02-respiratory system assessment
DESCRIPTION
sistem respirasiTRANSCRIPT
Respiratory System Assessment
Dr Abdelhaleem Bella
The hardest conviction to get into
the mind of a beginner is that the
education upon which he is engaged
is not a college course...but a life
course, for which the work of a
few years under teachers is but a
preparation.
The Basic
• Medicine is learned at the bedside and not in the classroom
• Practice makes perfect
• Rapport AND NURS ( Name + Understanding+ Respect+ Support)
• Start with open ended questions , frequent summary, clarify conclude .
• Anatomical , Physiological ,Aetiological and Impact
HISTORY
Introduction : General Info
Summary
HPI
SH
PSH Drugs
Presenting Complaint
PMH
SR
FH
PH
Common Symptoms
1. Cough 2. Sputum 3. Dyspnea 4. Wheeze 5. Chest Pain 6. Snoring and EDS 7. Hoarseness 8. Hemoptysis` 9. General : Fever , Sweating, Wt Loss, Appetite
When the Patient Has Cough .
1 How long have you had the cough? 2 Do you cough up anything? What? How much? 3 Have you had sinus problems? 4 Is the sputum clear or discoloured? Is there any blood in the
sputum? 5 Have you had high temperatures? 6 Does coughing occur particularly at night (acid reflux)? 7 Have you become short of breath? 8 Have you had lung problems in the past? 9 Have you been a smoker? Do you still smoke? 10 Have you noticed wheezing?-Asthma, chronic obstructive
pulmonary disease (COPD)? 11 Do you take any tablets?-ACE inhibitors
Cough Duration
Cough Character
When the patient complains of Breathlessness
1 How long have you been short of breath? Has it come on quickly? 2 How much exercise can you do before your shortness of breath stops
you or slows you down? Can you walk up a flight of stairs? 3 Have you been woken at night by breathlessness or had to sleep
sitting up?-Paroxysmal nocturnal dyspnoea (PND), orthopnoea 4 Have you had heart or lung problems in the past? 5 Have you had a temperature? 6 Do you smoke? 7 Is there a feeling of tightness in the chest when you feel breathless?-
Angina 8 Do you get wheezy in the chest? Cough? 9 Is the feeling really one of difficulty getting a satisfying breath?-Anxiety 10 Is it painful to take a big breath?-Pleurisy or pericarditis 11 Did the shortness of breath come on very quickly or
instantaneously?-Pulmonary embolus (very quick onset) or pneumothorax (instantaneous onset)
Dyspnea And Onset+
Duration
Dyspnea Extra
EXAMINATION
General Appearance: Blue Bloaters and Pink Puffers
Sputum
Pattern of Breathing
Hand Examination: Cyanosis
Nail :Staining
Diabetes mellitus Amyloidosis Median/ulnar nerve injury; Thermal injury; and Jaundice. Consider yellow nail syndrome if a patient has lymphedema and bronchiectasis.
Nails : Yellow Nails
A, Schamroth sign. In the absence of clubbing, opposition of the index fingers nail to nail creates a diamond-shaped window (arrowhead). In clubbed fingers, the loss of the profile angle because of the increase in tissue at the nail bed causes obliteration of this space (arrowhead). B, Distal phalangeal finger depth (DPD)/interphalangeal finger depth (IPD) represents the phalangeal depth ratio. In normal fingers, the IPD is greater than the DPD. In clubbing, this relationship is reversed
Nails : Clubbing
Nails : Clubbing and possible disease
Nails: Clubbing
‘nail clubbing’, ‘drumstick fingers’, ‘Water-glass nails’ for the resemblance and ‘Hippocratic fingers
1. Periungual erythema and softening of the nail bed (spongy feeling on palpation)
2. Increase in the normal 160-165o angle between the nail bed and proximal nail fold (Lovibond’s angle) (Figure 2)
3. Increase nail curvature (secondary to the increase Lovibond’s angle)
4. Enlargement giving the drumstick appearance hypertrophic osteoarthropathy(HOA) characterised by
periostitis of long bones and pain. It is also referred to as ‘Piérre Marié-Bamberger syndrome’.
Hand : Flapping Tremor
Central Cyanosis : Lips
Face : Congestion
Face: Horner Syndrome
Cervical Lymph Nodes
CHEST
Chest : Inspection ,distended Veins
Chest Inspection: Pectus Carinatum
Chest Inspection : Pectus Excavatum
Chest Inspection : Scars
Chest Inspection : Scars
Chest Inspection : Scars
Chest Inspection : Scars
Chest Inspection: Barrel
Chest Inspection : Kyphoscoliosis
Harrison Sulcus and asso signs
Palpating the Trachea
Inspection : chest expansion
Palpation: Chest Movement
Percussion
Sequence
Percussion Notes
Auscultation
Auscultation: Breath sounds
Auscultation : Breath Sounds
Bronchial :Heard over the trachea and mainstem bronchi (2nd-4th intercostal spaces either side of the sternum anteriorly and 3rd-6th intercostal spaces along the vertebrae posteriorly). The sounds are described as tubular and harsh. Also known as tracheal breath sounds. Bronchovesicular :Heard over the major bronchi below the clavicles in the upper of the chest anteriorly. Bronchovesicular sounds heard over the peripheral lung denote pathology. The sounds are described as medium-pitched and continuous throughout inspiration and expiration. Vesicular : Heard over the peripheral lung. Described as soft and low- pitched. Best heard on inspiration. Diminished :Heard with shallow breathing; normal in obese patients with excessive adipose tissue and during pregnancy. Can also indicate an obstructed airway, partial or total lung collapse, or chronic lung disease.
Pathophysiology and Clinical Signs
FURTHER SYSTEM EXAMINATIONS
INVESTIGATIONS
“Learn to love the freedom of the student life, only too quickly to pass away; the absence of the coarser cares of after days, the joy in comradeship, the delight in new work, the happiness in knowing that you are making progress. Once only can you enjoy these pleasures.”
Osler W. The Master-Word in Medicine. In: Aequanimitas, With Other Addresses to Medical Students, Nurses and Practitioners of Medicine.3rd ed. New York: McGraw-Hill Book Company, 1932: 362.
INVESTIGATIONS
Normal Female CXR
Peak Flow Meter
Pulmonary Function Test
SUMMARY & CONCLUSION
http://www.meddean.luc.edu/lumen/MedEd/medicine/pulmonar/IMAGES/CD-LungSounds/mac/cugell-07july11.swf
http://www.stethographics.com/main/physiology_ls_introduction.html