RESPIRATORY EXAMINATION

1. INSPEKSI
 GENERAL ; dyspnea,nasal
flaring,cyanosis,clubbing, use of
respiratory muscles
 CHEST ; skeletal
deformities,symmetry AP diameter
 Respiratory rate;
regular/irregular,depth
 Respiratory pattern
2.palpasi
 check symmetry of expansion

 Palpate each rib….any pain/discomfort?

 Note position of trachea

 Tactile fremitus
with client seated, have him repeat “ ninety-nine “ in a
deep voice. Move your hands on chest from apices to
bases. Compare intensity and symmetry of vibrations
3. PERKUSI

Patient may be sitting or

standing. Percuss downward from
apices; first front, then back.
Strike with equal force on left and
right sides of chest and compare
degree of resonance
4. auskultasi
Use stethoscope.Listen to back,alternating left and right
parallel points,moving from apices to bases. Listen to
anterior apices.
 Concentrate on quality of breath sounds
 Compare length of inspiration with length of
expiration
 Listen for breath sounds- bronchial ,
bronchovesicular, vesicular
 Listen for adventitious breath sounds- rales, rhonchi,
wheezes. Do they disappear after coughing
 SAMPLE WRITE UP
Thorax oval, AP diameter < lateral
diameter. Symmetrical expansion.
Respiratory rate 14,regular rhythm.
Thoracic breathing pattern. No
tenderness or masses on palpation.
Tactile fremitus equal bilaterally,
resonant on percussion.Vesicular breath
sounds bilaterally throughout. No
wheezes or crackles present.
 PRECORDIAL INSPECTION
• Client in supine position or with head and chest
slightly elevated
• Compare chest for symmetry
• Observe thoracic configuration –barrel chest,bulges.
• Note nutritional status; thin, obese
• Respirations; rate,rhytym, dyspnea
• Skin – color changes. Note vascularity
• Visually locate apical area,tricuspid area,aortic area
Next…………..

• Stand to client’s right and use tangential

lighting to note any precordial pulsations

• Identify apical impulse- note locations[ apical

beat not always observable ]
 PRECORDIAL PALPATION

• Stand to client’s RIGHT and place RIGHT palm

over apical area

• Locate apical beat with index or middle finger

 CARDIAC AUSCULTATION

• Stand at RIGHT side of client with client

SUPINE and auscultate apical area
• Listen closely and identify first and second
heart sounds [ S 1 and S 2 ]
• Continue to listen until you have correctly
identified the two heart sounds
• Count heart rate for one minute; identify
rhythym as regular, irregular
 SAMPLE WRITE UP

• Apical impulse left at 5th ICS at MCL.

No thrills, pulsations noted. Apical
pulse 72., S1 S2 SINGLE sound
regular. No murmur
 ABDOMINAL EXAMINATION
INSPECTION

• Position of comfort
• Abdominal contour
• Symmetry – asymmetry due to fluid, air, tumor,
hernia, pregnancy
• Skin – color, lesions, vessel pattern, scars
• Umbilicus- inverted/everted, hernia, lesions
• Movement- peristalsis, pulsations
auscultation
Listen 2 – 3 minute
 BOWEL SOUNDS – Absent [ paralytic ileus ],
increased gastritis, early obstruction ]

Percussion
Palpation
• Muscular tension
• Enlarged organ
• Masses