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Flashcards in Respiratory Exam Deck (25)
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1
Q

What are the main steps in a respiratory exam?

A
Prepare the patient
Hand hygiene
General inspection
Hands
Wrist
Head and neck
Anterior and lateral chest wall
Posterior chest wall
Measure peak flow
Conclude and close assessment
2
Q

How should you prepare the patient?

A

Introduction and consent
Explanation
Exposure: undress to waist; provide gown
Position: examine from right; 90 degrees

3
Q

What should you generally inspect?

A

Environment and patient

4
Q

What should you look at in the hands?

A

Nails

Fingers

5
Q

What should you check at the head and neck?

A
Conjunctivae
Lips, tongue, and palate
Trachea
- One finger
- Feel either side
- Midline or deviated
6
Q

What should you check at the anterior and lateral chest wall?

A
Inspection - including axillar
Expansion
- Lower and upper
- Hands anteriorly over lower rib cage
- Thumbs opposed to each other and off chest wall
- Ask patient to take deep breath
- Degree of expansion
- Symmetry of movement
- Upper anterior chest using flat of your hands
Percussion
- Down midclavicular line every 2nd intercostal space
- 2 on axillar
- Alternate right and left sides to compare
Auscultation
- Same places as percussion
- Listen for one complete breath cycle
- Patient breaths in and out through open mouth
Vocal resonance
- Same places as percussion
- Patient says 99
7
Q

What should you check at the posterior chest wall?

A
Move patient to edge of bed
Inspection
Expansion
- Hands over posterior lower rib cage - over lung bases
- Thumbs opposed to each other and off chest wall
- Patient takes deep breath
- Degree of expansion and symmetry
Percussion
- Rotate scapulae - patient hugs themselves
- 2 positions in upper zone
- 2 positions in lower zone
Auscultation
- Same sites as percussion
- Breathe in and out through mouth
Vocal resonance
- Same sites as percussion
8
Q

When is peak flow useful?

A

Small proportion of patients with asthma

9
Q

Where is peak flow recorded?

A

On peak flow chart

10
Q

What should you check at the wrist?

A

Radial pulse

Respiratory rate

11
Q

What is peak flow used for?

A

Monitoring degree of airflow obstruction

12
Q

What might you find on a general inspection?

A
General mental state - high CO2 makes you drowsy
Alertness
Respiratory effort - use of accessory respiratory muscles
Coughing
Wheezing
Stridor
Supplemental oxygen
Sputum in a cup
13
Q

What might the nails show?

A

Peripheral effects of respiratory disease

Clubbing

14
Q

How long should you measure PR and RR for?

A

15 sec each

15
Q

What do you look for in the conjunctivae?

A

Anaemia

16
Q

What do you look for in the lips and tongue?

A

Cyanosis

17
Q

What does a deviated trachea mean?

A

Away from lung - tension pneumothorax

Towards lung - collapsed lung

18
Q

Where is the trachea?

A

Behind the manubrium

19
Q

Where does the trachea bifurcate?

A

At the manubriosternal joint

20
Q

Where are the apex of the lungs?

A

2.5 cm above medial 3rd of clavicles

21
Q

Where are the borders of the lungs?

A

Line starts at sternoclavicular joint
Continues along lateral border of sternum to 4th costal cartilage
Border of right lung arcs down to
- 6th rib in midclavicular line
- 8th rib in midaxillary line
- 10th rib adjacent to vertebral column posteriorly
Border of left lung similar but deviate laterally at 4th costal cartilage to form cardiac notch
Posterior border from C7 to T10 4 cm from midline

22
Q

Where is the oblique fissure?

A

line between spinous process of T2 to 6th costal cartilage anteriorly

23
Q

What does the oblique fissure coincide with?

A

Medial border of scapula when hands behind head

24
Q

Where is the horizontal fissure?

A

On right side

From 4th costal cartilage back to intersect with oblique fissure

25
Q

Where do the inferior borders of the pleura extend to?

A

8th rib in midclavicular line
10th rib in midaxillary line
12th rib in paravertebral line