Principles of Chest Examination - Education for Health of Chest Examination Natalie Harper...
Transcript of Principles of Chest Examination - Education for Health of Chest Examination Natalie Harper...
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Principles of Chest Examination
Natalie HarperRespiratory Advanced Nurse Practitioner – Dorset County HospitalFoundation Trust
UK/KOL/17/0009 Date of Preparation: February 2017
The views expressed in this presentation are those of the speaker and are not necessarily those of the meeting sponsors.
This presentation may contain off-licence information. Please refer to the product SmPCs for the approved indication for use.
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Disclosures:
• Teva UK Limited
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Chest examination
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• Always start with a general examination
• Then focus on respiratory aspects of a chest examination
PLEASE NOTE: Being competent at chest examination takes a lot of time and practice.
This is an introductory session only, so please seek the support and guidance of someone in your practice or workplace to help you develop your chest examination skills further.
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Landmarks
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Anterior chest
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Lateral chest
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Posterior chest
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Physical exam techniques
Inspection
Palpation
Percussion
Auscultation
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Inspection
Pectus excavatum
Pectus carinatum
Kyphosis
Scoliosis
Kyphoscoliosis
Symmetry of chest movement
Ease/difficulty of breathing including use of accessory muscles
Audible sounds – wheeze, stridor etc
Colour – do they look cyanotic?
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Pectus excavatum and carinatum
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Assessing for spinal deformities
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Assessing for spinal deformities
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Inspection/palpation
From the hand upwards:
HANDS
Clubbing
Tar staining
Peripheries and capillary refill time
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Clubbing Tar staining
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Capillary refill
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Inspection/palpation
WRISTC02 retention flapPulseRespiratory rate (done immediately after pulse before letting go, so patient is unaware you’re counting their breaths)
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Fine and course tremor
Fine tremor of Beta Agonist overuse Course tremor of CO2 retention
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Inspection/palpation
From the hand upwards:
NECK
JVP (jugular venous pressure)
Lymph nodes
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JVP
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Lymph nodes
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Inspection/palpation
FACE
Conjunctiva for anaemia
Central cyanosis
TRACHEA
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Changes in the face, eyes and mouthYellowing of the skin and sclera
Corneal arcus XanthelasmaPaleness in the
conjunctiva
Angular stomatitisGlossitis
Blue lips –central cyanosis
Dry tongue
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Tracheal alignment abnormalities
• Tension pneumothorax - shifts away from affected side
• Pleural effusion - shifts away from affected side
• Fibrosis or atelectasis - shifts towards affected side
• Pulmonary consolidation - no shift
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Palpation: chest expansion
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Palpation: tactile vocal fremitus
• Bilateral comparison of vocal vibrations
• Increased with alveolar consolidation
• Decreased with increased distance between lung and chest wall
– pneumothorax, pleural effusion
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Tactile fremitus
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Percussion
• Assess density of underlying tissue by resonance of sound
• Presence of fluid will produce a dull sound
• Air between the lungs and the chest wall (pneumothorax) produces a hollow note
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Percussion
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Percussion notes
Resonance – normal
Dullness – increased density
• Atelectasis, alveolar filling/consolidation, pleural effusion, fibrosis
Hyperresonance – decreased density
• Hyperinflation (COPD), pneumothorax
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Auscultation – areas
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Video
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Feel calves fortenderness/warmth/swelling
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Deep vein thrombosis
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Sacral and pitting oedema
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Any questions?