Respiratory H&P (history and physical)

Respiratory H&P

Reaspiratory Symptoms

1) Cough:

a) dry --> asthma, interstitial fibrosis

b) productive – voluminous, thin sputum (bronchorrea) seen in bronch-alv carc

c) early morning – bronchitis, bronchiectasis

2) dyspnea – SOB is usually b/c ©-pulm dysfxn; correlates best w/work of breathing

3) chest pain

a) rad to neck/left hand - © pain

b) worse with inspire – pleuritic (infxn) pain

4) hemoptysis (massive = 500 ml in 24 h)

5) FHx Tb, Occ Hx, Exp to dusts, Smoke Hx

Respiratory Inspection

1) Color – Pallor = anemia

2) Cyanosis – blue seen on lips, nails, buccal muc, b/c ßHgb ; © dz (RàL) or lung dz. (hypoxia)

3) Nails – look for cyanosis, clubbing (obliteration of nail bed angl); b/c lung CA, chron pulm infxn.

4) Breath – ketone = DKA; putrid = bad dental hygiene OR anaerobic pulm infxn

5) Resp Distress – nl = 10-12/min, 5-6 sighns/hour; tachypnea à impending resp failure

6) Acc musc retract – inward movement of supraclav notch, intercostals during insp à UAO

7) Respiratory alternans – intercostals, diaphragm alternate being dom musc of insp; imp resp fail

8) Paradoxical motion – opp mvmt of intercostals and diaphragm (one cntrct, other pass) --> IRF

9) Wheezing – severe asthma; stridor – UAO

10) Ant-post diameter increased w/hyperinfl of lung (COPD)

11) Use of acc musc of resp (scalene, SCM) à severe pulm dysfxn; good index of dz severity

Respiratory Palpation –

ID tender areas, diff ref’d pain from underlying lung vs. pain orig in chest wall; helps assess parenchymal status

1) Fremitus – palpable vibr transm thru bronch-pulm system to chest wall when pt speaks

2) ß/absent fremitus = pleural effusion, pneumothorax, fibrothorax

Respiratory Percussion

–
assess density of tissue under area; assess liver span, diaphragmatic mtn.

Flatness – fluid

Dullness – parenchymal consolidation

Resonance – nl lung

Hyperresonance- free air/hyperinfl lung

Tympany – large pneumothorax

Respiratory Auscultation

Vesicular – most of lungs; I > E

Bronchovesicular – b/w scapulae; I = E

Bronchial – over manubrium; I < E

Tracheal- over trachea in neck; I = E

Crackles

1) late inspiratory – fine, profuse, repeat breath-to-breath; first at base of lungs, spread upward as condition worsens; caused by ILD, early CHF

2) early inspiratory – coarse, few, at mouth and chest wall; chronic bronchitis and asthma

3) midinspiratory, expiratory – bronchiectasis?

Wheezes/rhonchi – air flows rapidly thru bronchi that

are narrowed nearly to closure; bronchial asthma, chronic bronchitis, CHF

Persistent local wheeze – partial bronch obstruct

Stridor – insp wheeze; larynx/trachea obstruct

Pleural rub – creaking/grating sounds due to inflamm

mediastinal emphysema