Inspection of the Respiratory System

1. General Survey

• Observe for:

  • Signs of respiratory distress

  • Use of accessory muscles

  • Posture (e.g., patient leaning forward in orthopnea)

  • Presence of oxygen devices or inhalers at the bedside

2. Hands and Nails

• Look for:

  • Cyanosis

  • Clubbing (loss of Schamroth’s window)

  • Tar staining (suggestive of smoking)

  • Other chronic respiratory disease signs (e.g., peripheral cyanosis)

3. Face and Mouth

• Inspect for:

  • Central cyanosis (bluish lips or tongue)

  • Plethoric complexion (may indicate polycythemia or CO₂ retention)

  • Conjunctival pallor (suggestive of anemia)

  • Oral candidiasis (associated with steroid inhaler use)

4. Chest Inspection

a. Shape

• Note chest wall deformities such as:

  • Barrel chest (e.g., emphysema)

  • Pectus excavatum (sunken sternum)

  • Pectus carinatum (protruding sternum)

  • Kyphosis

  • Scoliosis

b. Symmetry

• Compare both sides for equal movement during respiration.

c. Trachea and Apex Beat

• Check for visible deviation or displacement of the trachea or apex beat.

d. Chest Movements

• Assess for reduced or asymmetrical movement in all regions:

  • Supraclavicular

  • Infraclavicular

  • Mammary

  • Axillary

  • Scapular

e. Other Findings

• Look for:

  • Dilated veins over the chest wall

  • Scars (from previous surgery or trauma)

  • Sinuses

  • Intercostal indrawing

  • Supraclavicular hollowing

  • Infraclavicular flattening

  • Drooping of shoulder

  • Alar flaring (nasal flaring)

  • Use of accessory muscles

5. Additional Clues

• Observe for:

  • Signs of chronic illness (weight loss, muscle wasting)

  • Respiratory rate and rhythm

  • Abnormal breathing patterns (e.g., Cheyne-Stokes, Kussmaul’s respiration)