Respiratory Assessment
Anterior
Inspect:
State that you would wash hands
Introduce self to Pt
Pt is alert and oriented x 3 (know what x 3 means)
Respiratory rate 12-20 per minute, even and unlabored
Skin color is tan, with multiple scattered hyperpigmented flat macules
No nasal flaring, no circumoral cyanosis, no use of accessory muscles
Trachea is midline
No visible intercostal bulging or retraction
No visible lumps bumps masses or lesions
(Describe musculature)
AP diameter is 2 hands transverse to 1 hand anteroposterior, 2 to 1
Palpate:
Trachea is midline
Palpate for tenderness: begin 2 cm supraclavicular
Ask pt if any pain- if none, state non-tender
No palpable lumps, bumps, lesions, masses or crepitus (touch bone to assess)
Palpate for respiratory expansion:
Put 2 thumbs toward the xiphoid process in the costal margin, pinch up skin, ask pt to take a
deep breath in, let out
Respiratory expansion is even or equal bilaterally
Palpate for tactile fremitus using the ulnar surface of the hands
Begin 2 cm supraclavicular, 4 spots on the anterior
Pt say “99” (Don’t palpate over bone)
Tactile fremitus is even bilaterally, decreasing at the bases
No percussion, auscultation on anterior
Posterior
Inspect:
Skin is tan with multiple scattered etc.
Spinous process is aligned
Palpate:
Palpate for tenderness: begin 2 cm suprascapular
Ask pt if any pain, if no, state non-tender
No palpable lumps, bumps, lesions, masses or crepitus (touch bone to assess)
Palpate for respiratory expansion:
Get to T10
Pinch up skin, Pt takes deep breath in, let out
Respiratory expansion equal bilaterally
Palpate for tactile fremitis, using ulnar surface of hands
Begin 2cm suprascapular
5 spots, don’t go over bone
Pt say “99”
Tactile fremitis equal bilaterally, decreasing at the bases
Percuss:
Begin 2cm suprascapular
9 spots
Resonates throughout
Percuss for diaphragmatic excursion
Begin mid scapular, approx t7
Pt take deep breath in, blow out hold
Percuss from resonance to dullness
Mark
Take deep breath in, hold
Continue percussing down the same line from resonance to dullness
Mark, measure
State pt measurement, normal = 3.5 – 5, up to 7 or 8
State that if you do it on one side, you would do it on the other
Auscultate:
Using diaphragm of stethoscope for high-pitched sounds
Begin 2 cm suprascapular
9 spots
Auscultate 3 different sounds on anterior
Bronchial, bronchovesicular, vesicular
Will be tested on one of the following:
Egophany, “EEEEE” (should sound like “EEE”, not “AAA”)
Whispered pectoriloquy “1,2,3” (should be muffled, faint or inaudible-with consolidation, will
sound loud)
Bronchophony “99” (should hear muffled, indistinct “99”, if clear, indicates pathology)
For test, will only ausculate one spot, but real assessment would be on all 5 spots
Know what each test means
Know what would cause increased fremitus, decreased fremitus