Respiratory ENT Assessment Guide
Respiratory ENT Assessment Guide
Action Advice/Diagram/Findings
1 Introduce yourself to the patient and gain consent for examination, wash/sanitize hands.
Assist the patient to lay of the couch (or may sit on the
The patient can lie at either 45o or upright, whichever is
2 edge) and remove all top garments (remember
more comfortable.
dignity).
Is the patient alert, comfortable/distressed, in pain, colour,
breathless or laboured breathing, needing to sit upright, any
General observation of the patient from end of the obvious respiratory noises, accessory muscle use.
3
bed.
Medication, inhalers, nebulizer, oxygen, cigarettes in
immediate surroundings.
Clubbing may indicate chronic lung disease, pulmonary
fibrosis, CA lung.
Inspect both hands and fingernails for clubbing, tar
Tremor is a coarse, jerky movement of the wrist, which may
4 staining (smoker), tremor, peripheral cyanosis and
be a sign of carbon dioxide retention due to respiratory
perfusion (CRT).
failure. It may indicate the
severity of the patient’s condition but should be considered
alongside other signs.
Chest infections, asthma exacerbations, hypoxia may cause
tachycardia. A ‘bounding’ pulse may be a sign of carbon
dioxide retention.
Palpate the radial pulse for rate and rhythm, count
5
respiratory rate. Normal respiratory rate can vary from 14 to 25 per minute
but this depends on the patient and the condition.
Tachypnoea can generally be suspected at >25 breaths per
minute.
Abnormal facial swelling can be attributed to blockage of the
superior vena cava due to tumour invasion or thrombosis or
could be due to angioedema.
Percuss the front and back of the chest and axillae, Listen for dull, resonant and
comparing both sides. tympanic sounds over each area
percussed. Dull may = consolidation,
hyper resonant may = hyperinflation.
Percussion may be difficult in women
11 because breast tissue is in the way.
Assess tactile fremitus at the front and back of the Get the patient to say ‘99’ – whilst they are speaking,
chest and in the axillae, comparing both sides. concentrate on the vibration transmitted to your hand. The
vibration should be the same on both sides. Check left and
right clavicle, chest wall and axillae. Vibration is increased
12 over areas of consolidation (e.g., due to pneumonia).
Ask the patient to breathe in and out briskly if they can and
listen to the sounds generated. Listen for abnormal breath
sounds and adventitial sounds for example:
Action Advice/Diagram/Findings