CSFP: Respiratory System examination

Overview
Introduction
Wash hands Greet patient and introduce yourself State what you are going to do (i.e. respiratory system examination) Get patient to undress Angle the bed to 45 degrees Stand at the foot of the bed and examine for the following things (observe) o Obvious difference in the heaving of chest of the patient o Colour of patient o Surgical scars on the anterior of patient o Rapidity of the rise and fall of the chest Move to right side of the bed o Hand (Inspect) Liver flap (or asterixis) Clubbed fingers Nicotine stains Tremors Pulse rate (together with respiratory rate) o Face (Inspect) Eyes Jaundiced sclera (pull up) Anemic pallor of the conjunctiva (pull down) Hemorrhages of the small arteries of the eye, which can be seen in the sclera Mouth Cyanosis at the bottom of the tongue (get pt to lift tongue to touch the ceiling of the mouth) o Neck (Inspect and pulpate) Tracheal displacement to the side Decrease in cricosternal distance Indicates rising and falling of the rib cage (accessory muscles used) JVP Palpate lymph nodes (check for enlargement) o Chest (Inspect, Pulpate, Percuss and Auscultate) Disparities in rising and falling of the chest wall between the two sides (I) Done by putting thumb on mediastinum while rest of hand placed on the chest

OIPPA

3 places Check for any abnormalities of the chest wall (I) Percuss the patient (between intercostal spaces) Auscultate the patient (compare both sides) by getting him/her to take deep breath in + subsequently saying ninety-nine when your steth touches skin Front Side Back