호흡기 검사 I: 검사 및 촉진
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Q1: What signs of respiratory distress should you look for during inspection?
During inspection, observe for hoarse voice, fast respiratory rate, unusual posturing like tripoding, use of accessory muscles, inward movement of intercostal muscles, coughing with sputum, wheezing, and cyanosis. These signs indicate the patient is struggling to breathe and require immediate clinical attention and oxygen therapy.
Q2: How do you assess chest expansion during a respiratory exam?
Place your hands just below the nipple level with thumbs touching at the midline and fingers extended laterally. Ask the patient to take a deep breath. Normal chest expansion occurs when thumbs separate by approximately 5 centimeters or more. This technique can be performed on both anterior and posterior surfaces.
Q3: What does a barrel chest indicate about lung function?
A barrel chest, characterized by bulging with abnormal increase in anteroposterior diameter, indicates conditions like COPD and emphysema. This deformity reflects chronic lung disease and severely impaired respiratory mechanics. Unlike congenital chest deformities, barrel chest develops from prolonged pulmonary dysfunction and represents significant pathology.
Q4: What does clubbing of the nails suggest in respiratory assessment?
Clubbing, detected when thumbnails placed side-by-side fail to form a diamond shape, suggests pulmonary fibrosis, cystic fibrosis, or bronchogenic carcinoma. This finding indicates chronic respiratory or systemic disease and warrants further investigation to identify the underlying pathology causing this sign.
Q5: How do you palpate the trachea and what does deviation indicate?
Place your right index finger in the sternal notch and palpate the lateral borders of the trachea to determine if it occupies the normal midline position. A deviated trachea can indicate underlying lung pathology such as pneumothorax, pleural effusion, or mass effect requiring further diagnostic evaluation.
Q6: What is tactile vocal fremitus and how is it assessed?
Tactile vocal fremitus measures vibrations transmitted through the chest wall when a patient phonates. Place the hypothenar sides of your hands on the lower anterior chest and ask the patient to say "99" at each position. Vibrations should feel equal bilaterally; asymmetry suggests abnormal underlying lung tissue or consolidation.
Q7: Why is lymph node assessment important in respiratory examination?
Palpate cervical, supraclavicular, and axillary lymph nodes to assess for lymphadenopathy, which is abnormal number or size of lymph nodes. Enlarged nodes can indicate respiratory tract infection or other systemic conditions. Careful bilateral palpation helps identify asymmetry and guide diagnosis of pulmonary disorders.