Respiratory Examination

Introduction

• Wash hands, Introduce, Explain, Permission

• Exposure, Position, Pain

• Surrounding

General Examination

• General condition of the patient

• Hands

  • Flapping tremor

  • Fine tremor

  • Clubbing

  • Temperature and colour and cap refill

  • Tar staining

  • Yellow nails, nail fold vasculitis

  • Wasting of intrinsic muscles

  • Palmar erythema

  • Palpate wrist for tenderness (HPOA)

  • Look for evidence of rheumatoid arthritis, including nodules, scleroderma, dermatomyositis

  • Thin, bruised skin (steroids)

• PR, RR

• Blood pressure

• JVP

• Face

  • Face - skin rash, cushingoid faces

  • Eyes - Conjunctival pallor, Jaundice,Horners (Ptosis, Enophthalmos, Meiosis, Anhidrosis)

  • Mouth-central cyanosis, oral candida, microstomia

• Trachea: Position, Tug and Descent

• Lymph node

• Legs - pedal odema, DVT, clubbing

Inspection

• Shape, scar, radiotherapy mark

• Chest wall movement

Palpation

• Chest wall expansion

• Vocal fremitus

Percussion

Resonant/Hyper resonant/Dullness/Stony dullness

Auscultation

• Breath sound

• Vocal resonance

Precordial Examination

• Apex beat

• Palpable P2/ Loud P2

Complete Examination

• Sputum pots, PEFR, CXR, ABG

• SPO2

• Observation chart

• Drug chart