Respiratory Examination Flashcards
What is the procedure of the respiratory examination?
Vital signs
Blood pressure
Initial survey
Inspection
Palpation
Percussion
Auscultation
What do we access with vital signs?
Access pulse at : Wrist (radial artery), brachial artery, Neck (Carotid artery)
Breathing (BPM)
Temperature
What is the process of blood pressure?
Find estimation of systole? (Osculatory gap)
Place bell over artery to the estimated range
Very slowly release until you can hear heart beat = systole Keep slowly releasing and when the heart rate can’t be heard = diastole
What is involved in the initial survey of the patient?
A global overview of the patient:
- Gender
- Age
- Appearance (ill, well, tired etc.)
- Over/underweight
- Body language
- Risk factors from case history
What symptoms and signs can be seen in the initial survey of the patient?
Wheezing
Grunting
Tachypnoea
Cyanosis
Nostril flaring
Running out of breath
Sweating
Body position
What is involved in the inspection of the patient?
Inspect hands:
- Digital clubbing (Lung cancer/CVD), Tar staining, Peripheral cyanosis (nail beds)
Arms:
- IV track marks (lung infection/abscess from drug use)
Head & face:
- Lips, gums & oral mucosa for central cyanosis, breathing rate, rhythm, depth, adventitious sounds e.g. wheezing, stridor, crackles.
Neck:
- Accessory respiratory muscle involvement (SCM), Trachea position/tracheal tug
Chest:
- Asymmetry, deformity (e.g. kyphosis, scoliosis)
- Changes in AP diameter (pigeon, barrel, funnel),
- Retractions, bruising (=> trauma)
- Chest movement (paradoxical breathing, chest trauma)
(Observe anterior, lateral and posterior views)
What is involved in palpation of the patient?
Access the trachea (position), sternum and ribs for tenderness (fracture) and intercostal spaces (for pleurisy)
Chest expansion: Place hands on posterior chest (At level of 10th rib), wrap fingers around so thumbs touch, ask patient to take deep breath and watch movement of the hands and the thumbs move away from each other.
Tactile fremitus: Place the balls of both palms on the chest wall, have the patient repeat 99
Access and compare the tactile fremitus bilaterally
What causes increased tactile fremitus?
Consolidation of the lung
Lung tumour
What causes decreased tactile fremitus?
Pleural effusion
Pleural thickening
Pneumothorax
Bronchial obstruction
COPD/emphysema
What is involved in the percussion assessment?
Tapping your finger that is placed on the thorax wall of the patient (listen for percussion sound)
Diaphragm level + excursion
What causes the percussion sound?
Vibrations through the chest wall from the tapping of the finger
What are the different types of percussion sounds and examples of conditions with these sounds?
Resonance - Sound of normal air filled lungs
Hyper resonance - Sound of excessively air filled lungs (emphysema)
Dull - Sound when lung tissue density is increased (Pneumonia)
Flat - Solid or ‘stony’ percussion note (pleural effusion & tumours)
What are the steps of diaphragm level and excursion?
· Ask patient to fully exhale
· Percuss inferiorly from middle of scapulae
· Sound will convert from resonant to dull when end of diaphragm is reached (mark this point)
· Have patient fully inhale and mark again where resonant becomes dull
What is involved with auscultation of the patient?
Place diaphragm of stethoscope on breathing areas.
Have patient breath in and out through mouth
Sound expected on broncho vesicular areas?
An equal amount of inspiration and expiration sounds
