Hi my name is a nursing student at USA. I will be conducting your respiratory exam today.
Respiratory rate of 15 breaths per minute. Within normal range of 10-20.
Breathing pattern is regular, automatic and relaxed indicating diaphragm and intercostal muscles are being used. No use of accessory muscles noted. Posture is relaxed, no retraction or bulging of the interspaces.
Now I will exam your chest expansion. Take a beep breath. Symmetric expansion noted. Breaths are smooth and moderately deep. I will repeat for the posterior. Deep breath. Symmetrical expansion noted.
Skin-tone is tan and consistent. No cyanosis or pallor. No visible lesions. Open mouth. Keep head back. Lips and mucous membranes of the mouth, as well as the nose are pink and moist. No visible lesions.
Nails are pink, normally shaped with a 160 degree angle, no indication of clubbing. Nail base is firmly attached to the nail bed and the nail bed is firm. Capillary refill time is prompt, less than 2 seconds indicating good peripheral vascular perfusion and cardiac output.
Inspection of thorax indicates spinous processes are straight. Symmetric thorax with downward ribs at 45 degree angle. The anteroposterior to transverse diameter is 1:2, within the normal range.
No lesions, scars are present. No excessive hair present. Fine vellus hair is normally distributed.
Now I will palpate, please indicate if there is any tenderness of pain. Skin is warm, moist and firm. Temperature consistent with the rest of the body. No lumps, lesions, or crepitus noted. No tenderness noted.
To check tactile fremitus, I will need to have you say “blue moon” each time I touch you. Both anterior and posterior fremitus is equal bilaterally.
Now I will percuss the posterior lungs fields. Resounance noted at the apices, indicationg normal adult lung tissue. Dullness would be heard over organs and flat sounds would be heard over bone.
Hyperresonance will be heard if the lungs are over-inflated, as in emphysema or a pneumothorax. Dull sound indicates abnormal lung tissue, indicating possible pneumonia, atelectasis or a tumor.
Now I will check for diaphragmatic excursion. Please exhale and hold your breath. I will percuss down until the sound changes from resonant to dull. I will mark this measurement. Now take a deep breath and hold it. I will continue to percuss down until sound changes to dullness. I will measure the difference. Normal range is 3 to 5 cm. An abnormally high level of resonance or absence of excursion would indicate pleural effusion or atelectasis of the lower lobes. A well conditioned person may have a larger range of 7 to 8 cm.
Now I will have you breathe deeply through your mouth as I auscultate the breath sounds on both the anterior and posterior.
Normal bronchial sounds over the trachea and larynx are loud and high pitched. Inspiration is shorter than expiration.
Brochiovesicular sounds are over the major brochi along the upper sternum and vertebrae. Normal sounds are moderate in pitch and amplitude. Inspiration equals expiration.
Normal vesicular sounds over the peripheral lung fields are low pitched and soft. Inspiration is longer than expiration.
No adventitious sounds such as crackles indicating possible pneumonia or wheezes with asthma or emphysema are present. No decreased lung sounds indicating possible obstruction or increased lung sounds indicating dense tissue indicative of pneumonia.
