Respiratory Exam

Introduction

Wash Hands Introduce yourself and your role to the patient Explain the purpose of the exam and what it entails to patient Obtain consent Sit patient upright on right side of bed

General Inspection

Pain Respiratory distress or SOB Use of accessory muscles to breathe Discoloration: Pallor, Cyanosis, Plethora Coughing Wheezing Stridor Cachexia Accessories: supplemental O2, ventilators, inhaler

Hands

Clubbing Clubbing is the loss of angle between nail and nail bed causing increased nail convexity Ask patient to hold distal phalanges back to back; a lack of space between the nail beds indicates clubbing

Peripheral cyanosis Blue discoloration extending medially from finger tips

Tar staining: Dark discoloration between fingers from holding cigarettes.

Wasting Feel the mass of thenar and hypothenar regions and test patient's ability to abduct and adduct fingers.

Asterixis

Vitals

Head and Neck

Eyes

Horner's Syndrome: Anhidrosis, partial ptosis, miosis Pallor of conjunctiva

Nose

Nasal polyps Nasal septal deviation

Mouth

Inflammation of pharynx and tonsils Central cyanosis Dentition

Palpation

Sinuses

• Frontal
• Ethmoid
• Maxillary

Lymph Nodes

• Submental
• Submandibular
• Pre-Auricular
• Post-Auricular
• Anterior Cervical Chain
• Supra-Clavicular
• Posterior Cervical Chain
• Occipital

Tracheal Deviation and Tug

Back, Axillary, and Chest

Inspection

Chest wall deformities: barrel chest, pectus excavatum, pectus carinatum, scoliosis, kyphosis

Scars

Palpation

Chest expansion > 5cm

Percussion

Auscultation

Broncho-Vesicular Sounds

Vocal Resonance