In a respiratory examination, a care provider will check a patient for signs of respiratory distress and underlying disease. Forms of this examination may be integrated into a full physical and it is common to combine the cardiac and respiratory examinations because they involve similar steps. Patients should expect to undress and wear a gown, and will spend the exam in a seated position.
A quick assessment is the first stage of a respiratory examination. Patients may be encouraged to talk to allow the care provider to listen for warning signs of respiratory problems like wheezing, halting breathing, or hoarseness. While the patient talks, the care provider can check the face and hands for signs of cyanosis, indicating poor circulation and inadequate oxygen flow. Any symptoms and the patient’s primary complaint can also be discussed.
In a physical examination, the doctor can palpate the hands, looking for issues like slow capillary return when the nail beds are pressed. In healthy individuals, if the nails are pressed, they flash white and then red as blood flows back in. People with sluggish circulation and those who are not getting enough oxygen will retain whiteness in the nail beds. The doctor can also check for clubbing and staining of the fingers, which may indicate heart problems.
Doctors may also palpate the head and neck. They can look for issues like nodules, an abnormally positioned trachea, and swollen lymph nodes. The respiratory examination also includes a check of the patient’s pulse and respiration rate. Once these preliminaries are finished, the doctor can uncover the chest and check it for signs of abnormalities before tapping it and listening to the resulting sounds. This percussive examination can reveal fluid in the lungs or other issues.
The final step of the respiratory examination may be auscultation, where the doctor listens to the lungs with a stethoscope. This requires several repositioning maneuvers to hear all the breath sounds, paying close attention to crackling and other issues. It is important for patients not to talk during this stage, because this can cover up breath sounds and it is also uncomfortable for the care provider, who hears an amplified version of the patient’s voice.
Some other procedures may be included in a respiratory examination. The doctor can ask the patient to use a peak flow meter to address concerns about lung health. Patients can also be asked to cough to allow the care provider to collect more information. Individual care providers may have additional steps they include to assess patient health.