Respiratory examination Flashcards
Initial observations n shit
Need for immediate intervention
Patient appears comfortable and does not look distressed. He/she is not sweaty or cyanosed and respiration is not laboured or requiring use of accessory muscles.
Environment:
- Inhalers/nebulisers, oxygen, vomit bowl or sputum pot (check inside)
- No monitors or leads
- NEWS2 chart - look at this if present
Hands
Tar staining of fingers
Interlace fingers - peripheral cyanosis, anaemia
Fingernail clubbing - nail angle (squat) , fluctuation, curvature, soft tissue bulk
Cap refill
Turn over hands and compare warmth
Arms
Fine tremor - (overuse of Beta agonists)
Flapping tremor - (CO2 retention)
Pulse rate AND Respiratory rate
Inspect arms:
- Track marks
Head
Lightly pull down on eyelids and ask patient to look up:
- Conjuctivae for Pallor / Anaemia
Lips - Central cyanosis
Tongue - Central cyanosis
Back of mouth - swollen tonsils ± white patches indicating infection
Neck
Tracheal position
Crico-sternal distance
Ask patient to swing legs over side of bed and GIVE THEM A PILLOW
- Check lymph nodes
Back of chest
INSPECTION
- Scars / skin lesions
- Asymmetry
- Kyphosis or scoliosis
- Dilated veins
Lung expansion (3 places): - "Lung expansion is even"
Percussion - 5 areas
- Compare each side
Auscultation - 5 areas with deep breaths in and out each time:
- “Vesicular breathing”
- “Normal intensity of breath sounds”
- “No added breath sounds”
- “No abnormalities during either inspiration or expiration”
Vocal resonance - 5 areas with ‘99’
- “loudness and clarity of the voice is equal between sides”
Front of chest
Inspection - scars, lesions, dilated veins, visible abnormalities in the sternum or chest wall, no evidence of mediastinal displacement
Apex beat:
- State if palpable and the (expected) location
Chest expansion:
- Symmetrical
Percussion
Auscultate on deep breaths in/out:
- Vesicular breathing
- Normal intensity of breath sounds
- No added sounds
Vocal resonance
