 Hi, welcome to Nursing School Explained and this video on a focused respiratory assessment. Now we always listen to the patient's lung sounds whenever we assess them, but when there's an underlying respiratory condition we need to make sure that we focus a little bit more on their chest and their lung sounds. Now there are some special respiratory assessment techniques that can be used that you might have learned about in nursing school such as bronchophony, egophony, whispered pectoriloquy and all these special tests. Now I'm not going to demonstrate these in this focused respiratory assessment, but I have some another video where I go into how to do this so that you can also see how that's done, although it's not very commonly used. So let's take a look at the focus respiratory system assessment right here. Hi, my name is Petra, I'll be your nurse today. I'm going to do an assessment. Is that okay? Yeah. Okay. First of all, let me do some hand hygiene here. And then I'll put on some gloves and can you tell me your name? Steve Jobs. And what year is it? 2022. Where are you right now? I'm at hospital. And why are you here? I'm having trouble breathing. Okay. So we'll take a look at you here and we'll take a good look at your lungs and do all those good assessment things. So first let me go ahead and check your eyes. Look straight at the tip of my nose here, please. Okay. And then open up. Okay. Great. So now I'm going to take a listen to your, actually we'll take a look at your chest first. So let me uncover you. And first I want to inspect just his chest and see any kind of chest movement that might be unusual. And of course I also have already checked his vital signs and assessed his respiratory rate. Just by inspecting I can see if there are any abnormalities going on, any paradoxical chest movement where maybe one part is moving in a different direction from the other one or if everything is okay. I also want to make sure that I palpate his chest because if there was any subcutaneous emphysema I couldn't detect that unless I'm palpating his chest. And subcutaneous emphysema is something that a patient can have if they had air escaping the lungs into the pleural cavity such as we would see in a normal thorax. And so by just palpating I feel make sure that there's no abnormalities. I can also check for any kind of lumps or anything like that. These, the subcutaneous emphysema would feel like rice crispies underneath the skin. Once you've touched it you really know exactly, you will know exactly what I mean. So we've inspected, we've palpated. Now I'm going to percuss his chest and I have a special, a certain video on percussion techniques. I'm not going to go into too much of an explanation here. But again just like with auscultation I want to compare the left side and the right making sure that the sounds are nice and hollow because underneath the chest, the chest wall we have the lungs and they are filled with air so they're going to be nice and hollow. And just watch the other percussion video that I have right there. So now I've done my inspection palpation percussion and now I'm going to go ahead and auscultate. Whenever I place my stethoscope on your chest please take a nice deep breath in and out through the nose. Go ahead. I'm starting to get lightheaded. I'm sorry? I'm starting to get lightheaded. Okay that's actually quite normal because I'm having you take some nice deep breaths so I'll just slow down the, the speed, the way that I'm going down on your chest okay? Okay. Are you feeling a little better now that we just talked? Just a little, yeah. Okay. So take a nice slow deep breath and again. So long, clear, nice and clear. Are you still dizzy or are you okay? I'm okay. Okay, very good. So now I'm going to just listen to your heart. So I'd like for you to just breathe nice and normally, okay? Okay, good. Thank you. And one more thing I want to do is I want to check your chest excursion which basically means the way that your lungs inflate. So I'm going to place my hands right here on your chest and take a nice deep breath. Okay, good. And do that again. We'll make sure we'll do this nice and slow. Are you doing okay or are you dizzy? I'm okay. Okay. And then one more time. So I'm checking here that every time he inhales my hands move in a symmetrical way with his chest wall and so his chest wall movement is okay here with the chest excursion. Now I also need to assess your back. Is it okay? Is it better for you if you sit up or roll onto your side? I can sit up. Okay, great. Let's do that. So now I'm going to check the chest excursion here again. So take some nice deep breaths. It's always a little bit more visible towards the bottom. And one more time. Good. So if there was some underlying pathology or maybe some consolidation underneath one side it would not possibly not be equal on the chest excursion here. And so then again I want to palpate and see if I can feel any abnormalities here. And theoretically you could do both sides at the same time. It's just a little bit more practical I think to do one side at a time and notice if there's anything unusual. And so now that we have done the inspection I'm going to auscultate. So nice deep breaths again whenever I touch my stethoscope I'll just make sure that I go a little bit slower so you don't feel dizzy. And if you feel dizzy just let me know. Okay, so one thing on the auscultation on the respiratory system whenever you listen to a patient's lungs make sure that you follow in this left to right version from the top to the bottom. And make sure that you get all the way out to the sides here to hear the lateral chest specifically because on the right side we have three lobes rather than on the left side where we only have two. And on the right side there's a middle lobe here that you really can't hear from below and if you miss listening to the side here you could miss an abnormality and the right middle lob pneumonia is fairly common. So make sure that you always follow it and then move out to the sides and listen to the mid axillary line here on both sides. So now that I'm done with auscultating I'm going to percuss again, again going in this methodical way, staying away from any bony prominences such as the scapula and the ribs making sure that I hear this hollow sound underneath. And so I'm done with my inspection, palpation, auscultation and the percussion. I've done a little bit out of order but I got them all done. Okay, let's have your lay back down. So now I'm going to check your upper extremities. Can you squeeze my fingers on both sides real tight? Okay, excellent. And then let me check your circulation. While I'm here I can also check for any clubbing of the fingernails and the patients with a respiratory issue and these nails look all normal. I'll check for his radial pulses, strong and equal and then one more strength test. Can you pull me towards you and then turn your hands away and push me away? Okay, good. And this would also be a good opportunity to assess an IV site in the hospital setting if the patient has an IV. Okay, next I'm going to check your abdomen so I'll get you uncovered. And again first I'll inspect and everything looks pretty good here. Now I'll auscultate for bowel sounds. When was the last time you had a bowel movement? Yesterday. Okay. I'm going to palpate your abdomen now. Let me know if you feel any pain. Any tenderness? No. Okay, so I'll push a little bit more now. Any pain? No. And I'll check your bladder. That is not the standard. Okay, so now we'll move on to your lower extremities. We can tuck your arms. So let me get you uncovered here. Can you press down against my hands like on a gas pedal? Great. Pull your toes to your nose. Bend that knee here please. Kick your shin out against my hand and pull the calf back. Great. Relax. Let me see the other side. Bend the knee. Kick out against me and pull back. Good. Now let me check your circulation. Nice strong pulses and all the way down here. Okay, great. We're all done. Thank you. Thank you for watching this video on the Focused Respiratory Assessment. Please also make sure to check out the other focused assessment videos in the physical assessment playlist. Thanks for watching Nursing School Explained and I'll see you soon right here.