Respiratory Examination and Assessment Training DVD

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THAT I HAVE PUT TOGETHER

THAT HAS EVERYTHING YOU NEED TO LEARN ABOUT OR TOWARDS YOUR

QUEST TO PERFECT BEING A MEDICAL PROFESSIONAL.

RESPIRATORY EXAMINATION

&

ASSESSMENT

TRAINING DVD

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LEARNER OBJECTIVES

Describe techniques for inspection during the respiratory examination, including observing the chest, identifying landmarks,

counting respiration and describing variations in respiration including expected respirations, bradypnea, tachypnea, apnea, hypernea,

hyperventilation, hypoventilation, Kussmaul, Cheyne-Stokes, Biot's dyspnea, orthopnea and retractions. Describe techniques for palpation

during the respiratory examination, including thoracic expansion, tactile fremitus and midline trachea techniques. Describe

techniques for percussion during the respiratory examination, including evaluation of percussion tones and diaphragmatic excursion.

Describe techniques for auscultation during the respiratory examination, including evaluation of expected and adventitious

breath sounds. Evaluate findings related to risk factors, inspection, palpation, percussion and auscultation.

IN THIS VIDEO DVD YOU WILL LEARN:

• A Stethoscope
• A Peak Flow Meter

• The patient must be properly undressed and gowned for this examination.
• Ideally the patient should be sitting on the end of an exam table.
• The examination room must be quiet to perform adequate percussion and auscultation.
• Try to visualize the underlying lobes of the lungs as you examine the patient.
• Observe the patient for general signs of respiratory disease (finger clubbing, cyanosis, air hunger, etc.).

• Observe the rate, rhythm, depth, and effort of breathing. Note whether the expiratory phase is prolonged.
• Listen for obvious abnormal sounds with breathing such as wheezes.
• Observe for retractions and use of accessory muscles (sternomastoids, abdominals).
• Observe the chest for asymmetry, deformity, or increased anterior-posterior (AP) diameter.
• Confirm that the trachea is near the midline?

Identify any areas of tenderness or deformity by palpating the ribs and sternum.

1. Assess expansion and symmetry of the chest by placing your hands on the patient's back, thumbs together at the midline, and ask them to breath deeply.
2. Check for tact

Percuss from side to side and top to bottom using the pattern shown in the illustration. Omit the areas covered by the scapulae.

1. Compare one side to the other looking for asymmetry.
2. Note the location and quality of the percussion sounds you hear.
3. Find the level of the diaphragmatic dullness on both sides.
4. Find the level of the diaphragmatic dullness on both sides.
5. Ask the patient to inspire deeply.
6. The level of dullness (diaphragmatic excursion) should go down 3-5cm symmetrically.

Percuss from side to side and top to bottom using the pattern shown in the illustration.

1. Compare one side to the other looking for asymmetry.
2. Note the location and quality of the percussion sounds you hear.

Percussion Notes and Their Meaning

Flat or Dull 

Pleural Effusion or Lobar Pneumonia 

Healthy Lung or Bronchitis 

Hyperresonant 

Emphysema or Pneumothorax 

Use the diaphragm of the stethoscope to auscultate breath sounds.

Auscultate from side to side and top to bottom using the pattern shown in the illustration. Omit the areas covered by the scapulae.

1. Compare one side to the other looking for asymmetry.
2. Note the location and quality of the sounds you hear.
3. Auscultate from side to side and top to bottom using the pattern shown in the illustration.

1. Compare one side to the other looking for asymmetry.
2. Note the location and quality of the sounds you hear.

Breath sounds are produced by turbulent air flow. They are categorized by the size of the airways that transmit them to the

chest wall (and your stethoscope). The general rule is, the larger the airway,

the louder and higher pitched the sound. Vesicular breath sounds are low pitched and normally heard over most lung fields.

Tracheal breath sounds are heard over the trachea. Bronchovesicular and bronchial sounds are heard in between.

Inspiration is normally longer than expiration Breath sounds are decreased when normal lung is displaced by air

(emphysema or pneumothorax) or fluid (pleural effusion). Breath sounds shift from vesicular to bronchial when there is is fluid in the

lung itself (pneumonia).

These tests are only used in special situations. This part of the physical exam has largely been replaced by the chest x-ray. All these tests become abnormal when the lungs become filled with fluid (referred to as consolidation).

Ask the patient to say "ninety-nine" several times in a normal voice.

1. Palpate using the ball of your hand.
2. You should feel the vibrations transmitted through the airways to the lung.
3. Increased tactile fremitus suggests consolidation of the underlying lung tissues.

1. Ask the patient to say "ninety-nine" several times in a normal voice.
2. Auscultate several symmetrical areas over each lung.
3. The sounds you hear should be muffled and indistinct. Louder, clearer sounds are called bronchophony.

1. Ask the patient to whisper "ninety-nine" several times.
2. Auscultate several symmetrical areas over each lung.
3. You should hear only faint sounds or nothing at all. If you hear the sounds clearly this is referred to as whispered pectoriloquy.

1. Ask the patient to say "ee" continuously.
2. Auscultate several symmetrical areas over each lung.
3. You should hear a muffled "ee" sound. If you hear an "ay" sound this is referred to as "E -> A" or egophony.

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