Visual Examination

Total Page：16

File Type：pdf, Size：1020Kb

Visual Examination • Consider the impact of chest shape on the respiratory condition of the patient – Barrel chest – Kyphosis – Scoliosis – Pectus excavatum (funnel chest) – Pectus carinatum Visual Assessment of Thorax • Thoracic scars from previous surgery • Chest symmetry • Use of accessory muscles • Bruising • In drawing of ribs • Flail segment www.nejm.org/doi/full/10.1056/NEJMicm0904437 • Paradoxical breathing /seesaw breathing • Pursed lip breathing • Nasal flaring Palpation • For vibration of secretion • Surgical emphysema • Symmetry of chest movement • Tactile vocal fremitus • Check for a tracheal tug • Palpate Nodes http://www.ncbi.nlm.nih.gov/books/NBK368/ https://m.youtube.com/watch?v=uzgdaJCf0Mk Auscultation • Is there any air entry? • Differentiate – Normal vesicular sounds – Bronchial breathing – Wheeze – Distinguish crackles • Fine • Coarse • During inspiration or expiration • Profuse or scanty – Absent sounds – Vocal resonance http://www.easyauscultation.com/lung-sounds.aspx Percussion • Tapping of the middle phalanx of the left middle finger with the right middle finger • Sounds should be resonant but may be – Hyper resonant – Dull – Stony Dull http://stanfordmedicine25.stanford.edu/the25/pulmonary.html Pathological Expansion Mediastinal Percussion Breath Further Process Displacement Note Sounds Examination Consolidation Reduced on None Dull Bronchial affected side breathing Vocal resonance Whispering pectoriloquy Collapse Reduced on Towards Dull Reduced None affected side affected side Pleural Reduced on Towards Stony dull Reduced/ Occasional rub effusion affected side opposite side Absent Empyema Asthma Reduced None Resonant Normal/ Wheeze throughout Reduced COPD Reduced None Resonant/ Normal/ Wheeze throughout Hyper-resonant Reduced Pulmonary Normal or None Normal Normal Bibasal crepitations Fibrosis reduced throughout Pneumothorax Reduced on Towards Hyper-resonant Reduced/ None affected side opposite side Absent http://www.cram.com/flashcards/test/lung-sounds-886428 sign up and test yourself..

Copy Link

Recommended publications

Respiratory Examination Cardiac Examination Is an Essential Part of the Respiratory Assessment and Vice Versa
Respiratory examination Cardiac examination is an essential part of the respiratory assessment and vice versa. # Subject steps Pictures Notes Preparation: Pre-exam Checklist: A Very important. WIPE Be the one. 1 Wash your hands. Wash your hands in Introduce yourself to the patient, confirm front of the examiner or bring a sanitizer with 2 patient’s ID, explain the examination & you. take consent. Positioning of the patient and his/her (Position the patient in a 3 1 2 Privacy. 90 degree sitting position) and uncover Exposure. full exposure of the trunk. his/her upper body. 4 (if you could not, tell the examiner from the beginning). 3 4 Examination: General appearance: B (ABC2DEVs) Appearance: young, middle aged, or old, Begin by observing the and looks generally ill or well. patient's general health from the end of the bed. Observe the patient's general appearance (age, Around the bed I can't state of health, nutritional status and any other see any medications, obvious signs e.g. jaundice, cyanosis, O2 mask, or chest dyspnea). 1 tube(look at the lateral sides of chest wall), metered dose inhalers, and the presence of a sputum mug. 2 Body built: normal, thin, or obese The patient looks comfortable and he doesn't appear short of breath and he doesn't obviously use accessory muscles or any heard Connections: such as nasal cannula wheezes. To determine this, check for: (mention the medications), nasogastric Dyspnea: Assess the rate, depth, and regularity of the patient's 3 tube, oxygen mask, canals or nebulizer, breathing by counting the respiratory rate, range (16–25 breaths Holter monitor, I.V.
