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Checklist for Posterior Chest Examination

The checklist for posterior chest examination includes the following:

Observation of Surroundings:

 

  • Posture: Sitting leaning forward
  • Medications: (inhalers, nebulizers, O2 cylinder)
  • Sputum cup: Color, quantity, smell
  • Edibles

 

Introduction

 

  • Introduction
  • Greetings
  • Permission for examination
  • While introducing observe for hoarseness, pursing of lips, use of accessory muscles and nasal flaring

 

Inspection

 

  • Intercostal recession
  • Chest shape-barrel, pectus excavatum/carinatum
  • Chest movements- symmetry
  • Prominent chest wall veins
  • Scars
  • Deformities- kyphosis, scoliosis
  • Aspirations marks or dressing
  • Respiratory rate and pattern of respiration
  • Audible sounds

 

Palpation:

 

  • Bony tenderness
  • Subcutaneous emphysema if appropriate
  • Chest expansion posteriorly
  • Tactile vocal fremitus

 

Percussion:

 

  • Supraclavicular fossae and back of chest wall including axillae
  • Check for diaphragmatic excursion

 

Auscultation:

 

  • Supraclavicular fossae and back of chest wall including axillae
  •  If areas of dullness on percussion, test for vocal resonance
  • Listen for added sounds (rhonchi, crackles, wheeze, rub)

 

Examine the Front Chest:

 

  • Visible apex beat, displaced trachea
  • Palpate for tracheal tug, tracheal shift, apex beat

 

Relative GPE:

 

  • Examine hands to assess circulation for warmth and venodilation- (CO2 retention)
  • Nails- tar staining (smoking), clubbing/cyanosis (fibrosis, bronchiectasis)
  • Hands- flapping tremor (CO2 retention), HPOA (Chronic pul. Conditions)
  • Pulse- bounding ( CO2 retention)
  • Raised JVP- cor pulmonale
  • Lymph nodes- cervical, supraclavicular and axillary (infection, malignancy)
  • Face- polycythemia (COPD), cyanosis (respiratory failure I)
  • Eyes- horner’s syndrome- pinpoint pupil and ptosis (malignancy)
  • Tongue- central cyanosis (respiratory failure-I)
  • Feet- ankle edema (cor pulmonale)

 

Conclusion:

 

  • Thank the patient, summarize and present findings

 

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