structured examination of the respiratory system
DESCRIPTION
This is the structured approach to a full examination of the respiratory system as would be expected in an OSCETRANSCRIPT
Jonathan Downham 2010
Respiratory ExaminationJonathan Downham Advanced Nurse Practitioner 2008
OSC
E
FIRST THINGS FIRST!! WASH HANDS
INTRODUCEPERMISSIONEXPLAIN REPOSITION
FIRST IMPRESSIONS
MOVING UP THE ARM
NECK- LYMPH AND JVP
FACE AND MOUTH
CHEST
FIRST IMPRESSIONS
ENVIRONMENT
DRIP STANDSCATHETER BAG
SPUTUM POT
DRUGS
MONITORS
OXYGEN
WALKING AIDS
CIGARETTES
BED OR CHAIR?
GENERAL INSPECTION
TIRED
POSITION
AVPU
RATE AND DEPTH
HANDS COLOUR
FEEL
Newly Sprouted FingersNeoplasia – bronchial carcinoma, mesotheliomaSuppurative lung disease – cystic fibrosis, bronchiectasis, abscess, empyemaFibrotic lung disease – cryptogenic fibrosing alveolitis, connective tissue disease (e.g. RA, SLE)
CLUBBING
LOOK
PULSE CHECK
BLOOD PRESSURE
CYANOSIS
HORNERS SYNDROME
ANEAMIA JAUNDICE
PURSED LIPS
NASAL FLARING
TEETH
TONGUE
FACE
NECK- JVP
NECK- LYMPH GLANDS
INSPECTION
PALPATION
PERCUSSION
AUSCULTATION
INSPECTION
RATE AND DEPTH
SCARS SHAPE
SYMMETRY
PALPATION
Jonathan Downham 2010
WHY DO WE PERCUSS AND AUSCULTATE FRONT AND
BACK?
PERCUSSION
PERCUSSION
PLEURAL EFFUSION= STONY DULLNESS
PNEUMOTHORAX = HYPER-RESONANCE
CONSOLIDATION = REDUCED RESONANCE
DON’T FORGET THE
LIVER!
AUSCULTATION
BREATH SOUNDSADDED SOUNDSVOCAL FREMITUS
AUSCULTATION
PLEURAL EFFUSION= REDUCED BREATH SOUNDS
PNEUMOTHORAX = ABSENT BREATH SOUNDS
CONSOLIDATION = REDUCED BREATH SOUNDS
WHEEZE
CRACKLES
POPPING SOUNDS CAUSED BY AIR PUSHING THROUGH SECRETIONS. SOMETIMES DESCRIBED AS COARSE OR FINE.
WIPERS
GENERAL EXAMINATION
HANDS AND PULSE
FACE
NECK
INSPECTION
PALPATION
PERCUSSION
ALSCULTATION