[Show full text]
THE DUBLIN MEDICAL SCHOOL and ITS INFLUENCE UPON MEDICINE in AMERICA1 by DAVID RIESMAN, M.D
THE DUBLIN MEDICAL SCHOOL AND ITS INFLUENCE UPON MEDICINE IN AMERICA1 By DAVID RIESMAN, M.D. PROFESSOR OF CLINICAL MEDICINE IN THE UNIVERSITY OF PENNSYLVANIA PHILADELPHIA, PA. HE Irish, a mixture of primitive universal genius like Robert Boyle, Ireland pre-Celtic peoples and of Goidelic did not produce a perpetuating body of Celts coming from the European learned men who made their influence felt T continent, developed in the early beyond the confines of the Green Island. Middle Ages, out of their own resources Of the history of Irish medicine in the and untouched in any marked degree by the Middle Ages, little is known and the all-pervading influence of Rome, a remark subject is largely an untilled field. Norman able indigenous culture. In particular they Moore (St. Barth. Hosp. Rep., 1875, it elaborated a native type of Christianity 145) has resuscitated a few of the original which with characteristic energy and manuscripts in the Irish language. Most wandering spirit they carried to Scotland, of them are translations from the works of to Northern England—to Northumbria—to Bernard de Gordon, especially from his France, to Belgium, and to Switzerland. “Lilium Medicinae”; of John of Gaddes- St. Columba, of Iona, and St. Columbanus, den’s “Rosa Anglica”; of the works of of Luxeuil, stand forth as the great militant Avicenna, of A verroes, of Isaac, and of the missionaries of that first flowering period Salernitan School. Much space is given to of Irish civilization. Although they and their the writings of Isidorus. This Isidorus is successors had to succumb to the greater the famous Spanish churchman, bishop might of Latin Christianity,2 they left of Seville, who not only was a master of dotted over Europe a number of large theology but a writer upon every branch of monasteries which became active centers of knowledge of his day.
[Show full text]
Pleurisy Dry and Exudative: Symptoms and Syndromes Based on Clinical-Instrumental and Laboratory Methods of Study
Topic: Pleurisy dry and exudative: symptoms and syndromes based on clinical-instrumental and laboratory methods of study. Syndrome of fluid and air accumulation in the pleural cavity in pathology of the respiratory system Objective 1. Patient S. 25 years old, has complaints of severe pain in the left half of the chest, exacerbated by deep breath, lack of air. He first felt sick 3 days ago, noticed a one-time increase in body temperature to 37,5°C. On examination: rapid superficial breathing, the left half of the chest is slower in the act of breathing. Clear pulmonary sound is determined by percussion. During auscultation, there is a pleural friction sound to the left, it is louder in the armpit. The pain increases with inhalation, decreases with lying on the side of pain. In the general clinical blood test - moderate leukocytosis, ESR - 17 mm / h. Questions: 1. What is the diagnosis? 2. What (all) data will the doctor receive when auscultating the patient's lungs with this pathology? 3. How can you distinguish the pleural friction sound from the pericardial friction sound? 4. What is the normal respiratory rate? What is the respiratory rate of rapid breathing? 5. What are the possible causes of this disease. Task 2. Patient M., 33 years old, has complaints of chills, fever up to 38,5°C for 3 days, dry cough, pain in the right half of the chest. The pain is exacerbated by breathing and coughing. Objectively: the skin is pale, the lips are cyanotic, the respiratory rate is up to 30 per minute, the right half of the chest is enlarged in volume, the intercostal spaces are smoothed.
[Show full text]
Clinical Usefulness of 'Vocal Fremitus' and 'Vocal Resonance'
RESEARCH Clinical usefulness of ‘vocal fremitus’ and ‘vocal resonance’ Kyaw San Hla MMedSc, MRCP, FRACP, is Senior Lecturer and staff physician, James Cook University, Mackay Base GP perceptions and practice Hospital, Queensland. kyaw. [email protected] Assessment of vocal fremitus (VF) and vocal resonance The study was approved by the Ethics Committee at Mackay (VR) (whereby vocal vibrations are felt or heard during Base Hospital. a clinical examination) is an established part of physical examination of the respiratory system. Textbooks on Results clinical examination include these procedures as part of Sixty-seven responses were obtained (64 GPs and three the standard method.1–3 general practice registrars), providing a response rate of approximately 70%. Forty-four respondents (65.7%) Undergraduate and postgraduate candidates are required rarely performed VF/VR as part of routine chest examination to perform VF and VR when they undertake qualifying (Figure 1). 50 44 assessments, however the reliability of findings from More than half (53.7%) 40 these procedures is controversial.4 It is also unusual to disagreed with the statement 30 see experienced doctors performing VF/VR during actual that ‘routine inclusion of either chest examination. The author of the only identifiable study VF or VR on chest examination Count 20 9 on clinicians’ attitudes toward VF/VR (which had only 14 is desirable’ (with 11.9% strongly 10 6 2 3 3 respondents) remarked ‘it will be rare to see physicians disagreeing). More than a quarter 0 near about about about about rarely doing both or even one of them although the majority has (28%) remained neutral.
