Structured examination of the Respiratory System

Jonathan Downham 2010

Respiratory ExaminationJonathan Downham Advanced Nurse Practitioner 2008

OSC

E

FIRST THINGS FIRST!! WASH HANDS

INTRODUCEPERMISSIONEXPLAIN REPOSITION

FIRST IMPRESSIONS

MOVING UP THE ARM

NECK- LYMPH AND JVP

FACE AND MOUTH

CHEST

FIRST IMPRESSIONS

ENVIRONMENT

DRIP STANDSCATHETER BAG

SPUTUM POT

DRUGS

MONITORS

OXYGEN

WALKING AIDS

CIGARETTES

BED OR CHAIR?

GENERAL INSPECTION

TIRED

POSITION

AVPU

RATE AND DEPTH

HANDS COLOUR

FEEL

Newly Sprouted FingersNeoplasia – bronchial carcinoma, mesotheliomaSuppurative lung disease – cystic fibrosis, bronchiectasis, abscess, empyemaFibrotic lung disease – cryptogenic fibrosing alveolitis, connective tissue disease (e.g. RA, SLE)

CLUBBING

LOOK

PULSE CHECK

BLOOD PRESSURE

CYANOSIS

HORNERS SYNDROME

ANEAMIA JAUNDICE

PURSED LIPS

NASAL FLARING

TEETH

TONGUE

FACE

NECK- JVP

NECK- LYMPH GLANDS

INSPECTION

PALPATION

PERCUSSION

AUSCULTATION

INSPECTION

RATE AND DEPTH

SCARS SHAPE

SYMMETRY

PALPATION

Jonathan Downham 2010

WHY DO WE PERCUSS AND AUSCULTATE FRONT AND

BACK?

PERCUSSION

PERCUSSION

PLEURAL EFFUSION= STONY DULLNESS

PNEUMOTHORAX = HYPER-RESONANCE

CONSOLIDATION = REDUCED RESONANCE

DON’T FORGET THE

LIVER!

AUSCULTATION

BREATH SOUNDSADDED SOUNDSVOCAL FREMITUS

AUSCULTATION

PLEURAL EFFUSION= REDUCED BREATH SOUNDS

PNEUMOTHORAX = ABSENT BREATH SOUNDS

CONSOLIDATION = REDUCED BREATH SOUNDS

WHEEZE

CRACKLES

POPPING SOUNDS CAUSED BY AIR PUSHING THROUGH SECRETIONS. SOMETIMES DESCRIBED AS COARSE OR FINE.

WIPERS

GENERAL EXAMINATION

HANDS AND PULSE

FACE

NECK

INSPECTION

PALPATION

PERCUSSION

ALSCULTATION