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General
- Patient in gown or loosely dressed
- ALWAYS examine sequentially from side to side
Pulmonary Inspection
- Identify the oblique and horizontal fissures
- Look for asymmetry and deformity of the chest wall and trachea
- Observe rate, rhythm, depth, and effort of breathing
- Look for and stated significance of increased A/P diameter
Pulmonary Palpation
- Palpate the anterior, posterior, and lateral chest
- Identify areas of tenderness
Special Considerations
- Chest expansion
- Tactile fremitus
Pulmonary Percussion
- Place distal middle finger against chest and tapping smartly with opposite middle finger produced a good percussion "note"
- Percuss a minimum 6 anterior points
- Percuss a minimum 4 posterior points
- Percuss a minimum 1 lateral point bilaterally
- Identify lobes of each lung bilaterally
Pulmonary Auscultation
- Auscultate a minimum 6 anterior points
- Auscultate a minimum 4 posterior points
- Auscultate a minimum 1 lateral point bilaterally
- Identify lobes of each lung bilaterally
- Be able to articulate a description of: rales/crackles; wheezes; rhonchi; abnormal I/E ratio
Peak Flow Monitoring
- Use correct technique with Peak Flow Meter
- Repeat 3 times and record highest reading
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