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Respiratory Therapy · Patient Data Evaluation

Physical Assessment and Cardiopulmonary Examination

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On this page 7 sections
  1. In 30 seconds
  2. Why this matters
  3. The college version
  4. Eli explains
  5. Worked example
  6. Key takeaway
  7. Study tools

In 30 seconds

Cardiopulmonary assessment follows a head-to-toe, systematic sequence: look (inspection), feel (palpation), tap (percussion), and listen (auscultation). General appearance and vital signs screen for distress; breathing patterns reveal the kind and severity of ventilatory problem; percussion notes and breath sounds localize air, fluid, or obstruction in the chest. The therapist performs and documents these findings; interpreting them into a diagnosis or treatment plan is the physician's role.

Why this matters

The physical exam is where instability is first recognized. A therapist who detects stridor, paradoxical chest movement, or a rapidly changing level of consciousness is performing a safety function: flagging an urgent situation so it is escalated immediately to qualified clinicians or the local emergency response system. Consistent, systematic technique — always comparing one side to the other, always noting the patient's baseline — is what makes the exam reliable enough to act on. No finding authorizes the therapist to independently diagnose or treat; it authorizes accurate reporting and timely escalation.

The college version

1. Inspection: the eyes-first screen

Inspection assesses level of consciousness (often summarized with the Glasgow Coma Scale, or GCS, which scores eye, verbal, and motor responses), (sweating), skin color and (bluish tint from low oxygen), and (rounded, bulbous fingertips from chronic hypoxia). It also reveals chest configuration, such as a barrel chest (an increased front-to-back diameter typical of chronic air trapping), tracheal shift, use of accessory muscles, intercostal or supraclavicular retractions, and paradoxical movement where part of the chest moves opposite to the rest.

2. Palpation and percussion: feeling and tapping for density

Palpation checks (the vibration of the voice transmitted through the chest — decreased over fluid or air, increased over consolidated solid lung), (a crackling, "rice-krispies" feel of subcutaneous emphysema, meaning air in the tissue), and expansion symmetry (whether both sides move equally). Percussion produces resonance (normal air-filled lung), hyperresonance (extra air, as in pneumothorax or air trapping), dullness (fluid or consolidation), or flatness (solid, as over the liver or a large effusion).

3. Auscultation: listening for airflow

Normal vesicular breath sounds are soft and low-pitched over most lung fields; bronchial (or tubular) sounds are louder and higher-pitched over the large airways. Abnormal sounds include crackles (rales; discontinuous popping from fluid opening small airways), wheezes (continuous musical sounds from narrowed airways), rhonchi (low-pitched, snoring sounds from secretions), stridor (a harsh upper-airway sound), and a pleural friction rub (a grating sound from inflamed pleural surfaces).

How it works

  1. General appearance and vital signs establish baseline and urgency.
  2. Breathing pattern and chest movement are inspected.
  3. Palpation assesses fremitus, crepitus, and expansion symmetry.
  4. Percussion maps resonance, hyperresonance, dullness, and flatness across the chest.
  5. Auscultation compares breath sounds side to side.
  6. Findings are documented and correlated; abnormal or urgent findings are escalated.

Common confusions

Do not confuseWithDifference
CyanosisPallorCyanosis is bluish (low oxygen); pallor is pale (low blood flow)
WheezesRhonchiWheezes are high-pitched musical; rhonchi are low-pitched snoring from secretions
CracklesPleural friction rubCrackles are in the lung and clear with cough sometimes; a rub is a grating pleural sound
StridorWheezeStridor is loudest over the upper airway on inspiration; wheeze is more diffuse and expiratory
HyperresonanceResonanceHyperresonance means extra air; resonance is normal air
Cheyne-StokesKussmaulCheyne-Stokes waxes and wanes with pauses; Kussmaul is uniformly deep and rapid

Memory aids

"IPPA" — Inspection, Palpation, Percussion, Auscultation — the four pillars of the chest exam, performed in that order. Adding "from the doorway" reminds the therapist that general appearance comes first, before any hands-on technique.