[Show full text]
Gas Exchange and Respiratory Function
LWBK330-4183G-c21_p484-516.qxd 23/07/2009 02:09 PM Page 484 Aptara Gas Exchange and 5 Respiratory Function Applying Concepts From NANDA, NIC, • Case Study and NOC A Patient With Impaired Cough Reflex Mrs. Lewis, age 77 years, is admitted to the hospital for left lower lobe pneumonia. Her vital signs are: Temp 100.6°F; HR 90 and regular; B/P: 142/74; Resp. 28. She has a weak cough, diminished breath sounds over the lower left lung field, and coarse rhonchi over the midtracheal area. She can expectorate some sputum, which is thick and grayish green. She has a history of stroke. Secondary to the stroke she has impaired gag and cough reflexes and mild weakness of her left side. She is allowed food and fluids because she can swallow safely if she uses the chin-tuck maneuver. Visit thePoint to view a concept map that illustrates the relationships that exist between the nursing diagnoses, interventions, and outcomes for the patient’s clinical problems. LWBK330-4183G-c21_p484-516.qxd 23/07/2009 02:09 PM Page 485 Aptara Nursing Classifications and Languages NANDA NIC NOC NURSING DIAGNOSES NURSING INTERVENTIONS NURSING OUTCOMES INEFFECTIVE AIRWAY CLEARANCE— RESPIRATORY MONITORING— Return to functional baseline sta- Inability to clear secretions or ob- Collection and analysis of patient tus, stabilization of, or structions from the respiratory data to ensure airway patency improvement in: tract to maintain a clear airway and adequate gas exchange RESPIRATORY STATUS: AIRWAY PATENCY—Extent to which the tracheobronchial passages remain open IMPAIRED GAS
[Show full text]
Chest Auscultation: Presence/Absence and Equality of Normal/Abnormal and Adventitious Breath Sounds and Heart Sounds A
Northwest Community EMS System Continuing Education: January 2012 RESPIRATORY ASSESSMENT Independent Study Materials Connie J. Mattera, M.S., R.N., EMT-P COGNITIVE OBJECTIVES Upon completion of the class, independent study materials and post-test question bank, each participant will independently do the following with a degree of accuracy that meets or exceeds the standards established for their scope of practice: 1. Integrate complex knowledge of pulmonary anatomy, physiology, & pathophysiology to sequence the steps of an organized physical exam using four maneuvers of assessment (inspection, palpation, percussion, and auscultation) and appropriate technique for patients of all ages. (National EMS Education Standards) 2. Integrate assessment findings in pts who present w/ respiratory distress to form an accurate field impression. This includes developing a list of differential diagnoses using higher order thinking and critical reasoning. (National EMS Education Standards) 3. Describe the signs and symptoms of compromised ventilations/inadequate gas exchange. 4. Recognize the three immediate life-threatening thoracic injuries that must be detected and resuscitated during the “B” portion of the primary assessment. 5. Explain the difference between pulse oximetry and capnography monitoring and the type of information that can be obtained from each of them. 6. Compare and contrast those patients who need supplemental oxygen and those that would be harmed by hyperoxia, giving an explanation of the risks associated with each. 7. Select the correct oxygen delivery device and liter flow to support ventilations and oxygenation in a patient with ventilatory distress, impaired gas exchange or ineffective breathing patterns including those patients who benefit from CPAP. 8. Explain the components to obtain when assessing a patient history using SAMPLE and OPQRST.
[Show full text]
Prognosis in Bronchiectasis
Arch Dis Child: first published as 10.1136/adc.6.31.1 on 1 February 1931. Downloaded from PROGNOSIS IN BRONCHIECTASIS BY LEONARD FINDLAY, M.D., D.Sc., M.R.C.P., Physician, East London Hospital for Children, Shadwell, and STANLEY GRAHAM, M.D., Physician, Royal Hospital for Sick Children, Glasgow. In 1927, we published in this journal' a communication embodying the results of our experience of bronchiectasis in childhood. We then expressed doubt regarding the correctness of the view held by some authors that the condition is curable. Nobecourt2, for example, in support of Hutinel3, has stated that recovery not infrequently does take place. This, he thinks, is brought about by the dilatation of the bronchi ceasing to increase, and, as the lung grows, the bronchi ultimately coming to have the normal proportions. Hutinel believed that the younger the age at which the bronchiectasis appeared the more likely was a cure to result. Thursfield and Paterson4 more recently have re-affirmed this favourable prognostic outlook. So far as we could see at the time of our first analysis the condition tended to get worse. From a study of the post-mortem material it was difficult, if not impossible, to understand how recovery could take place. Many of the lungs had the naked-eye appearance of a sponge or a hydatidiform mole. Naturally, of course, the post-mortem examples would be the most severe, though it is only fair to state that in several cases death had resulted from operative inter- ference and not in consequence of advancing pulmonary involvement.
