Respiratory system examination

Primary assessment Dr. Miada Mahmoud Rady

Chest examination Use the standard approach : Inspection ( looking ). Palpation and percussion ( touching ). Auscultation ( hearing ).

Chest examination Inspect the chest for any obvious DCAP-BTLS. Note the shape of the chest and symmetry of movement. Auscultate the lung fields, noting any abnormal lung sounds. Percuss the chest to detect any abnormalities.

Signs of respiratory distress Nasal flaring Retraction (intercostal , subcostal and supraclavicular). ( Sharp pulling of spaces in between ribs , below costal margins and above clavicle ) Cyanosis . ( bluish discoloration of lips , nail beds ) Rapid , shallow breathing .

Warning signs of breathing affection Altered mental status Shortness of breath Retractions Asymmetric chest wall movement Accessory muscle use Cyanosis Audible sounds Abnormal rate or pattern Nasal flaring

Steps of chest examination Inspection : Retractions . Trauma , wounds . Swelling . Discoloration , ecchymosis and bruising Bleeding . cyanosis

Inspection DCAP-BTLS = Deformities, Contusions Abrasions, Punctures/Penetrations, Burns Tenderness , Lacerations and Swelling.

Palpation Palpation of the chest : Tenderness Hotness Symmetrical expansion of the chest Crepitus Masses Broken ribs

PRINCIPLES OF PALPATION Have short fingernails. Warm your hands prior to placing them on the patient. Encourage the patient to continue to breathe normally throughout the palpation. If pain is experienced during the palpation. discontinue the palpation immediately. Inform the patient where, when, and how the touch will occur, especially when the patient cannot see what you are doing.

Palpate the anterior chest for excursion.

Percussion Rules of percussion : 1. Place your hand lightly against the surface to be examined. 2. Hyperextend the middle finger and apply firm pressure. 3. Strike the middle finger with one or two fingertips of the other hand.

Percuss the anterior chest. Copyright 2006 © Pearson Education Canada Inc.

Percussion of chest Compare the percussion note (resonant) with that of the corresponding area on the opposite side of the chest

Percussion

Auscultate the anterior chest.

Normal Breath Sounds

Pneumothorax diagnosis Pneumothorax is air in pleural cavity , signs of which are : Complaint : dyspnea and cheat pain. Inspection : may be fracture rib Palpation : limited chest expansion on affected side. Percussion : hyperresonance on affected side. Auscultation : diminished air entry on affected side.

How to identify location of heart apex Identify manubrium sternai Then second intercostal space Count down to the fifth intercostal space Apex is in the fifth intercostal space midclavicular line

Palpate for the apical impulse (PMI).

Auscultation of the heart Place the patient in a position that will bring the heart closer to the left anterior chest wall, such as sitting up and leaning slightly forward. Place your stethoscope at the fifth intercostal space over the apex of the heart. Ask the patient to breathe normally and hold the breath on inhalation.

Auscultate for heart sounds.

Examining the abdomen Inspect the abdomen for any DCAP-BTLS. Auscultate the abdomen for bowel sounds (if time and quiet environment permit). Palpate the four quadrants of the abdomen in a systematic pattern, beginning with the quadrant farthest from the patient’s complaint. Note any tenderness or rigidity.

Inspection DCAP-BTLS = Deformities, Contusions Abrasions, Punctures/Penetrations, Burns Tenderness , Lacerations and Swelling.

Light Abdominal Palpation

Abdominal Trouble Indicators Cullen’s sign Discoloration around the umbilicus suggestive of intra-abdominal hemorrhage. Grey-Turner’s sign Discoloration over the flanks suggesting intra-abdominal bleeding. Ascites Swelling in the flanks and abdomen. Borborygmi Loud, prolonged, gurgling bowel sounds.

Signs of acute abdomen from examination Abdominal guarding and rigidity. Abdominal tenderness Absent or decreased bowel sounds

Examination of different body parts

Palpate the cranium from front to back.

Inspect the mastoid process.

Palpate the facial bones.

Palpate the TMJ.

Inspect the external eye.

Test the pupil’s reaction to light.

You can test the extraocular muscles by moving your finger in an H pattern.

Check the corneal reflex.

Examine the external ear.

Palpate the external nose.

Inspect the internal nose with an otoscope.

Inspect the nose for nasal obstruction.

Palpate the frontal sinus.

Palpate the frontal sinus.

Palpate the maxillary sinus.

Palpate the lips.