Quick review

Topic Recap

Cardiopulmonary examination is a four-step, systematic process — inspection, palpation, percussion, and auscultation — supported by general appearance and vital signs. Breathing patterns, chest configuration, percussion notes, and breath sounds each contribute one piece of a diagnostic picture that the therapist assembles and reports. The therapist's scope is assessment and escalation; diagnosis and treatment remain the provider's responsibility, and all normal ranges, exam techniques, and interpretation criteria must be verified against the current NBRC detailed content outline, candidate handbook, AARC clinical practice guidelines, facility protocols, state licensure requirements, provider orders, and manufacturer instructions for use.

Knowledge Check

  1. What is the correct order of the four examination techniques?
  2. Which finding pair most suggests a pneumothorax (air in the pleural space)?
  3. Which breathing pattern is classically associated with metabolic acidosis?
  4. What does bronchial (tubular) breath sound heard over the peripheral lung suggest?
  5. Which sound is an upper-airway finding that requires immediate escalation?

Answers and Rationales

  1. Inspection, palpation, percussion, auscultation. This order moves from least to most intrusive and is performed consistently so findings are comparable across exams.
  2. Decreased tactile fremitus plus hyperresonance. Air in the pleural space blocks voice vibration (decreased fremitus) and produces an extra-air percussion note (hyperresonance).
  3. breathing. Deep, rapid, "air-hungry" respirations are the body's attempt to blow off carbon dioxide in metabolic acidosis.
  4. Consolidation (solid lung). Bronchial sounds are normally confined to the large airways; hearing them peripherally means dense, solid tissue is transmitting airway sounds to the surface.
  5. Stridor. It indicates a narrowed upper airway and can progress to complete obstruction, so it is a recognition-and-escalation situation.
Eli, the EliExplains learning guide

Eli explains

The same idea, in plain words

Explain it like I’m 10

Examining the chest is like checking a house before you know what is wrong: first you look at it from the outside, then you knock on the walls, then you listen for odd sounds. Inspection is looking — at color, breathing effort, and the shape of the chest. Palpation is feeling — for vibration when the person speaks and for air trapped under the skin. Percussion is tapping — a hollow, airy tap sounds different from a dull, solid tap, the way a full drum differs from a full water bottle. Auscultation is listening — normal lungs make a soft rustle, while fluid or a narrowed airway makes crackles or whistles.

A comparison that helps: percussion is the respiratory therapist's version of tapping a wall to find a stud. Hollow means air behind the wall; solid means something dense. Where it stops being exact is that a chest wall is not a uniform surface — muscle, fat, and ribs all change the sound, so percussion is a clue to confirm with other findings, never a diagnosis by itself.

Simple Example

A person who is breathing 30 times per minute, using neck muscles, with a dull tap over the right lower chest and reduced breath sounds there is likely to have fluid or collapsed lung tissue in that region — not a clean-air problem. Each step of the exam adds one more piece of the same picture.