[Show full text]
Community-Acquired Pneumonia in Adults: Diagnostic Reliability of Physical Examination Techniques and Their Teaching in Academia
James Madison University JMU Scholarly Commons Physician Assistant Capstones The Graduate School Fall 12-14-2018 Community-acquired pneumonia in adults: Diagnostic reliability of physical examination techniques and their teaching in academia Amber Tordoff James Madison University Lauren A. Williams James Madison University Follow this and additional works at: https://commons.lib.jmu.edu/pacapstones Part of the Bacteria Commons, Bacterial Infections and Mycoses Commons, Diagnosis Commons, Investigative Techniques Commons, Medical Pathology Commons, Respiratory Tract Diseases Commons, Virus Diseases Commons, and the Viruses Commons Recommended Citation Tordoff AL, Williams LA. Community-Acquired Pneumonia in Adults: Diagnostic Reliability of Physical Examination Techniques and their Teaching in Academia. JMU Scholarly Commons Physician Assistant Capstones. https://commons.lib.jmu.edu/pacapstones/44/. Published December 12, 2018. This Presentation is brought to you for free and open access by the The Graduate School at JMU Scholarly Commons. It has been accepted for inclusion in Physician Assistant Capstones by an authorized administrator of JMU Scholarly Commons. For more information, please contact [email protected]. Community-Acquired Pneumonia in Adults: Diagnostic Reliability of Physical Examination Techniques and their Teaching in Academia Amber Tordoff, PA-S and Lauren Williams, PA-S, James Madison University, Harrisonburg, Virginia _____________________________________________________________________________________ ABSTRACT Background:
[Show full text]
Chest and Lung Examination
Chest and Lung Examination Statement of Goals Understand and perform a complete examination of the normal chest and lungs. Learning Objectives A. Locate the bony landmarks of the normal chest: • Ribs and costal margin, numbering ribs and interspaces • Clavicle • Sternum, sternal angle and suprasternal notch • Scapula B. Define the vertical "lines" used to designate chest wall locations. Use the bony landmarks and conventional vertical "lines" when describing a specific area of the chest wall. • Midsternal line • Midclavicular line • Anterior, mid and posterior axillary lines • Scapular line • Vertebral line C. Describe the location of the trachea, mainstem bronchi, lobes of the lungs and pleurae with respect to the surface anatomy of the chest. D. Prepare for an effective and comfortable examination of the chest and lungs by positioning and draping the patient. Communicate with the patient during the exam to enlist the patient’s cooperation. E. Describe and perform inspection of the chest including the following: • Rate, rhythm, depth, and effort of breathing • Shape and movement of the chest F. Describe and perform palpation of the chest including the following: • Identify tender areas • Chest expansion • Tactile fremitus G. Describe and perform percussion of the chest, distinguishing a dull sound (below the diaphragm) from a resonant sound (over normal lung.) Use percussion to demonstrate symmetric resonance of the lung fields and to measure diaphragmatic excursion. H. Describe and perform auscultation of the lungs including the following: • Symmetric examination of the lung fields, posterior and anterior. • Normal breath sounds (vesicular, bronchovesicular, bronchial and tracheal), their usual locations and their characteristics. I. Define terms for three common adventitious lung sounds: • Wheezes are high pitched, continuous hissing or whistling sounds.
[Show full text]
Diagnostic Value of the Physical Examination in Patients with Dyspnea
REVIEW LEARNING OBJECTIVE: Readers will assess the diagnostic accuracy of physical signs in patients with dyspnea RICHARD A. SHELLENBERGER, DO BATHMAPRIYA BALAKRISHNAN, MD SINDHU AVULA, MD Associate Program Director, Internal Medicine Department of Pulmonary and Critical Care Medicine, Department of Internal Medicine, St. Joseph Residency Program, St. Joseph Mercy Ann Arbor Henry Ford Hospital System, Mercy Ann Arbor Hospital, Ann Arbor, MI Hospital, Ann Arbor, MI Detroit, MI ARIADNE EBEL, DO SUFIYA SHAIK, MD Department of Internal Medicine, Department of Internal Medicine, St. Joseph Mercy Ann Arbor Hospital, St. Joseph Mercy Ann Arbor Hospital, Ann Arbor, MI Ann Arbor, MI Diagnostic value of the physical examination in patients with dyspnea ABSTRACT aennec’s stethoscope has survived more L than 200 years, much longer than some of We reviewed the evidence for the diagnostic accuracy his contemporaries predicted. But will it sur- of the physical examination in diagnosing pneumonia, vive the challenge of bedside ultrasonography pleural effusion, chronic obstructive pulmonary disease, and other technologic advances? and congestive heart failure in patients with dyspnea and The physical examination, with its roots found that the physical examination has reliable diagnos- extending at least as far back as Hippocrates, tic accuracy for these common conditions. may be at a crossroads as the mainstay of diag- nosis. Physical signs can be subjective and lack KEY POINTS sensitivity and specificity. Modern imaging and laboratory studies may already be more trusted. Asymmetrical chest expansion, diminished breath sounds, If the physical examination is to survive, it egophony, bronchophony, and tactile fremitus can be must be accurate, reproducible, and efficient.
