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02-Respiratory System Assessment
02-Respiratory System Assessment
Dr Abdelhaleem Bella
The hardest conviction to get into the mind of a beginner is that the education upon which he is engaged is not a college course...but a life course, for which the work of a few years under teachers is but a preparation.
The Basic
Medicine is learned at the bedside and not in the classroom Practice makes perfect Rapport AND NURS ( Name + Understanding+ Respect+ Support) Start with open ended questions , frequent summary, clarify conclude . Anatomical , Physiological ,Aetiological and Impact
HISTORY
FH SR Summary
Common Symptoms
1. 2. 3. 4. 5. 6. 7. 8. 9. Cough Sputum Dyspnea Wheeze Chest Pain Snoring and EDS Hoarseness Hemoptysis` General : Fever , Sweating, Wt Loss, Appetite
Cough Duration
Cough Character
Dyspnea Extra
EXAMINATION
Sputum
Pattern of Breathing
Nail :Staining
Nails : Clubbing
A, Schamroth sign. In the absence of clubbing, opposition of the index fingers nail to nail creates a diamond-shaped window (arrowhead). In clubbed fingers, the loss of the profile angle because of the increase in tissue at the nail bed causes obliteration of this space (arrowhead). B, Distal phalangeal finger depth (DPD)/interphalangeal finger depth (IPD) represents the phalangeal depth ratio. In normal fingers, the IPD is greater than the DPD. In clubbing, this relationship is reversed
Nails: Clubbing
nail clubbing, drumstick fingers, Water-glass nails for the resemblance and Hippocratic fingers
1. Periungual erythema and softening of the nail bed (spongy feeling on palpation) 2. Increase in the normal 160-165o angle between the nail bed and proximal nail fold (Lovibonds angle) (Figure 2) 3. Increase nail curvature (secondary to the increase Lovibonds angle) 4. Enlargement giving the drumstick appearance
hypertrophic osteoarthropathy(HOA) characterised by periostitis of long bones and pain. It is also referred to as Pirre Mari-Bamberger syndrome.
Face : Congestion
CHEST
Percussion
Sequence
Percussion Notes
Auscultation
INVESTIGATIONS
Learn to love the freedom of the student life, only too quickly to pass away; the absence of the coarser cares of after days, the joy in comradeship, the delight in new work, the happiness in knowing that you are making progress. Once only can you enjoy these pleasures.
Osler W. The Master-Word in Medicine. In: Aequanimitas, With Other Addresses to Medical Students, Nurses and Practitioners of Medicine.3rd ed. New York: McGrawHill Book Company, 1932: 362.
INVESTIGATIONS
http://www.meddean.luc.edu/lumen/MedEd/medicine/pulmonar/IMAGES/CDLungSounds/mac/cugell-07july11.swf
http://www.stethographics.com/main/physiology_ls_introduction.html