the respiratory system

The respiratory system
Inspection
• Deformities and asymmetry.
• Respiratory movement.
• Respiratory movement (one-both sides).
• Using accessories muscle.
• Color of cyanosis (pulmonary edema).
• The shape of finger
(Clubbing  hypoxia and lung cancer).
• Rate, rhythm, depth and effort of breathing.
Palpation
• Tender area (pleura inflammation).
• Respiratory expansion:
- Anterior  place thumbs along costal margin, and hands to the lateral rib cage).
- Posterior  place thumbs in 10th ribs, and hands to the lateral rib cage).
- Ask the pt to inhale deeply.
- Normal  moves the hand equally.
• Tactile fremitus:
- Vibration transmission through bronchopulmonary tree.
1. Place both hands anterior and posterior.
2. Ask the pt to say "99" or "44".
- Decrease  pleural surface contain air, fluid and fibrosis or tumor.
- Increase  pneumonia.
Percussion
- Dullness  heart (anterior), fluid, and solid tissue.
- Resonance  lung.
- Hyper resonance  asthma, pneumonia, emphysema, and ….
• Percussion of diaphragm
1. Ask the pt to inspiration deeply.
2. Percuss up to down (when the sound change form resonance to dullness sign it).
3. Ask the pt to expiration deeply.
4. Percuss up to down (when the sound change form resonance to dullness sign it).
- Normally  5-6 cm.
Auscultation
• Vesicular: over most both lungs (inspiration > expiration).
• Bonchovesicular: in anterior 2nd I.C and between scapula (inspiration = expiration).
• Bronchial: menubrium bone (inspiration < expiration).
• Tracheal: trachea in the neck (inspiration = expiration).
• Abnormal sound:
- Crackles: pneumonia, fibrosis, bronchitis.
- Wheezes: narrow of air ways.
- Rhonchi: secretion in large air ways.
- Fracture rip: pain and tenderness in one or more rips (soft tissue injury).
• Voice sound: like tactile fremitus put by stethoscope