Respiratory Exam

September 22, 2015 Print Friendly Version of this page Print Get a PDF version of this webpage PDF
Introduces self
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1

Confirms name & age of patient
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1

Explains & gains consent
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1

Washes hands
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1

Exposes patient from waist up and positions at 45 degrees
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1

Asks if patient is in pain
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1

General inspection around bed & patient (comfortable, respiratory distress, pursed lips, added breath sounds, scars, chest deformities, sputum pot, oxygen, medication
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1

Asks patient to take deep breath in and out to inspect symmetry of chest expansion.
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1

Assesses hands for temperature, peripheral cyanosis, tar stains, clubbing, wasting and tremor
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1

Checks for CO2 flap
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1

Pulse (rate, rhythm, bounding pulse), respiratory rate and offers to assess blood pressure
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1

Inspects JVP
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1

Warns before assessing tracheal deviation
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1

Inspects face for conjunctival pallor, horner's syndrome and tongue for central cyanosis
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1

Palpates for apex beat
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1

Assesses chest expansion of front
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1

Percusses over front of chest comparing both sides
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1

Checks tactile vocal fremitus or whisper perilolquy on front of chest
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1

Auscultates over front of chest comparing both sides
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1

Inspects back and assesses expansion
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1

Percusses over back avoiding scapulae
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1

TVF or WP on back
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1

Auscultates back
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1

Examines lymph nodes of neck
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1

Checks for sacral & ankle oedema
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1

Thanks patient and offers help to redress
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1

Washes hands
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1

Requests oxygen saturations, temperature, chest xray, peakflow, sputum (microbiology, culture, cytology) and observations chart
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1

Summarise appropriately with only key findings.
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1

Offer appropriate differential diagnoses.
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1

Patient global score
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1
2
Potential differentials
  • COPD
    • Look for sputum pot, inhalers, nebulisers, dyspnoea, pursed lipped breathing, use of accessory muscles
    • CO2 retention flap, bounding pulse, tar stained fingers
    • Hyperexpanded (cannot palpate apex beat)
    • Resonant percussion note
    • Expiratory wheeze
    • Look for signs of cor pulmonale (raised JVP, right ventricular heave, ankle oedema)
  • Pulmonary fibrosis
    • Clubbing, possible central cyanosis, tachypnoea
    • Fine end-inspiratory crackles (like velcro)
    • Lack of sputum
    • Look for signs of autoimmune conditions in face and hands (e.g. SLE, rheumatoid arthritis) or cushingoid appearance from steroid treatment
  • Pneumonectomy
    • Scar on side or posteriorly
    • Trachea deviated towards 
    • Reduced expansion, dullness to percussion and absent breath sounds (may hear from other side)
  • Lobectomy

2 comments

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Anonymous
28 December 2015 at 12:20 delete

you need to include assess resp rate! :)

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16 January 2016 at 23:44 delete

Really grateful for your comment! I've updated it! :) Please let me know if you notice anything else

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