Respiratory Examination

Question 1

Outline general overview

Answer 1

Assess level of patient comfort/distress
Assess general signs of severity of illness
Assess the environment: is there sputum pots beside the bed? Is there any medication (e.g. inhalers)? Is the patient on oxygen?

Question 2

Outline pulse/resp rate.

Answer 2

Palpate the pulse over radial artery for 15 secs and discretely observe the patients resp. rate over a minute.

Question 3

What do we look for in hands?

Answer 3

• Tar staining
• Peripheral cyanosis or anaemia (interlock fingers)
• Clubbing: loss of nail angle, nailed fluctuation, increased curvature, increased bulk of soft tissues over terminal phalanges.
• CO2 retention: palmar warmth and pinkness, flapping tremor (ask patient to outstretch arms and bend back wrist)

Question 4

What do we look for when examining the head?

Answer 4

Examine the tongue looking for central cyanosis.

Assess the conjunctivae for pallor

Question 5

When examining the neck?

Answer 5

Assess the tracheal position: 
- Place index finger in sternal notch and push backwards to feel trachea
- Look each thumb round medial edges of sternocleidomastoid muscles 
Palpate the cervical lymph nodes
- Supraclavicular (scalene nodes)
- Anterior cervical chain
- Tonisillar 
- Submandibular 
- Submental 
- Post-auriclular 
- Posterior cervical

Question 6

Back of chest inspection?

Answer 6

• Any scars?
• Any visible abnormalities?
• Any skin lesions or dilated veins?

Question 7

Back of chest palpation?

Answer 7

• Check chest expansion: apex, middle, base

Question 8

Back of chest percussion?

Answer 8

• Percuss using back of middle finger: apex, superior, middle and inferior lobes moving from left to right as you go.

Question 9

Back of chest auscultation?

Answer 9

Apply diaphragm of stethoscope to skin:
- Ask patient to take big deep breaths in through open mouth
- Listen over whole chest in and same locations as have percussed moving from left to right
Vocal resonance:
- Ask patient to say 99 while you listen to each area you have previously auscultated.

Question 10

Front of chest inspection?

Answer 10

• Any scars?
• Any abnormalities?
• Any skin lesions or dilated veins evident?

Question 11

Front of chest palpation?

Answer 11

Do chest expansion
- Apex
- Mid thoracic
Find position of apex beat:
- Count down to the left 5th intercostal space mid-clavicular position.
- Use whole hand to feel the beat
- Once found make sure to check position.
- If not, is there any evidence of lower mediastinal displacement?
- If cannot be found, state ‘unpalpable apex beat’

Question 12

Front of chest percussion?

Answer 12

• Clavicles can be percussed directly
• Heart location will produce a ‘dull’ note
• 3 down either side of sternum
• 1 either side of lower lungs

Question 13

Front of chest auscultation?

Answer 13

• Ask patient to breath deep breaths in and out of open mouth, same areas as percussion
• Ask patient to say 99 each time stethoscope is placed on body

Question 14

Closure

Answer 14

Inform patient that examination is over

WASH HANDS