![]() ![]() pleural effusions/pulmonary fibrosis).įinger clubbing involves uniform soft tissue swelling of the terminal phalanx of a digit with subsequent loss of the normal angle between the nail and the nail bed. Joint swelling or deformity: may be associated with rheumatoid arthritis which has several extra-articular manifestations that affect the respiratory system (e.g.asthma, COPD, interstitial lung disease). Skin changes: bruising and thinning of the skin can be associated with long-term steroid use (e.g.Tar staining: caused by smoking, a significant risk factor for respiratory disease (e.g.Colour: cyanosis of the hands may suggest underlying hypoxaemia.Observe the hands and note your findings: The hands can provide lots of clinically relevant information and therefore a focused, structured assessment is essential. Prescriptions: prescribing charts or personal prescriptions can provide useful information about the patient’s recent medications.Fluid balance: fluid balance charts will give an indication of the patient’s current fluid status which may be relevant if a patient appears fluid overloaded or dehydrated.Vital signs: charts on which vital signs are recorded will give an indication of the patient’s current clinical status and how their physiological parameters have changed over time.Mobility aids : items such as wheelchairs and walking aids give an indication of the patient’s current mobility status.Cigarettes or vaping equipment: smoking is a significant risk factor for lung cancer and chronic lung disease (e.g.inhalers/nebulisers in asthma/COPD), catheters (note volume/colour of urine) and intravenous access. Other medical equipment: ECG leads, medications (e.g.Sputum pot: note the volume and colour of the contents (e.g. ![]() Look for other forms of respiratory support such as CPAP or BiPAP. Venturi mask, non-rebreathing mask, nasal cannulae) and the current flow rate of oxygen (e.g.
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