[Show full text]
Physical Examination of the Adult Patient with Respiratory Diseases: Inspection and Palpation
Eur Respir J, 1995, 8, 1584–1593 Copyright ERS Journals Ltd 1995 DOI: 10.1183/09031936.95.08091584 European Respiratory Journal Printed in UK - all rights reserved ISSN 0903 - 1936 SERIES 'CHEST PHYSICAL EXAMINATION' Edited by J.C. Yernault Physical examination of the adult patient with respiratory diseases: inspection and palpation B. Maitre, T. Similowski, J-P. Derenne Physical examination of the adult patient with respiratory diseases: inspection and pal- Service de Pneumologie et de Réanimation, pation. B. Maitre, T. Similowski, J-P. Derenne. ©ERS Journals Ltd 1995. Groupe Hospitalier Pitié-Salpêtrière, Paris, ABSTRACT: Inspection of the thorax identifies the breathing position adopted by France. the patient, the shape of the thorax, the dynamics of respiration (breathing pat- tern, symmetry of expansion, mechanics and synchrony of rib cage and abdominal Correspondence: T. Similowski movements). Inspection of the neck adds useful information, particularly with Service de Pneumologie et de Réanimation respect to the dynamics of breathing. Palpation ascertains the signs suggested by Groupe Hospitalier Pitié-Salpêtrière inspection with respect to the mechanics of breathing. It also assesses the state of 47-83 Bd de l'Hôpital 75651 Paris Cedex 13 the pleura and pulmonary parenchyma by studying the tactile fremitus. It inte- France grates extrarespiratory signs, such as enlarged lymph nodes or breast abnorma- lities. Extrathoracic respiratory signs should also be systematically looked for, Keywords: Clinical examination including cyanosis, finger deformation, pulsus paradoxus, and pursed lips breath- inspection ing. palpation Interobserver agreement about respiratory signs has repeatedly been studied, and respiratory system generally found to be low, as are clinical-functional correlations.
[Show full text]
Approach to Chronic Cough and Atopy Year 3 Clerkship Guide, Family Medicine Department Schulich School of Medicine and Dentistry ______Objectives 1
Approach to Chronic Cough and Atopy Year 3 Clerkship Guide, Family Medicine Department Schulich School of Medicine and Dentistry _____________________________________________________________________________________________ Objectives 1. Understand the principles of management for allergic conditions 2. Be able to conduct an appropriate history and physical exam for someone with a complaint of chronic cough. 3. Be able to outline a differential diagnosis for chronic cough. 4. Identify appropriate investigations for a child complaining of chronic cough. 5. Develop an approach for management of asthma. 6. Be able to distinguish between seborrheic dermatitis and atopic dermatitis. 7. Be able to identify other atopic conditions (allergic rhinitis and atopic dermatitis), order appropriate investigations for diagnosis and outline a plan for management. 8. Understand the correct management for an acute exacerbation of asthma. 9. Be able to explain and demonstrate when and how to use a puffer (see module) 10. Atopy refers to a genetic predisposition to the type 1 hypersensitivity reactions that most commonly manifest as allergic rhinitis, asthma, and atopic dermatitis. Approach to Chronic Cough History: When taking a history, make sure to identify the onset and nature of the cough, including whether it is productive, if there is associated dyspnea, what the cough sounds like and if there are any other symptoms (e.g. rhinorrhea, allodynia, malaise, headache, or fever) which might indicate an infectious cause. Determine what the circumstances were at the onset of the cough, as a cough that onset while playing or eating may lead to suspicion about a foreign body in the airway. Ask about any medications that may have been taken to control the cough and whether they were effective.
[Show full text]