Respiratory System Examination Flashcards
When conducting any clinical assessment what must be done to confirm the patient is the correct patient?
- name - date of birth - hospital number
When meeting a patient what must you always do to ensure the patient knows who you are?
- introduce yourself - tell the patient what you would like to do
What must you obtain from a patient before you do anything with them?
- gain consent
What is the normal angle the bed should be set at when examining a patient for a respiratory examination?
- 45 degrees
When examining a patient during a respiratory examination, do you conduct this from the left or the right of the patient?
- always the right
The first step during a a respiratory examination is to observe the patient from the end of the bed, what are we looking for?
- clinical signs of pathophysiology
The first step during a a respiratory examination is to observe the patient from the end of the bed, what are some simple signs to look for?
- pale colour - anxious - pain/distressed - sweaty - cachectic (wasting of the body) - awareness - smell
When smelling a patient during a respiratory examination, what do ketones smell like?
- sweet pear drops - sign of ketoacidosis
In addition to looking at the patient during a respiratory examination, other than the patient themselves, what else can be helpful?
- look around the bed - pulse oximeter - cannula - nasal cannulation
What is cachexia?
- extreme weight loss - muscle generally, but can be fat
What are 2 common examples where we may see cachexia?
- cancer - COPD or pulmonary fibrosis
What is the best way to measure the patients respiratory rate, which can change if you tell them you are going to measure it?
- after taking the patients pulse - dont tell them
What is the normal resting respiratory rate?
- 12-16 breaths/minute
What is tachypnoea?
- rapid breathing - normally >20 breathes/minute
What is dyspnoea?
- slow breathing
What are the 2 main muscles used during normal breathing?
- diaphragm - external intercostals
Will inspiration or expiration use more energy?
- inspiration
What are the main accessory muscles used during respiration?
- scalene - sternocleidomastoid - pectoralis minor and major - serratus anterior - latissimus dorsi
What groups of patients may excessively use their accessory muscles during respiration?
- obstructive lung disease, air gets trapped - COPD - asthma
When might a healthy person use their accessory muscles during respiration?
- during exercise
Why is pursed lips used during breathing?
- helps control exhalation - ⬆️ control of breathing
What is the normal process of pursed lips breathing?
- breathe in normally - purse lips and breathe out slower than normal
What patients may benefit from pursed lips breathing?
- COPD - helps slow breathing and control breathlessness
What is the crico cartilage?
- cartilage below thyroid cartilage - located at top of trachea
What is the crico-sternal distance?
- distance between inferior border of crico cartilage and suprasternal notch
What is a normal crico-sternal distance?
- 2-5cm
What may cause the crico-sternal distance to become shorter?
- hyperventilation - COPD patients - emphysema
What is intercostal recession?
- the intercostal muscles are sucked inwards
When might intercostal recession occur?
- reduced pressure in the lungs - caused by a blockage in the airways
When observing the patient, why can it be useful to ask them breathe slower than normal?
- observe any obvious pathophysiology - one lung expanding more than the other
What does congenital mean?
- born with the condition/disease
What is an example of an acquired abnormality of the chest wall?
- thoracic injury - kyphosis
What is kyphosis?
- front to back curvature - think of the letter K
Is kyphosis an acquired or congenital chest wall abnormality?
- both
- acquired = elderly
- congenital = kyphosis, scoliosis
Pectus excavatum is a congenital chest wall abnormality, what is it?
- sternum and/or several ribs grow inwards
- more common in males
Pectus carinatum is a congenital chest wall abnormality, what is it?
- sternum and/or several ribs point outwards
- more common in males
Hand examination is an important part of a respiratory examination, what are some basic things to look for or feel on the hands?
- hot/cold temperatures
- sweaty/clammy
- peripheral cyanosis (blue colour)
- White/pale (Raynauds Syndrome)
- Capillary refil
Hand examination is an important part of a respiratory examination, when looking at nails what is clubbing?
- finger tips swell like clubs
- first look from side on
- then feel for any swellings
- the look for schmaroths window ⬇️
Hand examination is an important part of a respiratory examination, when looking at nails what can we commonly see due to smoking?
- tar stains
Hand examination is an important part of a respiratory examination, when looking at palms what is palmar erythema?
- causes redness of palms - specifically at base of the thumb
Hand examination is an important part of a respiratory examination, when looking at palms what is Dupuytrens contracture?
- 1 or more fingers bend inwards
What is the most common cause of clubbing?
- lung cancer - accounts for 70%
What does idiopathic mean?
- no known cause of a disease
In addition to lung cancer, what 2 other systems can cause clubbing?
- cardiac - gastrointestinal
Can chronic infections cause clubbing?
- yes - empyema
Hand examination is an important part of a respiratory examination, what is the retention flap assessment?
- patients asked to hold hands out in front - palms face away and fingers apart - if CO2 build up wrists flap backwards and forwards
Why does a build up of CO2 lead to flapping of the wrists?
- CO2 affects motor centres in midbrain - specifically diencephalic - involved in motor coordination
What are some common causes of a tremor in hand flapping?
- B-2 agonist inhaler (salbutamol) - Parkinsons
When conducting a respiratory examination, a basic cardiorespiratory examination must be conducted, what physiological parameters are required?
- heart rate
- respiratory rate
- rhythm/strength
- blood pressure
What are the basic vital signs that need to be recorded?
- heart rate
- blood pressure
- SaO2
- temperature
- pule rate
What is the jugular venous pressure?
