SOP PHYSICAL EXAMINATION OF THE RESPIRATORY SYSTEM

Pre-interaction phase

Preparing tools:

1. Stethoscope
2. Handscoon
3. Penlight
4. Pencil/pen
5. Ruler

Working phase

1. Explain the procedure to be carried out

2. Washing hands
3. Protect client privacy

Inspection:

1. Observe the color of the face and lips (the presence of cyanosis)
2. Observe the patient’s nails (color and shape)
3. Use lightening to observe the nose and nostrils (polyps or not) or the is sputum,the
color
4. Use the ovservation of tonsils,the patient is asked to open the mouth and slightly
remove the tongue
5. Observe the skin area in front of the trachea (bruises,lesions,swelling)
6. Thorax: shadow lines,skin color,texture,presence of lesions,fractures
7. Observe the chest shape (anteroposterior)
8. Observe the curvature of the spine
9. Breathing movements and chest irritation

Palpation:

1. Sensation : pain or not

2. Thorax movement anterior/ respiratory excursion
3. Thorax movement posterior
4. Fokal Fremitus:
- Place the fingertip surface or the ulnar part of your hand or your fist on the posterior
chest, starting near the lung apex
- ask the client to repeat the word 99
- repeat the previous step, move your hand in sequence to the base of the lungs
 - compare fremitus in both lung areas and between the apex and the base of the
lungs in each lung using one hand that is transferred from one side of the client's
chest to the same area on the opposite side

Percusion:

5. Anterior thorax
- Start from the top of klavikula at supraklavikula space and continued to the low part of
diaphragm
- Compare one side of the lung with the other sicle

Posteriror thorax

- Ask clien to bow his head and fold hand forward the chest
- Do percussion at intercostal space with interval about 5 cm with systematic sequence

Diaphragm excursion

- Ask clien to take a deep breath and hold it second, while you do percussion along the
scapula line until faint sound appears at diaphragm height. Mark this point with the
pencil pr marker pen
- Repeat the procedure on the other side
- Ask the client to breath normally a few times and then take out the last overall breath
and hold it while you do an upward percussion from the marking the diaphragm
excursion during expiration in the chest on each side of the chest the chest
- Measure the distance between the two chests

Auscultation:

6. Anterior thorax
- Auscultation of the anterior chest using the sequence on percussion

Posterior thorax

-
Auscultation of the posterior chest using the percussion sequence
-
Ask the client to take a deep breath slowly through the mouth. Listen to the
breath sounds at each point during complete inspiration and expiration
- Compare the results at each point with the same point on the opposite side of
the chest
7. Explain the results of the examination to the client

Termination phase

8. Trimming tools
9. Nurses wash hands
10. Documentation right
 The Dialogue of respiratory system examination

Orientation phase:

Hello sir, good morning

Let me introduce my self..

I'm (......),

i'm a nurse who cares you today

At 8 a.m. until 2 p.m.

Okay sir, now i want to check your respiration

In this procedure i will doing inspection, palpation, perkusion, and auscultation

The aims for identification and decide your diagnos

This procedure will spent time 10 until 15 minutes

Before i do this procedure do you have any question sir? (Yes or No)

Okay if you not have question we will start the procedure right now

Work phase

- nurse doing handwash

- guide klien privacy

Sir i will close the beg

And now you can release your clothes

Now i will do inspection

1. Your face and and lips looks good normal, no sianosis, no pale

2. May i see your nail? The colour is pink, and form normal

3. Now i will check your nose.. There is no polip, no sputum

4. Then.. I will check your mouth.. Open your mouth.. Say "aa.." and pull out your tongue,
There is no tonsilitis, and your tonsil position normal, no expansion

5. Your skin trachea no bruised, no lesi, no swelling, no disorder

6. Your thorax is symmetrical, the colour is normal, the tekstur good, nothing lesi, and no
fracture

7. I see your chest is normal (not barrel or pigeon chest)

8. Your spine is good

9. Your movement breathing regular, and chest symmetry

Now, i will do palpation

1. I will palpation, excuse me... Is there any pain sir? (no) 3x

2. Now you can breath deep, good..

Your lungs ekskursion symmetry

3. Can you sit sir? (okay)

Now i will do palpation on your posterior

Breath deep sir. Okay.. Good.. No movement delay

4. Then i will check your focal fremitus

You can repeat after me say "seventy seven" (seventy seven) 3x

Your focal fremitus is normal

Then i will do percussion to know your lungs, heart, and liver position.

5. (Do percussion) (on patient back)

Now you can laying down

(do percussion)(on patient anterior/front)

Okay sir...

Now.. Breath normally

Then breath deep... And stand it.. While i do percussion

Good.. Now breath normally

Then exhale... And stand it..

The exsursion is good

Now i will do auscultation on your thoraxs

6. Excuse me.. (auscultation anterior)

Inhale... Exhale... (auscultation of each intercosta 2,3,4,5,6,7)

Now you can sit again, i will auscultation your posterior

Inhale... Exhale... (auscultation of each intercosta 2,3,4,5,6,7)

7. Okay sir we finish with this procedure

all of your is good

Termination phase

Okay sir now im done with this procedure, before i go do you have any question sir?

(no, i don't)

Okay if you not have question i will back to my room and i will come again at 12 a.m. to
check your vital sign..

Get well soon sir

Good morning..