occipital
Post-auricular
What do you assess after anterior chest wall?
Posterior chest wall
What steps do you repeat for posterior chest wall?
Inspection
Chest expansion
Percussion
Auscultation
Vocal resonance
What are the last steps?
Check for any evidence of pitting oedema ( sacral or pedal)
Assess the calves for any signs of DVT
What is the general order for the exam?
Intro
Consent
General Inspection
Hands
Face
Eyes
Mouth
JVP
Trachea
Anterior chest inspection ( Inspection, Expansion, Palpation, Percussion, Auscultation )
Get the sit up on the bed
Posterior chest inspection ( Examination, Expansion, Palpation, Percussion, Auscultation)
Lymph nodes
Get them to sit back down
Pedal/Sacral Oedema
