Guide to Clinical Examination/Respiratory examination
First should always be a visual inspection of the patient from the end of the table. This will include looking for shortness of breath, cough, wheeze, stridor, cyanosis, and cachexia.
After that, proceed for a brief hand examination, looking at both the top and bottom of the hands. Pay attention for tar staining, bruising, thin skin, clubbing of the fingernails, tremor. Then proceed to assess for asterixis, feel for temperature, and respiratory rate. Normal = 12-20 breaths per minute.
Inspect for central cyanosis. Pull down on the lower eyelid and assess for anemia. Get the patient to open their mouth, asking to put their tongue to the roof of the mouth assessing for angular stomatitis.
Inspect the chest for wall deformities or scars. For scars, this will include the central chest (sternotomy & thoracotomy), clavicular (pacemaker), and mid-axillary (chest drain). Assess the tracheal position. Cricosternal distance is normally 3-4 fingers. Palpate apex beat - fifth intercostal space mid-clavicular line. Assess chest expansion which involves placing your hands around the patient's chest and getting them to breathe. Reduced chest explain refers to lung collapse or pneumonia. Percuss the lung fields. Please note cardiac dullness.