UNIFASE_Curso de Semiologia Médica_Exame: Respiratório_Profa.: Telma Lima

Summary

This detailed respiratory system inspection video script walks through the step-by-step process of assessing a patient's respiratory health. It covers both passive and active evaluations, including thoracic symmetry, palpation for abnormalities, respiratory patterns, and auscultation for lung sounds. The script also highlights techniques for measuring diaphragm movement, detecting masses or pain, and evaluating vocal resonance. Key procedures such as observing for irregular breathing patterns, checking for pectorilogy, and performing percussive and auscultation techniques are thoroughly explained, offering a comprehensive approach to respiratory examination.

Takeaways

• 😀 The respiratory examination begins with a visual inspection of the thorax, assessing symmetry, diameter, and possible deformities or lesions.
• 😀 A key step in the inspection involves checking for abnormal findings in the chest, including signs of bulging, retractions, and other deformities.
• 😀 Active respiratory examination is performed by assessing the regularity of the patient's breathing cycles and identifying irregular types like Kussmaul or Cheyne-Stokes breathing.
• 😀 During the examination, the physician measures the patient's respiratory rate using subtle techniques to avoid disturbing the patient, ensuring accuracy.
• 😀 Abdominal and thoracic breathing patterns are observed, with men typically showing abdominal dominance, while women display a thoracic breathing pattern.
• 😀 The physician evaluates the relationship between inspiration and expiration, ensuring the expiration is approximately twice as long as inspiration in healthy cases.
• 😀 Palpation of the thorax helps assess sensitivity, costal integrity, and the presence of masses or subcutaneous emphysema using circular motions of the fingertips.
• 😀 The doctor performs thoracic expansion tests by asking the patient to take deep breaths while observing the movement of the rib cage to check for proper chest mobility.
• 😀 The thoracic vocal fremitus is evaluated by asking the patient to say '33', allowing the physician to detect any abnormal reverberations in the lungs.
• 😀 Percussion of the chest is carried out to detect changes in sound, from clear to dull or tympanic, especially to assess the liver's impact on the diaphragm and to detect fluid accumulation in the chest.

Q & A

What is the purpose of the respiratory inspection described in the script?

The purpose of the respiratory inspection is to evaluate the symmetry and condition of the chest, including the evaluation of any deformities, masses, or abnormalities, and assessing the overall functioning of the respiratory system.

How does the passive inspection of the respiratory system work?

The passive inspection involves visually evaluating the anterior and posterior regions of the thorax, checking for symmetry, deformities, and any abnormalities such as bumps, retractions, or lesions.

What is the significance of assessing the curvature of the spine during the respiratory exam?

Assessing the spine curvature helps identify conditions like kyphosis (excessive rounding of the spine) or lordosis (inward curve of the lower back), which may affect respiratory mechanics or indicate other health issues.

What are the signs that the examiner looks for in the respiratory pattern during the inspection?

The examiner checks for the regularity or irregularity of breathing cycles, the presence of abnormal breathing patterns like Cheyne-Stokes, Kussmaul, or Biot's respiration, and whether the breathing is predominantly abdominal or thoracic.

How is respiratory frequency measured during the examination?

The respiratory frequency is measured by observing the patient’s chest and abdomen while they breathe, often with the examiner discreetly checking the pulse to avoid influencing the patient's breathing patterns.

What is the purpose of evaluating the expansion of the chest during the examination?

The expansion of the chest is assessed to check the mobility of the rib cage during breathing, ensuring that the lungs are expanding symmetrically and normally.

How is the chest palpation performed during the exam?

Palpation involves using the fingertips in circular motions with light pressure to evaluate for areas of tenderness, abnormal masses, or changes in the costal cage's integrity.

What is the purpose of checking for tactile fremitus during the examination?

Tactile fremitus is used to assess the transmission of sound vibrations through the chest wall, which can indicate the presence of lung consolidation, pleural effusions, or other abnormalities.

How is the percussion of the chest performed and what is it used for?

Percussion involves tapping on the chest to listen for different sounds that indicate the presence of air (normal lung tissue) or abnormal fluids or masses. The examiner listens for tympanic sounds over the lungs and dullness over areas like the liver or heart.

What does the auscultation of the lungs aim to detect during the respiratory exam?

Auscultation aims to detect normal vesicular breath sounds and any adventitious sounds such as wheezing, crackles, or rhonchi, which could indicate respiratory conditions like asthma, pneumonia, or pulmonary edema.