Head to Toe Physical Examination for Dyspnea


1) Examination of the chest, beginning from the posterior thorax, the client in a seated position.

2) Chest observed by comparing one side to the other.

3) Actions done from the top (apex) to the bottom.

4) Inspection of the thorax poterior skin color and condition, scars, lesions, masses, spinal problems such as kyphosis, scoliosis and lordosis.

5) Record the number, rhythm, respiratory depth, and symmetry of chest movement.

6) Observation of respiratory type, such as: nasal breathing or diaphragmatic breathing, and the use of auxiliary respiratory muscles.

7) When observing respiration, record the duration of the inspiration phase (I) and expiratory phase (E). This phase normally ratio 1: 2. Prolonged expiratory phase indicate the presence of airway obstruction and is often found on the client Chronic Airflow Limitation (CAL) / COPD

8) Review the configuration of the chest and compare anteroposterior diameter (AP) and lateral diameter / tranversal (T). This ratio normally ranges from 1: 2 to 5: 7, depending on the client's body fluids.

9) Abnormalities in breast shape:
a) Barrel Chest
Arise due to the occurrence of lung overinflation. An increase in AP diameter: T (1:1), often occurs in emphysema clients.

b) Funnel Chest (Pectus Excavatum)
Arise in case of depression of the bottom of the sternum. This will compress the heart and major blood vessels, resulting in murmurs. This condition can occur in rickets, Marfan's syndrome or due to accidents.

c) Pigeon Chest (Pectus Carinatum)
Arise as a result of inaccuracies sternum, where an increase in AP diameter. Arise in clients with severe kyphoscoliosis.

d) kyphoscoliosis
Seen with the elevation of the scapula. This deformity would interfere with the movement of the lungs, can occur in clients with osteoporosis and other musculoskeletal disorders affecting the thorax.

Kiposis: increasing the normal curvature of the thoracic vertebral column causing the client looks bent.

Scoliosis: curved lateral thoracic vertebrae, accompanied by vertebral rotation

10) Observation symmetry of chest movement. Movement disorders or inadequate chest expansion indicates disease in the lung or pleura.

11) Observation of abnormal retractions intercostal spaces during inspiration, which can indicate airway obstruction.


Conducted to assess the symmetry of chest movement and observed abnormality, identified the skin's condition and knowing vocals / premitus tactile (vibration).

Palpate thoracic abnormalities were examined to determine the time of the inspection, such as: mass, lesions, swelling.

Assess also the softness of the skin, especially if the client complains of pain.

Vocal premitus: chest wall vibrations generated when speaking.


Nurses perform percussion to assess pulmonary resonance, the organ that is around and development (excursion) diaphragm.

Types of percussive sounds:

Percussive sound normal:
Resonant (Sonor) :: resonate, low tone. Generated in normal lung tissue.
Dullness: produced on the part of the heart or lungs.
Tympany :: musical, produced in the stomach that contain air.

Sound Percussion Abnormal:
Hyperresonant: resonated lower than the resonant and raised in the abnormal lung filled with air.

Flatness: very dullness and therefore a higher tone. Percussion can be heard on the thigh, which contains all of the area of tissue.


Is a very significant study, listening to breath sounds include normal, additional sounds (abnormal), and sound.

Normal breath sounds generated from the vibration of air passing through the airway from the larynx to the alveoli, the nature of the net.

Normal breath sounds generated from the vibration of air passing through the airway from the larynx to the alveoli, the nature of the net

Normal breath sounds:

a) Bronchial: often called the "Tubular sound" because the sound is produced by air passing through a tube (pipe), his voice loud, loud, with a gentle blowing. Expiratory phase is longer than inspiration, and there is no interruption between the two phases. Normal sounds in the trachea or suprasternal notch area.

b) Bronchovesicular: a combination of bronchial and vesicular breath sounds. His voice was loud and with a moderate intensity. Inspiration as long as the expiration. The sound was heard in the thoracic region where the bronchi covered by the chest wall.

c) Vesicular: sounds soft, smooth, like a breeze. The inspiration is longer than expiration, expiratory sounds like a hoot.

Additional breath sounds:

d) Wheezing: sound during inspiration and expiration, with the character of a loud voice, musical sounds associated with the continuous flow of air through a narrowed airway.

e) Ronchi: heard during inspiration and expiration phases, character voice sounded slow, loud, persistent snoring sound. Dealing with thick secretions and increased sputum production

f) Pleural friction rub: heard during inspiration and expiration. Character voice: rough, squeak, sounds like the friction resulting from inflammation of the pleural region. Often times clients also experience pain when breathing deeply.

g) crackles

Fine crackles: each phase more often heard during inspiration. Characters pop sound, broken due to the humid air passing through the area in the alveoli or bronchioles. Sounds like the hair rubbed.

Coarse crackles: more prominent at expiration. Character voice is weak, rough, scraping sound or truncated due to the presence of fluid secretion in the airway. It will probably change when the client coughs.

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