Focused Examination Sample Discussion

A client presents with a chief complaint of a cough that has lasted for a while. The cough was accompanied by fever and green sputum. However, recenty, the sputum has been blood-stained. The presenting problems mainly stem from the respiratory system. For this patient with respiratory system problems, a focused respiratory system health history and a focused physical examination are integral to determine the diagnosis and prognosis.

Focused Health History

A focused health history narrows down assessment to a specific system or organ/body region to detect possible errors without wasting time on non-affected areas (Wan & Zeng, 2020). According to the presenting problems, the patient has problems with the respiratory system; hence a focused respiratory system history is integral. The onset, duration, and frequency of the symptoms are integral in determining the primary diagnosis and severity of the condition. History of past respiratory illnesses such as asthma, tuberculosis, and pneumonia can be suggestive recurrence or etiology of current disease.

Tonsils and adenoids for this client were removed in her childhood Family history of respiratory illnesses, smoking history, and environmental exposures are also integral etiological factors. Additional information necessary in the patient’s history includes dyspnea, cough/sputum and its characteristics, fever, chills, chest pain for inflammation diagnosis, current and past medications, and exacerbating and relieving factors. The information is integral in informing the diagnosis and treatment.

A Focused Physical Examination of the Respiratory System

The focused physical examination reveals finer details unknown to the patient, informing the diagnosis and treatment (Cox & Ham, 2017). The focused physical examination is divided into four:

Inspection: Inspect the use of accessory muscles and labored breathing which could indicate congestion. Chest symmetry with breathing could reveal any injuries to the chest and conditions such as pneumonia, atelectasis, and fractured ribs. Inspecting the rate and depth of breathing is also vital. The color of the face, lips, and hands indicates oxygen levels and respiratory compromise. In addition, inspect for nasal flaring and an anxious look, which would indicate respiratory distress. Measuring the peripheral oxygen concentration is integral at this point (Cox & Ham, 2017).

Auscultation: Auscultating reveals problems in the lungs and respiratory tract problems through abnormal breath sounds. These breath sounds include fine crackles (asthma and COPD), coarse crackles (pulmonary edema), wheezes (asthma, emphysema, and bronchitis), rhonchi (pneumonia), and creaking (pleurisy) (Cox & Ham, 2017). Auscultation should be on both the anterior and posterior chest.

Palpation: Palpation of the chest reveals tenderness (due to pain and inflammation), asymmetry (with injury or severe diseases), diaphragmatic excursion, crepitus (lung inflammation and exudate formation), and vocal fremitus. Vocal fremitus is vibrations with talking, and breathing and areas where it is higher than others may indicate denser tissues in cases such as pneumonia or malignancy.

Percussion: Chest percussion will help elicit sounds to determine the underlying tissue. The characteristic sound produced is the resonant sound. Hyper resonance/ tympanic sounds indicate pneumothorax. The techniques used in the focus examination reveal characteristics of the chest integral in making a diagnosis.


  • Wan, X., & Zeng, R. (2020). Guide for Focused History Taking. In Handbook of Clinical Diagnostics (pp. 113-114). Springer, Singapore.
  • Cox, C. L., & Ham, J. (2019). Examination of the Respiratory System. Physical Assessment for Nurses and Healthcare Professionals