Respiratory Exam

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Respiratory Exam

Uncovered from waist up

General inspection-> nebulizer, oxygen mask, GTN spray

SOB ,scars, obvious deformity (barrel chest, pectus carinatum, pectus excavatum), use of accessory muscles, asymmetry, can't hear wheeze, able to talk not visibly breathless

Inspection of hands-> tar staining, cap refill, clubbing, peripheral cyanosis, clammy hands, temperature, fine beta agonist tremor, co2 retention tremor

Radial pulse rate, rhythm, character

Resp rate

Offer BP

Inspection of eyes -> Anaemia, horners eye signs (ptosis, miosis, enophthalmos)

Skin of face -> pallor, abnormal pigementation Addisons, asymmetrical sweating

Mouth -> Central cyanosis, hydration, signs of stridor

Neck -> JVP, scars, central lines, use of accessory muscles, palpate trachea and note deviation, circosternal distance

Chest -> Inspect for obvious deformities, scars, prominent chest wall veins

Feel for elevation, expansion, apex beat and comment on its location and if it is displaced

Percussion

Tactile Vocal Fremitus ( increased transmission consolidation, reduced transmission in effusion)

Auscultation

Inspect back for scars and symmetry

Feel for elevation and expansion

Feel for lymph node exam

Feel for sacral oedema

Percussion

Tactile vocal fremitus

Auscultates

Palpates ankle oedema

Also do -> chest xray, look at obs chart, cardiovascular exam, Peak flow, check sputum pot, look in notes for ABG measurements

- Pulmonary fibrosis- fine end inspiratory crackles, decreased expansion

- Pneumonthorax- increased resonance, decreased breath sounds on auscultation

- Pleural effusion - stony dull

- COPD / asthma- wheeze

- Lobectomy- scar , percussion dull at site