nasal flaring

a sign of labored breathing

cyanosis

bluish color of the lips and tongue that indicates inadequate oxygenation of the blood

diaphoresis

sweating which is a sign of stress and common in patients having a myocardial infarction

examination of the eyes

- pupillary reflexes tested by shining a light into the patient's eyes
- pupils should be equal, round, reactive to light, and accommodation
- dilated pupils that respond poorly to light are often a sign of neurological damage
- ptosis (drooping eyelid) is a sign of neuromuscular disease (myasthenia gravis)

examination of the neck

- assess for jugular venous distention
- JVD is a sign of right heart failure
- assess for tracheal position; the trachea may shift left or right of center when one lung collapses or when a tumor is present in the neck or upper mediastinum
- palpate for lymphadenopathy; could occur with infection or malignancy

barrel chest

an abnormal increase in A-P diameter (COPD)

kyphosis

an abnormal A-P curvature of the spine

scolliosis

an abnormal lateral curvature of the spine

kyphoscoliosis

an abnormal A-P and lateral curvature of the spine

restrictive lung disease

rapid and shallow breathing

intrathoracic airway obstruction

prolonged expiratory time

upper airway obstruction

prolonged inspiratory time

use of accessory muscles

indicates an increase in the work of breathing

abdominal paradox

occurs when the abdomen sinks inward with each inspiratory effort

respiratory alternans

occurs with diaphragm fatigue and is seen as alternating between breathing only with the chest muscles and only breathing with the diaphragm

vocal fremitus

palpating the chest while the patient repeats the words "ninety-nine"

chest palpation

- increased with pneumonia and atelectasis
- decreased with emphysema and pneumothorax
- thoracic expansion
- normally both sides of the chest expand evenly with normal or deep breathing
- one side may under expand when atelectasis, pneumonia, or a lung tumor is present
- both sides may expand poorly with emphysema

chest percussion

- done during examination to access resonance of the underlying tissue
- normal air-filled lungs normally resonate
- hyper-inflated lung and pneumothorax will demonstrate increased resonance to percussion
- decreased resonance with pneumonia, atelectasis, and pleural effusion

chest auscultations

performed with a stethescope:
- bell (most often used to auscultate heart sounds)
- diaphragm (most often used to auscultate lungs sounds)
- tubing
- ear pieces

auscultation technique

- ask the patient to breath a little deeper than normal
- start at the apices and move toward the base
- compare sounds from one side to the other
- listen for breath sounds and adventitious lung sounds

precordium examination

- inspected and palpated for normal and abnormal pulsations
- normal point of maximal impulse is created by a healthy left ventricular systole
- usually felt in the 5th intercostal space on the left at the midclavicular line
- abnormal pulsation on precordium can occur with right/left ventricular hyperophy

cardiac murmurs

caused by rapid blood flow through a narrowed valve or backflow through an incompetent valve

systolic murmur

occurs when the blood passes trough narrowed semilunar valves or backflows through incompetent AV valves

diastolic murmur

occurs when stenotic AV valves or incompetent semilunar valves

abdomen examination

- performed to inspect and palpate for distention or tenderness
- an enlarged or tender abdomen can negatively influence breathing

hepatomegaly

a large liver

ascites

an abnormal collection of fluid in the peritoneal cavity

digital clubbing

can be a serious sign of chronic cardiopulmonary disease

peripheral cyanosis

consistent with poor circulation

pedal edema

may be a sign of heart failure (COPD)

physical examination

provides reliable and important evidence regarding the patient's clinical condition

respiratory therapists

must be skilled at PE to assess the patient's condition and evaluate the effects of treatments

best evaluation

comes from looking at multiple parameters from the PE