Examination of Respiratory System — OmpathStudy

Continued from $1. TOPIC 3: LAND MARKS AND GENERAL EXAMINATION OBJECTIVES At the end of the session the learner should be able to 3. Identify landmarks for respiratory system examination 4. Perform general examination of the respiratory system 5. Interpret general examination findings of the respiratory system 3.0 OUTLINE I. Landmarks: - chest wall topography , suprasternal notch, angle of Louis, costal angle and vertebra prominence II. Lung borders: - Anterior, posterior and border of the diaphragm III. Lung fissures: A. Right horizontal - B. Right oblique – IV. Left oblique: V. Trachea: I. Inspection A. General approach 1. Client sitting upright 2. Uncovered to waist 3. Adequate lighting 4. Privacy B. Observations 1. Shape of thorax and symmetry 2. Ribs and intercostal spaces 3. Pattern of respirations 4. Oxygenation 5. Sputum production 6. Breath door C. Most common signs and symptoms of respiratory system include dyspnoea, cough, sputum production, chest pain or discomfort II. Palpation A. Purpose: further assess any observed abnormality by history or inspection B. Assess tracheal position C. Assess thoracic excursion (expansion) and symmetry D. Identify areas of tenderness E. Assess skin, subcutaneous, and bony structures F. Elicit tactile (vocal) fremitus 1. Fremitus - palpable vibrations transmitted to the chest wall when the client 2. speaks 3. Repeat words "ninety-nine" or "blue moon" 4. Use palmar bases of fingers or ulnar aspect of hand or fist 5. Make symmetrical comparisons III. Percussion A. Purpose: To evaluate lung borders 1. To evaluate levels of effusion 2. To detect changes in density B. Technique: 1. Percuss apices 2. Arms forward to move scapula laterally 3. Percuss over ICS, avoid bone 4. Percuss at 5 cm intervals, compare symmetrical areas 5. Measure diaphragmatic excursion C. Findings: 1. Normal a. Resonance 2. V/N a. Dullness or flatness over lung tissue b. Hyper-resonance IV. Auscultation A. Purpose: 1. To assess air flow 2. To assess presence of fluid, mucous, or obstruction in air passages 3. To assess condition of surrounding lungs and pleura B. Technique: C. Breath sounds: D. Tracheal (bronchial) 1:2 E. Broncho-vesicular F. Vesicular G. Voice sounds: Produced by the same mechanism that produces vocal fremitus; transmitted voice sounds as heard by the stethoscope on the chest wall 1. Bronchophony - "99" "blue moon" 2. Whispered pectoriloquy - "1, 2, 3" 3. Egophony - "e" sounds like "a" H. Adventitious sounds or abnormal sounds e.g. crackles, wheezes, rhonchi type of wheeze, pleural rub, stridor and grunting 4.0 LANDMARKS The anatomical landmarks utilized during the examination of the respiratory system comprise bony structures, imaginary lines and surfaces/regions on the anterior, lateral and posterior aspect of the chest wall. They are used to determine the surface area of various internal structures in the thoracic cavity. Table 1: Anatomical Landmarks Anterior Lateral Posterior Bony ❑ The sternum ❑ Ribs ❑ Scapula structures ❑ Angle of Louis ❑ Vertebral column ❑ Suprasternal notch ❑ Clavicles ❑ Ribs and costal cartilages Lines ❑ Midline/midsternal line ❑ Anterior axillary line ❑ Mid line ❑ Mid clavicular line ❑ Axillary line ❑ Interscapular line ❑ Intermammary line ❑ Posterior axillary line Spaces/regions ❑ Suprasternal ❑ Axillary ❑ Suprascapular ❑ Supraclavicular ❑ Infrascapular ❑ Infraclavicular ❑ Interscapular ❑ Supramammary ❑ Inframammary 4.1 Bony Structures The ribs and the intercostal spaces, found between the ribs, serve as the vertical reference guides to locations in the thorax 4.2 Surface Anatomy/Markings Anteriorly, the extent of the lungs runs from its apex about 2.5 cm above the clavicle to the lower border anteriorly at the 6th rib. To find this point the sternal angle (Angle of Louis) is used as it articulate with the 2nd rib and it is possible to palpate downwards to count ribs from here. At the 4th rib, on the midclavicular line the horizontal fissure is found which split the lung into upper, lower and middle lobes. Thus to auscultate the upper right lobe, this should be done anteriorly and above the 4th rib... likewise the lower lobe can be found posteriorly and below the 4th rib (but listen below the scapula,) with the middle lobe anteriorly below the 4th rib. Both the lungs and the pleura extend farther down in the posterior thorax than in the anterior thorax. The pleura usually extend 2 intercostal spaces beyond the extent of the lung to allow for the lungs' expansion during inspiration. The oblique fissure in either lung starts posteriorly at T3 (sternal angle approxT3-T4 anteriorly as a guide,) and runs diagonally round to the midclavicular line at the 6th rib. 4.3 Lines 4.4 Spaces Interscapular region Axillary 5.0 GENERAL EXAMINATION 5.1 General observations Respiratory rate Body mass (obesity, weight loss) Fever Confusion Features of respiratory distress o Breathlessness o Dyspnoea o Use of accessory muscles – sternocleidomastoid, platysma, pectoral mu