Chapter 1: History and Physical Exam

Info from 'Respiratory Care: Principles and Practice' 4th edition

components of health history

• chief complaint (CC)

• history of present illness (HPI)

• occupational and environmental history

• geographic exposure

• activities of daily living (ADLs)

• smoking history

• cough and sputum

• family history

• medical history

• review of systems (ROS)

OLD CART (acronym)

• Onset

• Location

• Duration

• Characteristics

• Associated manifestations

• Relieving factors

• Treatment

variables of creating a therapeutic climate

• caring demeanor

• competence

• eye contact

• judicial use of touch

• professional image

normal heart rate for adults

60-100 beats per minute (bpm)

normal respiratory rate for adults

12-20 breaths per minute

ideal blood pressure for adults

120/80

ideal body temperature

37°C / 98.6°F

normal SpO₂

95%-100%

How do vital signs differ in infants and children compared to adults?

• higher HR and RR

• lower BP

Biot’s respiration

• short bursts of uniform deep breaths followed by periods of apnea for 10-30 seconds

• due to brain injury, elevated ICP, and meningitis

Kussmaul respiration

• rapid, deep breathing to remove CO₂

• due to acidosis (ie, diabetic ketoacidosis)

Cheyne-Stokes respiration

• slow, shallow respirations that crescendo and decrescendo followed by periods of apnea

• due to old/young age, CVD, and CHF

elements of respiratory assessment

1. inspection

2. palpation

3. percussion

4. auscultation

inspection of respiratory system

• overall appearance (position, breathing, use of accessory muscles)

• anterior-to-posterior chest wall configuration (barrel chest)

• chest shape (pectus excavatum/carinatum)

• spine shape (scoliosis, kyphosis, lordosis)

• clubbing of nails (hypoxia)

• capillary refill

• cyanosis (central/peripheral)

• edema (pitting/non-pitting)

• jugular venous distention (JVD)

palpation of respiratory system

• tracheal position

• chest excursion (equal & bilateral, asymmetrical, paradoxical)

• tenderness

• subcutaneous emphysema (air under skin)

• tactile fremitus

• density

percussion of respiratory system

• resonance (normal/resonant, flat/dull, hyperresonant)

• diaphragmatic excursion

auscultation of respiratory system

• normal breath sounds

  • tracheal

  • bronchial

  • vesicular

  • bronchovesicular

• abnormal breath sounds

  • stridor (high pitch with inspiration)

  • grunting (distress in newborns)

  • fine crackles/rales (fluid/inflammation in small airways)

  • course crackles/rhonchi (rumbling due to mucus and airway narrowing)

  • wheezing (high pitch with expiration)

  • pleural friction rub