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ASSESSMENT OF RESPIRATORY SYSTEM

RESPIRATORY SYMPTOMS

Chest pain Dyspnoea Wheeze Cough hemoptysis

Chest pain

QUESTIONS TO ASK SITE NATURE OR QUALITY INTENSITY RADIATION DURATION ONSET RELIEVING AND AGGRAVATING FACTORS ASSOCIATED MANIFESTATIONS

CAUSES

CARDIOVASCULAR Angina MI PERCARDITIS DISSECTING AORTIC ANEURYSM

PULMONARY

TRACHEO BRONCHITIS PLEURAL PNEUMONIA, PE,NEOPLASM

GI

REFLUX ESOPHAGITIS DIFFUSE ESOPHAGEAL SPASM OTHER CAUSES CHEST WALL PAIN ANXIETY

DYSPNEA

NON PAINFUL UNCOMFORTABLE AWARENESS OF BRETHING

QUESTIONS

ONSET sudden or gradual Occurs on rest or exertion Interefere with daily activities Has dysnea altered the life style of patient Timing and setting of dysnea Associated symptoms Relieving and aggravating factors

CAUSES

LVF CHRONIC BRONCHITIS COPD ASTHMA ILD PNEUMONIA PNEUMOTHORAX ACUTE PE ANXIETY

COUGH

REFLEX RESPONSE TO STIMULI THAT IRRITATES RECEPTORS IN LARYNX ,TRACHEA, AND LARGE BRONCHI

QUESTIONS

SINCE WHEN ONSET OCCURS AT WHAT TIME OF DAY INTENSITY AGGRAVATING OR RELIEVING FACTORS DRY OR PRODUCTIVE

SPUTUM

AMOUNT COLOUR ODOUR CONSISTENCY BLOOD STREAKED

HEMOPTYSIS

COUGHING UP BLOOD IN SPUTUM IS HEMOPTYSIS

QUESTIONS

SINCE WHEN? PRECEDED WITH COUGH ? QUANTIFY COLOUR OF BLOOD FRESH OR ALTERED SETTING AND ACTIVITY ASSOCIATED SYMTOMS

DIFFERENTIATE FROM HEMETEMESIS

PRECEDED WITH NAUSEA ASSOCIATEED GI SYMPTOMS FOOD PARTICLES IN VOMITUS ACIDIC PH

CAUSES

LARYNGITIS TRACHEOBRONCHITIS PNEUMONIA POST NASAL DRIP CHRONIC BRONCHITIS BRONCHIECTASIS TB LUNG ABCESS

CONT..

ASTHMA GERD CA LVF MS PE INHALATION OF FUMES PARTICLES CHEMICLES OR GASES

CHEST CONTOUR AND SYMMMETRY

NORMALLLY LATERAL DIAMETER IS MORE THAN AP DIAMETER

DEFORMITIES

BARREL FLAIL FUNNEL PIGEON KYPHOSCOLIOSIS

RESPIRATORY RATE

14 TO 20 BREATHS PER MINUTE THORACO ABDOMINAL IN FEMALES ABDOMEN PROTRUDES OUT DURING INSPIRATION ABDOMENOTHORACIC IN MALES

TACTILE FREMITUS

WHEN SOUND WAVES TRAVEL THRU BRONCHOPULMONARY TREE THERE IS PALPABLE VIBRATIONS TRNSMITTED THRU CHEST WALL

HOW TO CHECK?

PLACE ULNAR BORDER OF YOUR HAND ON THE CHEST WHILE ASKING PT TO SPEAK NINTYNINE. COMP;ARE BOTH SIDES ANTERIORLY AND POSTERIORLY.

CAUSES OF DECREASED FREMITUS

WHEN TRANSMISSION OF VIBRATION FROM LARYNX TO THE SURFACE OF THE CHEST IS IMPEDED. OBSTRUCTED BRONCHUS COPD PLEURAL EFFUSION PLEURAL THICKENING PNEUMOTHORAX INFILTRATING TUMOUR

CHEST EXPANSION

5 TO 7 CM CAUSES OF UNILATERAL REDUCED CHEST EXPANSION FIBROSIS EFFUSION PNEUMONIA BRONCHIAL OBSTRUCTION

PERCUSSION

SETS THE CHEST WALL AND UNDERLYING TISSUR IONTO MOTION PRODUCING AUDIBLE SOND AND PALPABLE VIBRATION PENETRATES ONLY 5 TO 7 CM INTO THE CHEST

PERCUSSION NOTES

STONY DULL DULL RESONANT HYPERRESONANT TYMPANITIC

CAUSES

DULLNESS LOBAR PNEUMONIA STONY DULL ,PLEURAL EFFUSION ,HEMOTHORAX,EMPYEMA. HYPER RESONANCE , PNEUMOTHORAX AIR CONTAINING BULLA TYPANITIC GASTRIC AIR BUBBLE

DIAPHRAGMATIC EXCURSION

DESCENT OF DIAPHRAGM CHECKED THRU PERCUSSION NORMALLY WITH FULL INSPIRATION 5 TO 6 CM.

AUSCULTATION

INTENSITY TYPE ADDED VOCAL RESONANANCE

TYPES OF BREATH SOUNDS

VESICULAR BRONCHO VESICULAR BRONCHIAL AS IN PNEUMONIA,COLLASE WITH PATENT BRONCHUS,CAVITATION UPPER PART OF PLEURAL EFFUSION.

ADDED SOUNDS

CRACKLES FINE AND COARSE WHEEZES RONCHI PLEURAL RUB

CRACKLES

WHEN DEFLATED SMALL AIRWAYS OPEN UP DURING INSPIRATION. ILD,CCF. AIR BUBBLES FLOWING THRU SECRETIONSCHRONIC BRONCHITIS.

WHEEZES

WHEN AIRFLOW THRU NARROIWED BRONCHI WHISTLING SOUNDS PRODUCED. ASTHMA, COPD,CCF. LOALISED WHEEZE SIGNIFIES PARTIOAL OBSTRUCTION OF BRONCHUS BY TUMOUR OR FOREIGN BODY

STRIDOR

MUSICAL SOUND ENTIRELY INSPIRATORY. OBSTRUCTION OF LARYNX AND TRACHEA

PLEURAL RUB

WHEN ROUGHENED PLEURAL SURFACES RUB AGAINST EACH OTHER.

TRNSMITTED SOUNDS.

BRONCHOPHONY LODER AND CLEARER VOICE SOUNDS EGOPHONY QUALITY OF SOUNDS TURNED TP NASAL EE TO AY WHISPERED PECTORILOQUY LODER CLEARE WHISPERED SOUNDS. ALL ABOVE ARE FOUND IN CONSOLIDATION

THANK YOU

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