Detailed Skill Performance Evaluation: Respiratory Examination

Directions: You will have 10 minutes to complete the skill. All critical (C) steps and 80% of the noncritical steps
must be performed or verbalized. Special tests (S) will be performed if requested by examiner.
Start: End:
Performed Verbalized
Washes hands and dons appropriate personal protective equipment. C
Introduces self to patient using first and last name. Y/N
Notes general appearance and vital signs. Y/N
Respiratory general appearance (Stand in front of the patient and observe. Expose the chest..)
1. Evidence of respiratory distress (Includes all of the following steps.) Y/N Y/N
Observe rate, rhythm, depth, and effort of breathing Y/N
Assess patient’s color, looking for cyanosis Y/N
Listen to patient’s breathing for audible wheezing Y/N
Tracheal deviation (Look at neck from front of patient, then place finger alongside trachea
Y/N Y/N
and note space between it and the sternocleidomastoid muscle; compare to other side.)
Look for use of accessory muscles (Look at neck and supraclavicular area.) Y/N Y/N
Note any retraction of the interspaces during inspiration (Check lower interspaces anteriorly
Y/N Y/N
and posteriorly.)
Inspection (Be sure to get adequate exposure in order to examine the chest.)
1. Inspect thorax for deformities or asymmetry (Inspect in front of and behind the patient.) Y/N Y/N
2. Compare anteroposterior diameter with lateral diameter (Observe first from anterior
Y/N Y/N
perspective, then look lateral; make sure you have adequate exposure.)
3. Assess for asymmetric or impaired respiratory movement (Walk around patient and
Y/N Y/N
observe chest wall.)
Palpation
1. Palpate areas of reported pain or areas where lesions or bruises are evident for tenderness
S Y/N
(Use one or both hands, depending upon history.)
2. Test for chest expansion (Place hands on costal margin with thumbs pointed toward each
other with a small fold of skin in between. Have patient take a deep breath, then check for Y/N
symmetry of expansion. Can be performed anteriorly or posteriorly.)
3. Perform tactile fremitus if indicated (Anterior: Using ball of hand or ulnar side of hand,
feel with both hands at the same time. Start at apex and move down to level of xyphoid, at
midclavicular line, stopping at just above breast and starting under breast. Posterior: Ask S Y/N
patient to cross arms in front. Start at apex and move along the medial scapular border to
the level of the 10th rib, then move laterally on each side.) Use an appropriate diphthong.
Percussion
1. Percuss both sides of chest at each level (posterior, lateral, anterior) using proper
locations and sequence (Posterior: Ask patient to cross arms in front. Start at apex and
move along medial scapular border to level of 10th rib, then move laterally (midaxillary
Y/N
line) on each side. Anterior: Using a ladder pattern, percuss both sides starting
supraclavicular, moving down to level of xyphoid along midclavicular line, skipping the
breast. Performing percussion supine will help displace breasts laterally.)
2. Demonstrate proper technique (Middle finger is hyperextended, and distal
interphalangeal (DIP) joint is pressed on skin surface. Middle finger of striking hand strikes Y/N
DIP joint with a brisk motion.)
3. Percuss for diaphragmatic excursion: posterior chest only (Percuss first during quiet
respiration to establish approximate level of diaphragm. During full expiration, percuss
S Y/N
from level of resonance (below scapula) to level of dullness along midclavicular line.
Repeat during full inspiration and measure difference. Repeat on the other side.)
Developed by Albany Medical College, Center for Physician Assistant Studies | Bickley: Bates’ Guide to Physical Examination
and History Taking, Twelfth Edition. Copyright © 2017 Wolters Kluwer Health
 Detailed Skill Performance Evaluation: Respiratory Examination

Directions: You will have 10 minutes to complete the skill. All critical (C) steps and 80% of the noncritical steps
must be performed or verbalized. Special tests (S) will be performed if requested by examiner.
Start: End:
Performed Verbalized
Auscultation
1. Listen to breath sounds using the diaphragm of the stethoscope (Anterior: Auscultate
comparing sides in a “ladder pattern” starting at apex and moving down to level of xyphoid
along midclavicular line, skipping the breast. Performing auscultation supine will help
Y/N
displace breasts laterally. Posterior: Ask patient to cross arms in front. Start at apex and
move along medial scapular border to level of 10th rib, then move laterally (midaxillary
line). Listen in two areas at and above the xyphoid level on each side.
2. Ask patient take deep breaths through open mouth Y/N
3. Listen for the pitch, intensity, and duration of expiratory and inspiratory sounds Y/N
4. Identify any adventitious sounds such as crackles (rales), rhonchi, or wheezing Y/N
5. Perform posttussive auscultation if indicated S Y/N
6. Perform voice transmission tests (if indicated) to further assess suspected consolidation:
bronchophony, egophony, and whispered pectoriloquy (Using the same auscultatory steps,
S Y/N
listen for changes as patient says “Scooby doo” (bronchophony) or any change from “ee”
sound to “ay” sound (egophony) or a clearer whispered voice (whispered pectoriloquy).
Adequate exposure was maintained for all inspection steps. C
Adequate draping was maintained for all steps. C
Evaluation: #Y = #C =
min. = 25/31 min. = 3
Comments on quality of performance:
Needs remediation?

Y/N

Developed by Albany Medical College, Center for Physician Assistant Studies | Bickley: Bates’ Guide to Physical Examination
and History Taking, Twelfth Edition. Copyright © 2017 Wolters Kluwer Health