Notes Physical examination- Assessment of cardiopulmonary system

PHYSICAL EXAMINATION

The physical examination includes the assessment of cardiopulmonary system.

Inspection :

·        Skin and mucous membrane colour

·        General appearance

·        Level of consciousness

·        Adequacy of systemic circulation

·        Breathing patterns

·        Chest wall movement

·        Observe the rate, depth, rhythm, and quality of respirations, noting the position the client assumes for breathing.

·        Variations in the shape of the thorax that may indicate adaptation to chronic respiratory conditions.

·        Observe nails for clubbing

·        Observe chest wall movement for retraction.

·        Observe the patients breathing pattern and assess for paradoxical breathing

·        Assess for Kussmaul’s respiration, apnea, Cheyne stokes respiration

·        Assess the shape of the chest wall.

Palpation:

·        For thoracic excursion, areas of tenderness, tactile fremitus, PMI

·        Extremities for peripheral circulation

·         Feet and legs determines the presence or absence of peripheral oedema

·        Pulses in the neck and extremities to assess arterial blood flow

Percussion

·        It detects the presence of abnormal fluid or air in the lungs

Auscultation

·        It helps to identify normal and abnormal heart and lung sounds

DIAGNOSTIC TESTS

The diagnostic tests to assess respiratory status, function and oxygenation includes:

• sputum specimens

• throat cultures

• visualization procedures

• venous and arterial blood specimens

• pulmonary function tests

• X rays

Measurement of arterial blood gases:

Blood for these tests is taken directly from the radial, brachial, femoral arteries or from catheters placed in these arteries.

Pulmonary function tests:

• ·        Measure lung volume and capacity.
• ·        The client breathes into a machine (spirometer).
• ·        The tests are painless, but the client's cooperation is essential.
• ·        It requires the ability to follow directions.
• ·        Nurses need to explain the tests to clients beforehand and help them to rest afterward because the tests are often tiring.