Respiratory Examination

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Respiratory Examination

• Miss L E Pearce

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Objectives

• To succinctly examine the chest and present your
  findings to a consultant examiner in 6 minutes
• Discuss disease processes behind your clinical
  findings
• Pass the exam.

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Stand at the end of the bed STOP Look for a few
seconds Show you are looking around the
bed Oxygen Pulse Oximeter Monitoring Inhalers
/ GTN Catheters / Drains Fluids /
Antibiotics Noises Wheeze, Stridor, Cough
Position Comfortable? RR, accessory muscles,
blue is bad !! Two big breaths
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HANDS/ARMS

• Look at both hands for
• Clubbing
• Cyanosis
• Nicotine staining
• Steroidal Skin
• Stretch out arms for CO2 retention tremor
• Palpate radial pulse

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HEAD

• ? Cushingoid
• Look at the eyes
• Conjunctival pallor
• Look at the mouth
• ?candida (steroid inhalers)
• Dentician / Nutrition tongue
• Hydration
• Cyanosis
• Breath (ketosis/halitosis)

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CHEST (FRONT)

• Feel for position of Trachea
• Expansion
• 2 places
• Percussion
• Including apex
• Technique!!
• Auscultation
• Apex
• Upper Mid Zones
• Axilla

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CHEST (BACK)

• Palpate Lymph nodes
• Expansion
• Percussion
• Auscultation
• ?Effusion
• ?Crackles ? Cough
• ?consolidation
• Vocal Fremitus (99)

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THEN

• Cover the patient up
• Turn to the examiner
• Present your findings!!!

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FINDINGS

• The hardest part!
• Stand up straight
• Take your stethoscope and hold it in your hands
  behind your back
• Look the examiner in the eye
• No ers
• No thought I heards

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Normal Examination findings

• I examined this elderly gentlemans respiratory
  system. On general inspection from the end of
  the bed he appeared comfortable at rest. There
  were no peripheral signs of respiratory disease.
  Chest expansion was equal bilaterally. Percussion
  note was resonant throughout the chest. There
  was good air entry bilaterally with no added
  sounds.
• To complete my examination I would like to look
  at the observations chart and assess peak flow
  and perform spirometry testing
• In summary, this is an elderly gentleman with
  normal respiratory examination.

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Male 55yrs. Fibrosis. RR 30

• I examined this gentlemans respiratory system.
  On inspection from the end of the bed he was
  tachypneoic with a respiratory rate of 30 but was
  not using his accessory muscles to breath. Chest
  expansion was equal bilaterally and percussion
  note was resonant. On auscultation there were
  fine inspiratory creps bilaterally.
• In summary this gentleman has examination
  findings consistent with those of bibasal
  pulmonary fibrosis.

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QUESTIONS?