respiratory assesment

Question 1

1

Answer 1

Washes hands/ dons appropriate PPE
Introduces self to patient
Permission – gains consent

Question 2

2

Answer 2

Inspects general appearance from end of bed (student must provide 3 examples) e.g.s:
looking for obvious distress e.g. crying, may indicate pain
signs of illness
cyanosis (hypoxia): The tips of the fingers, toes, ears and nose may become cold and bluish in color.
diaphoresis(fever): excessive sweating with no clear cause
use of accessory muscle (abnormal breathing

Question 3

3

Answer 3

Inspects hands (student must provide 3 examples) e.g.s:
looking and feeling for warmth (peripheral circulation)
skin turgor test (hydration): pinch and let it drop
colour e.g. pallor (peripheral circulation): very pale
colour e.g. palmar erythema(see aide memoire): abnormally red palms (might be inflammation indicating infection)

Question 4

4

Answer 4

Inspects fingers and nail beds (student must provide 3 examples) e.g.s:
cyanosis: fingernails turn blue or purplish
clubbing: diamond shape
tar staining: smoking sign
leuchochia / koilonychia: white nail beds

Question 5

5

Answer 5

Checks capillary refill time

Question 6

6

Answer 6

Assess for fine tremor and asterixis
Ask the patient to hold out their hands in an outstretched position and observe for a fine tremor which is typically associated with beta-2-agonist use (e.g. salbutamol).

asterixis
flapping hands

Question 7

7

Answer 7

Assess radial pulse and rhythm:
Pulse rate = bpm Rhythm: Regular / irregular

Question 8

8

Answer 8

Assess respiratory rate discreetly: (just be looking at them)
Respiratory rate = breaths/min 12 to 16 breaths per minute.

Question 9

9

Answer 9

Inspects the eyes (student must provide 3 examples - what & why) e.g.s:
anaemia: If it is a very pale peach colour or yellow, this may indicate that you have iron deficiency or iron deficiency anaemia. we want a nice pink
Jaundice: The white part of your eyes may look yellow with jaundice. we want a nice white
corneal arcus: a white or grey opaque ring around the iris. signs of low lipid metabolism
xanthelasma: a harmless yellow bump on or near your eyelid skin. may signal that cholesterol is building up in your blood vessels.

Question 10

10

Answer 10

Inspects the mouth - to explain rather than conduct due to masks (student must provide 3 examples) e.g.s:
looking at condition of teeth: good dental hygen signifies good health
inspecting tongue and lips for cyanosis: check that ithey are a nice pink (raise the tongue)
signs of oral thrush: white patches

Question 11

11

Answer 11

Inspect anterior, posterior, sides of chest (abnormalities/ scars): check for scars to check if theyve had any hearth, lung or chest surgeries)

Question 12

12

Answer 12

Assess the supra and infraclavicular nodes bi-laterally (assess for Virchow’s node)

Question 13

13

Answer 13

Assesses position of trachea (check for Tracheal deviation)

pneumothorax, pleural effusion, mediastinal mass and pulmonary fibrosis

Question 14

14

Answer 14

Consider A-P diameter and costal angle

Have the client sit with arms at the sides. Stand in front of the client and assess shape and configuration. costal angle is the space in between ribs
Barrel chest is a visible symptom of COPD, emphysema, osteoarthritis, and CF.

costal angle is like chest expansion but I’m checking for a 90 degree angle. copd is less than 90

Question 15

15

Answer 15

Assess chest expansion - anterior
4. Ask the patient to take a deep breath in.
5. Observe the movement of your thumbs (in healthy individuals they should move symmetrically upwards/outwards during inspiration and symmetrically downwards/inwards during expiration ).
6. Reduced movement of one of your thumbs indicates reduced chest expansion on that side.
Respiratory causes of reduced chest expansion
Symmetrical: pulmonary fibrosis
Asymmetrical: pneumothorax, pleural effusion

posterior
basically do the same thing

Question 16

16

Answer 16

Palpate for tactile fremitus (anterior, posterior, sides)
Technique
1. Ask the patient to say “99” repeatedly at the same volume and in the same tone.
2. Palpate the chest wall on both sides, using the ulnar border of your hand.
3. Cover all major regions of the chest wall, comparing each side at each location.
Abnormal tactile vocal fremitus
Increased vibration over an area suggests increased tissue density (e.g. consolidation, tumour, lobar collapse).
Decreased vibration over an area suggests the presence of fluid or air outside of the lung (e.g. pleural effusion, pneumothorax).

posterior

sides

Question 17

17

Answer 17

Percuss – anterior (must compare side to side)

the finger beat
do six times
five is on the niple and six is on the sides
Types of percussion note
Resonant: a normal finding (listen to the example in the video demonstration).
Dullness: suggests increased tissue density (e.g. cardiac dullness, consolidation, tumour, lobar collapse).
Stony dullness: typically caused by an underlying pleural effusion.
Hyper-resonance: the opposite of dullness, suggestive of decreased tissue density (e.g. pneumothorax).

posterior

sides

Question 18

18

Answer 18

Auscultate – anterior (must compare side to side with diaphragm (bell Ok for very top of lungs))

supraclavicular
infraclavicular but more toward the middle of the chest)
middle of chest
on the nipple
side

posterior roughly the same position

side

Question 19

19

Answer 19

closure thanking the patient and asking them to put on their shirt

Question 20

20

Answer 20

SBAR REPORT

SITUATION

BACKGROUND

ASSESSMENT

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