Learning Guide HT&PE Adult Respi

8/11/2019 Learning Guide HT&PE Adult Respi

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Skill Laboratory Module

BLOCK : Respiratory systemTOPIC : Respiratory history taking and physial e!amination inadults

I" #$%$R&L OB'$CTI($After completing skill practice, the student will be able to perform respiratoryhistory taking and physical examination.

II" SP$CI)IC OB'$CTI($At the end of skill practice, the student will be able to perform the procedureof respiratory physical examination systematically including:

History taking

Systematic physical examination of respiratory system by performing

inspection, palpation, percussion and auscultation

III" S*LL&B+S ,$SCRIPTIO%

-". Sub Module Ob/eti0eAfter finishing skill practice of clinical examination, the student will be ableto perform history taking and physical examination of respiratory disorders

-"1 $!peted ompeteniesStudent will be able to demonstrate the procedure of history taking ofrespiratory disorders

-"-" Methoda. Presentationb. Demonstrationc. oachingd. Self practice : role!play

-"2 Laboratory 3ailitiesa. Skills laboratory: table, chairs, and examination couchb. "rainersc. Patient : real patient and modeld. Student learning guide

e. "rainer#s guidef. $eferences


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-"4 (enueSkills laboratory

-"5 $0aluationa% Point nodal e&aluation

b% 'S(

-"6" Sub Model Ob/eti0e After finishing skill practice of clinical examination, the student will be

able to perform respiratory system physical examination.

-"7" $!peted CompeteniesStudent will be able to demonstrate the procedure of physical

examination of:

)ocating er&ical lymph node

"racheal position

)ocating chest abnormalities &ertically and circumferentially Shape and mo&ement of the chest

"actile fremitus

hest Percussion

*ormal breath sounds

Presence and absent of ad&entitious sounds

Presence and absent of transmitted &oice sounds +bronchophony,

egophony and whispered pectorilouy%


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I(" L$&R%I%# #+I,$ )OR P8*SIC&L $9&MI%&TIO% O) &,+LTR$SPIR&TOR* P&TI$%T

Proedure 3or linial e!amination%o Steps Task . 1 - 2 4

&"CLI$%T &SS$SSM$%T

-. reet client respectfully and with kindness

/. "he patient should be gi&en adeuate explanation abouthistory taking and the goal or expected result of history taking

0. 1dentifying patient#s data + described elsewhere%

B" 8ISTOR* T&KI%#" Take a medial history onsidering :

- hief complaint

! Dyspnea! 2e&er

! ough +expectoration% ! hest pain

/. Present illness +depends on the chief complaint%

hronology of chief complaint! )ocation! 3uality! Se&erity! "iming +onset, duration, freuency%! Setting in which the symptoms occur! 2actors that precipitate, aggra&ate or alle&iate! Any associated manifestation+s%

0 eneral medical history

! Past history! 2amily history

+Asthma and other atopic disease Alpha - antitrypsin%! 'ccupational history! "uberculosis contact! Smoking history

C P8*SIC&L $9&MI%&TIO%

I PR$P&R&TIO%

- "ell the patient what is going to be done/ Help the patient on to the examination table

0 4ash hands thoroughly with soap and water and dry with aclean dry cloth or air drier

5 "he examiner should stand at the patient#s right side


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II $9&MI%&TIO% T$C8%I;+$

A

6

C

eneral Physical (xamination +described elsewhere%

)ocating er&ical )ymph *odes-. 7ake the patient comfortable and relax

/. 2lexed the neck slightly forward and if needed slightlytoward the examination0. Palpate using the pads of your index and middle fingers5. 7o&e the skin o&er the underling tissue in each area8. Describe location, uantity, si9e +diameter%, consistency,

mo&ability, presence specific formation +package%.

