Page 1 of 1: Pulmonary Exam

Kai1111 · Credits: 2036 My Scrapbook

Here are a few PE video links:

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After introduction, and hand washing...explain to your patient your plan.....

Start from head, downwards, looking for organ systems that can have an impact on the pulmonary system.....try to speak out loud so that the SP and examiner know what and why you are doing something.

1. Eyes - examine for palor (anemia), ptosis (CA), periorbital edema (thyroid, chf)
2. Nares - examine turbinates as reactive airways and vasculitities (sp?) can be assoc w abnormailites in this area.
3. Sinuses - same as #3....palpate and r/o pain
4. Oral cavity - many vasculitic and oral neoplasms have same risk factors and may accompany path.
- check for cyanosis
5. Neck - Palpate lymph node chains: submental, submandibular, ant cervical, post cervical and supraclavicular
- Check for JVD
- Assess trachea
6. Extremities - r/o LE edema
- assess cap refill
- r/o clubbing
g. Pulsus Paradox - In all seriousness, I've never seen or done this exam in practice....but it has been emphasized in the videos I've watched and the course I took...it makes me nervous, so I'm trying it on my patients and family members. Curious to know if anyone out there uses this test regularly.
h. Respiratory Rate - document and observe patient's breathing....look for symmetric expansion of chest.
- do chest wall expansion test
- look for kyphosis, scoliosis, pectus excavatum and carinatum, barrel chest.

j. TACTILE FREMITUS
- posteriorly, make sure you have the pt cross their arms to open up the scapulae. I'm going to use the ulnar surface of my hand.
Then move anteriorly.

k. PERCUSSION
- measure chest wall excursion (nl 5-6 cm)
- ant and post percussion....don't forget the ant triangles; apicies of lungs.

l. AUSCULTATE
- again, posteriorly, have pt cross arms/grap shoulders
- if you hear any abnormalities, proceed with bronchophony, egophony('ee' to 'ay') and whispered petoriloquy.

m. Peak Flow check

Any other thoughts? Thanks.

sairauddin · Credits: 3963 My Scrapbook

Good job Kali

bush5 · Credits: 1122 My Scrapbook

Hello

Pulmonary Examination
Wash your hands

Always inform the patient what you are going to do? take the permission.

Ask the patient where are you? Who am I? what is the day today?
Mr. is sitting comfortably( or in disterss) with no obvious signs of distress. He/she is well oriented time to place

I am looking at her face for any ptosis, lip pursing nasal flaring.

I am going to look into your eyes for any pallor, jaundice

By lookin at face there is no plethora, no moon shaped faces, no jaundice no edema of face

Can you open your mouth please, turn your tongue agaisnt your palate. I am looking for any cyanosis. simultaneously i am looking for any pharygitis, enlarged tonsils and mouth hyiegiene. listen fo r stridor

I am going to press your face at different points. if you expereience any discomfort please let me know. look for signs of sinusitis.

can you please show me your hands, look for clubbing cyanosis, contractures, erythema, nicotine staining

Now I am going to feel your neck for enlarged lymph nodes.

I am going to touch your neck ( feel for trachea for mobility and deviations)

Mr./ms for my examination I need to expose your chest is that fine? can you please do it for me? Thank you

I am looking at chest for movements.

chest is moving equally on both sides, there is no Intercoastal retractions no use of accessory musches. I can not see any kyphosis, scoliosis, pectus excavatum . no signs of chest trauma, no scars, no visible veins

comment on pmi

Now, ms i am going to feel your chest

I am going to keekp the heel ofmy hand on different parts of chest. whenever i will keep it, can you say 99 please

say 99, say 99 on ant chest

now cross your arms: on post chest say 99

now can you please keep your hands over your head say 99 ( axilla)
thank you

Now I am going to keep my hands over your back, can you please take a deep breath for me? ( check for respiratory excursion)
Thank you

Now I am going to tap on your chest

tap all the areas and measure the diaphragmatic excursion

Now I am going to listen to your chest

check for respiratory sounds, extra sounds wheezes, crackles rales

listen for air entry over all the areas

check for brochophony, egophony, whispered pectroliquoy.

Now I am going to listen to heart

Now i am going to keep my stethoscope over your neck. can you please take deep breath for me and exhale it as fast as your can? check for peak expiratory flow rate

cover

explain the patient about your findings and possible management

ask the patien about any concerns

thanks the patient

tahir2008 · Credits: 530 My Scrapbook

ALL DEPEND UPON TIME AVAILABLE FOR CASE.

-Greet the patient
-Explain that you are there do to lung examiantion
-Ask about any chest pain, SOB or trauma to chest in the past
-Tell the patient that if he felt uncomfortable during the examination just tell him and we will stop there.

-WASH YOU HANDS
-ASK FOR VITALS

-Expalin General Appearance, any distress
-No cyanosis
-No plethora
-No nasal flaring
No congested neck veins

Start with inspection- ( if time is not a problem look inte eyes, mouth and nails for clubbing)

-Tell the patient that you are feeling for pulse and calculate respiratory rate.-
-Tell the patient that you are going to expose his chest if its fine with him
-Look at chest from both front and behind, sides
-No respiratory distress, both sides are moving symmetrically with respiration, no scar, no dilated veins,no flial chest no kyphosis and scoliosis
-
Palpation-
-Now I am going to feel for your neck and chest with my hands
-First I am felling for your nec-- Check tracheal alignment
-ChecK Lymph nodes
-Compress the chest A-P and side-side, and compredd on sternum for any tenderness
-Now I am going to keep my hands at your back hold your breath and then take deep brath in/out- CHEST Expansion
-Now Iam going to keep my hand at certain places and say 99 when I tell you to say that- Copare both sides, Always do in supraclavicular areas, bacy( with hands crossed), and axillary areas(with hands on head)- TVF

Percussion
-Now, I am going to TAP at you chest always compare and do in all areas including axillary and back
- Diahagramatic Excursion-( you can SKIP IT)

Auscultation-
-Now I am going to listen to your lungs in different areas, Take deep breath in/out
-Do in all areas- axill and back
-Listen to lung Bases for any crackels
- Comment on egophony. bronchophony and whisper

-Dress the patient
-Ask if feeling fine
-Explain your findings
-Ask his concerns and adress them
- Nexy cousrse of action- invest,etc

-thank the patient for coperatiing

Kai1111 · Credits: 2036 My Scrapbook

Awesome....really appreciate the extra perspectives....to my h&p I will add:

Ask for vitals
Assess orientation/mental status
Comment on breathing, nasal flaring, pursed lip breathing
Comment on nicotine staining
Have pt put hands on head to listen over axilla

Any thoughts about Pulsus Paradoxicus?

Bush5,....could you explain your assessment of peak flow using your stethascope over the trachea....seems really useful and cool. Haven't learned that technique....thanks!

vanjik · Credits: 371 My Scrapbook

when I took the case of CAP in QE2,

the SP only had severe chest pain at left side, there was no other sign ..

so, I think we need to palpate the patient's chest...

Kai1111 · Credits: 2036 My Scrapbook

Agreed....compress sternum and palp for crepitance, etc.....We did check for pmi, so, perhaps, at that part of the exam, should add more palp of CW.

rida · Credits: 251 My Scrapbook

hello.....
when we have time we can also checkf or
CO2 retention by asking the pt, extend both elbows and hyperextand both wrists to see if any flabbing tremor
thank........

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