- direct measure of the venous pressure
What may cause an ⬆️ in jugular venous pressure?
- ⬆️ in right atrium pressure
- pulmonary hypertension
- right heart failure
- superior vena cava obstruction
Why is the internal rather that the external vein used when assessing the jugular venous pressure?
- internal has no obstructions
- direct flow to the right atrium
Where can the jugular venous pressure be measured?
- between the 2 heads of sternocleiodmastoid muscle
- patient sat at 45 degrees
- measure from sternal angle to limit of venous pulse
What is the abdominojugular test, when assessing jugular venous pressure?
- pressing of the abdomen
- ⬆️ blood flow back to heart
- ⬆️ pressure = ⬆️ jugular venous pressure
- normal is <3cm
What happens to jugular venous pressure during inspiration or if the patient is lying flat?
- it falls
When conducting a respiratory examination, what can we look for in the eyes, specifcally the conjunctiva?
- conjunctiva pallor (covering on inside of eyelids)
- pale can be sign of aneamia
What can we sometimes see on patients faces during a respiratory examination?
- rash on the face
- erythematosus (meaning red)
- often butterfly shaped rash on face of patients
When conducting a respiratory examination, what can we look for in the mouth?
- telangiectasia - thread like veins
- telos = “end”
- angeion = “vessel”
- ektasis “a stretching out, extension, dilation,”
- mucous membranes can become blue (cyanosis)
What is miosis in reference to the eyes?
- meiosis = greek for ‘closing of the eyes’
- small pupils (generally in one eye)
- think m = mini pupils
What is ptosis in reference to the eyes?
- ptosis = ‘greek for fall’
- falling of the eyelids
- droopy eyelids
- think P for pitching it up
What is enophthalmos in reference to the eyes?
- eyeballs sink into the head
What is anhidrosis in reference to the eyes?
- lack of sweating
When assessing lymphadenopathy what are the 5 steps? S.S.C.T.S
- Size - Site - Consistency - Tenderness - Symmetry
What is sarcoidosis?
- collection of inflammatory cells
- tend to be around hilar lumph nodes
- granulomas can form
What is tracheal deviation?
- deviation of the trachea
What is the apex beat?
- tip of heart
What examining the anterior and posterior thoracic chest, what are the 4 things to do and in what order?
1 - inspection visually
2 - palpation (feeling)
3 - percussion (tapping)
4 - auscultation (listening)
- I.P.A.A
Where is the maximum effect of the heart beat felt?
- apex beat
Where is best to hear the apex beat?
- 5th intercostal space on mid clavicular line - count down from 2nd rib
What can cause a displacement of the apex beat?
- left ventricular hypertrophy
- mediastinal shift
- pneuomothroax
- lymphadenopathy
- cardiomegaly
What may cause a right heave of the heart?
- right ventricular hypertrophy - right heart failure - lung disease
Where would you place the heel of your hand to assess the right side of the heart?
- left parasternal area - in line with nipples or just below
When palpating the lungs how should you place your hands on the anterior and posterior aspects of the chest?
- thumbs should be at sternum - hands go under the pecs
When percussing (tapping) the thoracic wall which finger is generally tapped?
- middle finger
What should percussion of normal lungs sound like?
- low resonance/hollow sound
What should percussion of lungs with a pleural effusion sound like?
- dull on percussion
When percussing the lungs what is hyper-resonance?
- pneumothorax - increased air in thoracic cavity
When percussing the heart and lungs how will they sound?
- dull - they are thick tissue so little air
Why does speaking cause changes in the sound when listening to the lungs?
- vocal cords create vibrations - vibrations move down the trachea as well as up
What number do we ask patients to say when listening to the lungs?
- 99
What is tactile vocal fremitus?
- vibrations created from saying 99 - feel chest wall with hands
What can cause ⬇️ tactile vocal fremitus?
- vibrations do not vibrate as well
- air/fluid in lungs
- reduces lung density
What can cause ⬆️ tactile vocal fremitus?
- dense or inflamed tissue
What are the bell and diaphragm of the stephascope?
- diaphragm = larger round part - bell = small round part - both can be used for listening
What are the 2 parts of the the second heart sound (P2) you can hear when listening to the lungs?
- A2 = aortic valve is closing - P2 = pulmonary valve is closing
What does vesicular mean when listening to the lungs?
- normal breathing
What is wheezing when listening to the lungs?
- narrowing of the lungs - causes wheeze or whistling sound
What are monophonic, polyphonic and no wheeze as forms of wheezing when listening to the lungs?
- monophonic - one place in lungs (tumour) - polyphonic - multiple site in lungs (asthma, COPD) - no wheeze - silent lungs in asthma
What is crackling when listening to the lungs?
- ⬇️ compliance of the lungs - caused by fibrosis
When describing the sounds of the lungs what do you need to report?
- type of sound - location of sound - part of cycle (inspiration/expiration)
What is bronchial breathing?
- turbulent airflow in the lungs - listen by placing stethoscope on trachea
What is pleural rub?
- caused by pleurisy - inflammation of the pleural membranes
What is pleural rub when listening to the lungs?
- inflamed membranes rub together - sounds like walking on snow
In patients with suspected swelling, where are the 2 most common places to assess oedema?
- sacrum - lower limbs
What is pitting?
- pressure placed on skin to see if skin bounces back - if doesn’t then sign of oedema
What is pitting oedema a sign of?
- right heart failure - liver or kidney problems