2indings :- Preauricular in front of the ear2 Posterior auricular superficial to mastoid process3 'ccipital at the base of the skull posteriorly

4 "onsilar at the angle of mandible5 Submandibular midway between the angle and thetip of the mandible. "hese nodes are usually smallerand smoother than lobulated submandibular glandagainst which they lie

6 Submental in the midline a few cm behind the tip ofmandible

7 Superficial cer&ical superficial to sternomastoid8 Posterior cer&ical along the anterior edge of

trape9ius9 Deep cer&ical chain deep to the sternomastoid and

often inaccessible to examination. Hook your thumband fingers around either side of the sternomastoidmuscle to find them

10 Supracla&icular deep in the angle formed by thecla&icle and the sternomastoid

TR&C8$&-. 1nspect trachea for any de&iation from its midline position./. Place the finger along one side of the trachea and note the space between trachea and the sternomastoid.0. ompare it with the other side. *ormally the space

should be symmetrical.

, Loating Chest abnormalities To loate 0ertially&nterior hest

-. 1dentify the suprasternal notch/. 7o&e your down about 8 cm0. 2ind the hori9ontal bony ridge that ;oin the

manubrium to the body of sternum.


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5. 7o&e your finger laterally and find the ad;acent /ndriband costal cartilage

8. 2rom here you can walk down the interspaces.


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folds between your thumb and the spine.0. ask the patient to inhale deeply5. 4atch the di&ergence of your thumbs during inspiration

and feel for the range and symmetry of respiratory as thethorax expands and feel for the extent and symmetry of

respiratory mo&ement.

Tatile 3remitusa. use either the ball +the bony part of the palm at the base

of the fingers% or the ulnar surface of your hand and placeit in both side of the chest symmetrically

b. ask the patients to repeat the words @ninety nine or @one one one

c. repeat this examinations in other areas of the chestsymmetrically

Perussion-. hyperextend the middle finger of your left hand +thepleximeter finger%

/. press its distal interphalangeal ;oint firmly on the surfaceto be percussed.

0. AB'1D contact by any other part of the hand5. Position your right forearm uite close to the surface with

the hand cocked upward. "he right middle finger shouldbe partially flexed, relaxed, and poised to strike

8. Strike the pleximeter finger with the right middle finger+the plexor%, with a uick, sharp but relaxed wrist motion


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superimposed on the usual breath sound. Ad&entitioussounds are crackles +rales%, whee9es and rhonchi

7. if you hear crackles, listen for the following characteristicsa. loudness, pitch and duration +summari9ed as fine or

coarse crackles%

b. number +few to many%c. timing in respiratory cycled. location on the chest walle. persistence of their pattern from breath to breathf. any change after a cough or a change in the patients

positionC. if you hear whee9e or rhonchi , note their timing and

location and do they change with deep breathing orcoughing

. if you hear abnormally located broncho&esicular orbronchial breath sound, continue on to asses transmitted

&oice sound.-?.4ith stethoscope, listen in symmetrical areas o&er thechest, as you :g. ask the patient to say @ninety nine. *ormally the

sound transmitted through the chest wall are muffledand indistinct. )ouder and clearer &oice sounds arecalled bronchophony

h. ask the patient to sal @ee you will normally hear amuffled long ( sound. 4hen @ee is heard as @ay. An( to A change +egophony% is present.

i. Ask the patient to whisper @ninety nine or @one two

three @. "he whispered &oice is normally heard faintlyand indistinctly. )ouder, clearer whispered sounds arecalled whispered pectorilouy


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8ISTOR* T&KI%#

,*SP%$&TIMI%#

sine reurrent respiratory in3etion>

3e0er

hemoptysis

palpitation> hest pain

S$TTI%#

history o3 heart disease or its risk 3ators = history o3 smoking> air pollutants and reurrent

respiratory in3etion =

en0irontmental and emotional ondition

postpartum> postoperati0e period> prolong bed rest>

hipleg> C8)> COP,


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an!iety

C8$ST P&I%

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1" hat is it like = shar3> kni3e like> pressing

-" 8o< bad is it> se0ere =

2" hen does this omplain start= 8o< long = 8o< o3ten does it ome=

4" hat 3ator that make is

Learning Guide HT&PE Adult Respi

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