Respiratory Assessment: Physical Signs and Diagnostics

Head: Coloration and Cyanosis

Coloration: Cyanosis

Is cyanosis present? Cyanosis is not always blue! There is one exception: Pink Cherry coloration taken for carbon monoxide poisoning (CO).

Cyanosis may be central (fingertips hot) or peripheral (distal extremities cold). The distinction between central and peripheral cyanosis sets the type of respiratory illness.

Central cyanosis is also indicated when pressing the earlobe does not restore color, remaining pale blue.

Eyes

Note coloring, especially in joggers. Look for bulging eyes.

Lips

Observe "pursed-lip breathing". This breathing pattern is often acquired in respiratory illness. The patient produces whistling sounds and it is designed to extend the expiration time, optimizing breathing.

Nose

Check for nasal flaring, which is a sign of respiratory problems.

Neck and Thorax Assessment

Neck

Breathing difficulties can be so intense that the patient uses accessory muscles to breathe. We can also observe enlarged jugular venous distention (thickened jugular vein, often indicating respiratory problems stemming from heart disease, such as Right Heart Failure).

Thorax Morphology

Note the thorax morphology. Check for any wounds on the chest or spine. Significant kyphosis or lordosis can compromise breathing.

Tips for Extremities

1. Coloration: Check for distal cyanosis in the upper extremities.
2. Flapping Tremor: Observe for a flapping tremor associated with CO2 retention.
3. Clubbing: Note Clubbing (finger clubbing), which is the widening of the nail beds and nails.

Thorax Examination

Fremitus Touch (Tactile Fremitus)

To evaluate tactile fremitus, the examiner is placed behind the person with their hands on the chest. The person says "33" or any difficult word, and the examiner perceives the sound vibration through their hands. If there is pneumonia, for example, the sound perception in that area will be decreased.

Percussion

Used to perceive different sounds by tapping the fingers:

• R. Mate (Dull Sound): Indicative of condensation: parenchyma consolidation or fluid (pleural effusion).
• R. Tympanic (Tympanic Sound): Indicates air (Sound of a drum).

Auscultation

Listen for:

1. Normal Sounds:
   • a) Laryngotracheal sounds
   • b) Pulmonary murmur
   • c) Normal voice transmission
2. Abnormal Noises:
   • A) Changes in the transmission of breath sounds:
     • Breathing blower (tubal sound)
     • Egophony
     • Transmission of voice changes
   • B) Continuous added noises:
     • Rhonchi
     • Wheezing
     • Stridor
   • C) Intermittent added noises:
     • Crackle
     • Rattling
     • Pleural friction rub

Diagnostics

Non-Invasive Tests

A) NON-INVASIVE

• * RX thorax (Chest X-ray)
• * Lung function testing (Spirometry)
• * TAC (CT Scan)
• * Cultivation of secretions
• * Ultrasound
• * PreBes SKIN (Likely referring to PPD/TB testing or similar skin tests)

Invasive Tests

B) INVASIVE

• * Bronchoscopy
• * Thoracentesis
• * Arterial blood gas analysis