Worked example

  1. Start with general appearance before touching anything. The reason: level of consciousness, breathing effort, and color tell you immediately whether this is a stable screening exam or an urgent situation. Any sign of severe distress triggers recognition and escalation rather than a leisurely exam.
  2. Record vital signs as a set, not in isolation. Heart rate, blood pressure, respiratory rate, temperature, and SpO2 (pulse oximetry) are interpreted together because they compensate for one another; a rising heart rate and respiratory rate can be the first signs of failing oxygenation even when SpO2 still looks acceptable.
  3. Watch the breathing pattern. Eupnea is normal, easy breathing; tachypnea is fast and shallow; bradypnea is abnormally slow; Cheyne-Stokes is a cycle of progressively deeper then shallower breaths with pauses; Kussmaul is deep, rapid, "air-hungry" breathing; Biot's is irregular clusters of breaths with sudden stops; apnea is the absence of breathing. Each pattern points the provider toward a different underlying problem.
  4. Inspect the chest shape and movement. Tracheal shift suggests a mass or pressure pushing the airway to one side; a barrel chest suggests chronic air trapping; accessory-muscle use and retractions mean increased work of breathing; paradox suggests a flail segment or diaphragm problem. These are reported findings that change the urgency and direction of escalation.
  5. Palpate for vibration, air, and symmetry. Increased tactile fremitus over an area suggests solid, consolidated lung; decreased fremitus suggests fluid or air blocking vibration; crepitus means subcutaneous air; unequal expansion suggests one side is not inflating.
  6. Percuss to map density. Resonance is expected; hyperresonance over one side suggests trapped air; dullness suggests fluid or solid tissue; flatness suggests a completely solid region.
  7. Auscultate in a systematic, side-to-side pattern so both lungs are compared at the same levels. Reduced or absent sounds, or the presence of crackles, wheezes, rhonchi, stridor, or a friction rub, are each reported to the provider who will integrate them into a diagnosis.
  8. Correlate, then report. The value of the exam is the pattern — one abnormal finding in isolation is weak evidence, but inspection + palpation + percussion + auscultation together build a coherent picture that the provider uses to decide next steps.

Key takeaways

  • High yield: The sequence is inspect → palpate → percuss → auscultate, and it should be done the same way every time for consistency.
  • High yield: Decreased tactile fremitus plus hyperresonance points to air; decreased fremitus plus dullness points to fluid.
  • High yield: Stridor is an upper-airway sound and a potential airway emergency — recognition and immediate escalation are required.
  • Vital signs compensate for each other, so they must be read as a set.
  • Kussmaul breathing classically accompanies metabolic acidosis; Cheyne-Stokes is associated with certain brain and heart conditions.
  • A barrel chest suggests chronic air trapping; tracheal shift suggests mass effect or pressure.
  • Accessory-muscle use and retractions mean increased work of breathing.
  • Crackles suggest fluid opening small airways; wheezes suggest narrowed airways.
  • Bronchial breath sounds in an area that should be vesicular suggest consolidated (solid) lung.
  • The therapist reports findings; diagnosis and treatment selection are the provider's role.

Keep learning

Ready to build on this? Continue to the next lesson.

Practice Respiratory Therapy

This lesson has no separate scored set. Practice draws from the subject’s question bank.

Study tools & related lessonsYou’ll learn to · Key vocabulary · Related

You’ll learn to

  • Describe the four traditional examination techniques — inspection, palpation, percussion, and auscultation — and the order in which they are performed.
  • Interpret general appearance and vital signs (heart rate, blood pressure, respiratory rate, temperature, SpO2) as screening data.
  • Classify breathing patterns (eupnea, tachypnea, bradypnea, Cheyne-Stokes, Kussmaul, Biot's, apnea) and their typical associations.
  • Correlate percussion notes and auscultatory sounds with the underlying lung conditions they suggest, while keeping diagnosis with the provider.

Key vocabulary

GCS (Glasgow Coma Scale)
A score of eye, verbal, and motor responses
Diaphoresis
Profuse sweating
Cyanosis
Bluish skin from low blood oxygen
Clubbing
Rounded, bulbous fingertips
Tachypnea / bradypnea
Abnormally fast / slow breathing
Cheyne-Stokes
Waxing-waning breaths with pauses
Kussmaul
Deep, rapid, air-hungry breathing
Biot's
Irregular clustered breaths with abrupt stops
Tactile fremitus
Voice vibration felt on the chest wall
Crepitus
Crackling feel of air under the skin
Resonance / dullness / flatness
Normal, fluid, and solid percussion notes
Crackles / wheezes / rhonchi / stridor
Discontinuous, musical, snoring, and upper-airway sounds

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