PHYSICAL EXAMINATION OF RESPIRATORY SYSTEM

Before starting the physical examination

Stand at the right side of the patient

Greet and introduce
Consent mention which part physical examination of the body
Ask the patient in what language he prefer to communicate
Adequate privacy
Chaperone
Sanitization
Address the patient politely throughout the examination

1.

Good morning/afternoon/evening, Im Nageeshvari, medical student from AIMST University

and this is DR._________________
(Selamat pagi/tengah hari/petang, saya Nageeshvari, pelajar perubatan dari AIMST University
dan ini DR._________________)
2. Now Im going to do physical examination of _____________on you, may I get your
consent? Thank you.
(Sekarang saya akan melakukan pemeriksaan fizikal, boleh saya mendapat kebenaran anda?
Terima kasih)
3. May I communicate with you in ______________?
(Boleh saya berkomunikasi dengan anda dalam Bahasa _______________)
4. Adequate privacy have been provided.
5. I would like to have a chaperone with me and DR/Mr/Miss ______________ will be the
chaperone throughout this physical examination. (optional)
6. My hands have been sanitized / sanitized ideally.

GENERAL INSPECTION
1.

Access general inspection as follows.

Stand at the right side of the patient

Say I would like to start my physical examination by doing general inspection.

Ask the patient he is in pain or not

How are you today? (Apa khabar anda hari ini?)
Are you in pain anywhere right now? (Ada mana-mana tempat sakit sekarang?)

Ask the patient to assess orientation of time, place and person.

What part of day it is? (Pukul berapa sekarang?)
Where do you think you are right now? (Sekarang anda berada di mana?)
What is your fathers name? (Siapa nama ayah anda?)

The patient should be undressed to the waist and women should wear a gown a have a towel
or some clothing to cover their breast when front of the chest is not being examined
I would like you to undress yourself until your waist level for examination. (Saya mahu
anda untuk menanggalkan baju sehingga paras pinggang anda untuk pemeriksaan)

Start the respiratory examination by inspecting the respiratory signs including calculating
the respiratory rate as standing at the right of the patient

Then, stand at the right side foot of the patient and do comments for the following
components

Physical attitude

Mental status

State of the
patient

Position of the
patient
Conscious level

Orientation
Respiratory sign

Pattern of
breathing

The patient is
comfortable / is not comfortable,
not in pain / in pain,
and
without any abnormal movement / with abnormal movements.
He is
sitting over the edge of the bed/sitting of a chair
He is alert and conscious /
Patient is in confusion
He is not alert and conscious
during severe carbon
dioxide retention
He is well orientated to time, place and person / He is not
well orientated to time, place and person

Assess the pattern of breathing

by inspecting for
Muscle retraction during
breathing
Noise, speed, depth (deep
or shallow) and labored
respiration with the usage
of accessory, neck,
shoulder or abdominal
muscles

Normal pattern of breathing

There is no muscle
retraction during breathing
He has quiet, slow and
unlabored respirations with
no usage of accessory, neck,
shoulder or abdominal
muscles
He has a regular respiration
rhythm, with expiration

Respiration rhythm

taking about twice as long

as inspiration
Abnormal pattern of breathing
(next page)

8. Characteristic signs of COPD

Look for the usage of accessory muscle of respiration
Look for in-drawing of the intercostal or lower ribs anteriorly (sign of emphysema) and
supraclavicular spaces during inspiration
Look for pursed lips breathing
Check whether the patient is leaning forward with his arms on the knees

Dyspnea

Character of
cough

Watch the patient for signs of

dyspnea at rest.
Respiratory rate
Count the respiratory rate
by counting number of
breaths of 30 seconds and
times 2.
It is traditional to count
the respiratory rate
surreptitiously while
affecting to count the pulse
because respiratory rate is
under voluntary control.
Lack of usual explosive beginning
(bovine cough)
Muffled, wheezy, and
ineffective cough
Very loose productive cough

Dry and irritating cough

Barking or croupy cough

respiratory rate is

Sputum

Hoarseness

25

breaths per minute, hence

patient is in tachypnoea /
Patient respiratory rate is

16 breaths per

minute, hence patient is in

bradypnoea.

Vocal cord paralysis

COPD

Chronic bronchitis
Pneumonia
Bronchiectasis
Chest infection
Asthma
Carcinoma of bronchus
Left ventricular failure
Interstitial lung disease
Usage of ACE inhibitor drugs
Problem with the upper airway like pharynx and
larynx
Pertussis infection

Patient respiratory rate is

16-25 breaths per minute,
hence there is no sign of
dyspnea / Patient

(refer at the back for more information)

Patient has normal character of cough / The character of
cough is _________________
Assess for
The sputum is ________
Color
__________________
Volume / amount
Type (purulent, mucoid
or mucopurulent)
Time
Presence or absence of
blood
Listen to patients voice for
hoarseness which due to
Recurrent laryngeal nerve
palsy associated with
carcinoma of the lung (leftsided lung)
Laryngeal carcinoma
Laryngitis
Inhaled corticosteroid for

There is no hoarseness in
patients voice / There is
hoarseness in patients
voice.

asthma

General
appearance

Built

The patient is
Height

Weight

Tall / average in
height / short
and
Thin (loss in
weight) / average
in weight / obese

Sleep apnea patient tend

to be obese
Severe loss of weight
and muscle wasting shows
that patient is having
malignant disease

which is appropriate to his age /

which is not appropriate to his
age (calculate BMI)

He looks
Built

Hydration and
nutrition status

Cachectic / moderately built /well built

Look

The patient
looks normal
is ill looking / looks toxic

Gross
deformity

There is no any visible gross deformity (if there is gross

deformity mention)

Patient is well hydrated with good nutritional status / The hydration status
and nutritional status of the patient looks fair / The hydration and nutritional
status of the patient is poor.

*anything which are visible during general inspection should be mentioned, for example leg
swelling, hernia, masses anywhere on the body and many more.

Attachment
(mention only the

Name tag
Intravenous

There is a name tag on patients ____________

He is infused with __(fluid)__ by cannula through

attachments of
the patient)

cannulation

Nasal prong /
Oxygen mask

Urinary catheter

Surgical tube to
drain fluid
Instrument to
monitor vital sign
Insulin sliding
scale
POP cast

Bandage and gauze

Metered dose
inhaler
Sputum mug

Medications

intravenous drip which is attached on __(part of the

body)__
Or
There is a cannula for intravenous infusion which is
attached on __(part of the body)__
He is wearing nasal prong connected to ____ L/min
oxygen supply
Or
He is wearing an oxygen mask connected to ____ L/min
oxygen supply
He is a wearing a urinary catheter where the urine
collection bag is on the _______ side of the patient.
There is a surgical tube on __(part of the body)__ to
drain out the __________.
There is a __(instrument)__on the __(side of the
patient)__ of the patient to monitor the vital signs.