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Review of Systems |
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1. Respiratory distress, respiratory rate, symmetry, cyanosis, clubbing. 2. Check the trachea is central in the suprasternal notch. 3. Check that expansion is symmetrical on full inspiration. 4. Feel for transmitted vocal resonance (tactile vocal fremitus) with the flat of the hand, ask the patient to say ‘ninety-nine’) out loud whilst palpating the upper and lower zones in turn. 5. Percuss the lung to check for symmetry or resonance. The percussion note is dull when the underlying lung is consolidated, collapsed or fibrosed and very dull over pleural fluid. 6. Auscultation– listen in all areas with the bell or diaphragm. In normal respiration inspiration is heard with little expiration through the open mouth. Inspiration is normally slightly longer than expiration. Also listen for added sounds such as crackles, rubs and wheezes.
Gastrointestinal System 1. Again run through the sequence of inspection, palpation, percussion and auscultation. 2. Note any scars or abnormal areas of the abdomen. 3. Palpate the edges of the liver which may just be felt in the normal thin individual in the right hypochondrium during full inspiration. Are the spleen and kidneys palpable?
Maxillofacial region 1. Inspect the area for obvious abnormalities and facial asymmetry. 2. Check for lymph nodes and palpate the thyroid gland. 3. Note the presence of any scars and check the movement of the TMJ. 4. Examine the intra-oral region and note teeth present, OH, state of soft tissues and the presence of bridges or crowns. 5. Ensure that the condition (be it intra-oral or otherwise) that has prompted the admission remains unchanged. Check that all the appropriate investigations and radiographs are to hand. |
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Respiratory System |
