Clinical Examination of Respiratory System

 

Clinical Examination of Respiratory System

 

Inspection: Trachea, shape of the chest, movement of the chest movement of the chest, cardiac impulse.

 

Trachea: Note down whether the trachea appears to be central or deviated slight deviation of the trachea’ to the right may be found in healthy people.

 

                Significant displacement of trachea suggests that the position of mediastinum has been alterated by disease of lungs or pleurae.

 

a) Conditions while push the mediastinum away from the affected side i) Pleural effusion ii) Pneumothorax b) Conditions which draw it towards the affected side are: i) Fibrosis of the lung in tuberculosis or after bronch opneumonia ii) Collapse of one or more lobes of lung.

 

Shape of the Chest: Shape varies with the build of the individual normal shape Bilaterally symmetrical & ellipercalin shape, Pigeon chest in Rickets, Lateral Bending kyphosis; Forward bending, Barrel shaped, severe obstructive airway diseases are all seen in diseases affecting .the vertebrae, and in chronic bronchitis there is severe obstruction to airway.

 

3. Movements of the Chest: a) Rate of resp: 14/mm. Tachypnoea important sign of pulmonary disease. . .

 

Increased rate may result from;

i.       Exertion

ii.      Nervous excitement

iii.Fever.

iv.      Hypoxia

v.     Pleurisy with pain

vi.      Peritonitis

 

b) Ratio between respiration and pulse: In health is about 1 to 4 where as in pnenmonia Respiratory rate may occur as frequently as the pulse.

 

c) Type of Respiration

- Abdomino Thoracic .type (Males)

-  Thoraco - Abdominal type (Female)

Note down whether inspiration is prolonged or expiration is prolonged.

 

-Prolonged inspiration is commonly associated with.

                i) Laryngal disease                              ii) Tracheal disease

 

d) Movement: All the quadrants of chest move equally and bilaterally with the respiration. Chest Expansion: Normally it is 5.8cm (2-3) on deep inspiration in emphysema chest expansion may be 1 cm or less.

Resonance is increased:

1. Pleural cavity containing air S lung is more or less collapsed towards the hilum.
2. Hyper-resonant sound or tympanic sound is regularly found in pneurnothorax.
3. Emphysema

 

Resonance is diminished:

1. When the pleura is thickened
2. Pleural effusion
3. Pul. Febrosis
4. Collapse of lungs

 

Auscultation: Three observations must be made at this point.

1. Character or the breath sounds.
2. Character of the vocal resonance.
3. Presence or a absence of added sounds.

 

Breath Sounds: i) Vesicular breathing. ii) Bronchial breathing.

i.   Vesicular breath sounds are produced by the passage of air in and out of normal lung tissue and, heard all over the chest. Bronchil breath sounds are produced by the passage of air though trachea and large bronchi. Normally they can be heard by listening over the traches but they are not heard over the normal lungs tissue. i) Vesicular breathing is heard typically ‘in the axillary and infrascapallar regions. Inspiratory sounds is fairly intense pitch is low & rustling in quality. The expiratory sound follows that of inspiration without district pause.

ii.  Bronchial breathing: Students should listen over ‘the trachea. The inpirtory sound is moderately intense & becomes inaudible shortly before the end of respiration. Expiratory sound is generally harsh and aspirate. There is definite gap between inspiration and expiration. Breath sounds must be auscultated in the various regions, their character in each noted and similar regions on the two sides of the chest compared vesicular Breath sound maybe present but reduced in intensity in bronchia in General Breath sounds ‘may be diminished or absent in.

 

- Thickened pleura

- Pleural effusion

- Pneumothorx

Collapse or fibrosis

Bronchial breath sounds are heard in:

- Consolideration of lungs due to pneumonia. Bronchial sounds maybe heard whenever patient btonchei are connected to the Chest wall by a sufficiently uniform sound conducting medium.