Clinical Assessment of Pulmonary Patient - Manual Flashcards
what are ways in which shortness of breath can occur with positional changes
orthopnea = inability to lay down without dyspnea
paroxysmal nocturnal dyspnea = waking in the middle of night with gasping
asking patient about cough entails what information
dry vs productive
effective vs ineffective
sequential steps of pulmonary patient assessment
observation
palpation
percussion of the chest
auscultation
in observation what do we first look at
breathing musculature and observe any accessory muscle usage
- nasal flaring
why would examining the thorax be important
structural deformities
- kyphoscoliosis
- pectus carinatum / excavatum
how would we observe for signs of chronic disease
clubbing of digits
increased A-P diameter
horizontal ribs
how to measure chest excursion
in seated position
place tape measure around the chest
instruct patient to exhale maximally (take value)
instruct patient to inhale maximally (take value)
difference between is chest excursion
what are the landmarks for chest excursion measurement
axilla
xiphoid
midway between xiphoid and belly button
how to assess tracheal position
neck slightly flexed and SCM relaxed
at suprasternal notch, move index finger to sternoclavicular junction
– if soft tissue is encountered then this may indicate mediastinal/tracheal shift
how to palpate respiratory excursion
patient sitting upright with slight forward flexion
place thumb of each hand paravertebrally and equidistant from the spinal column
fingers outstretched to four lowest intercostal spaces
patient inhales maximally with hands accompanying the respiratory movement
record end placement of thumbs and hands
how to palpate lateral costal expansion
patient seated - facing the patient, therapist places palms of each hand on
8-10th rib at mid-axillary line
patient maximally inhales
observation of symmetrical excursion
how to palpate diaphragmatic movement
patient seated
therapist places palm of hand horizontally beneath xiphoid
maximal inhalation
therapist palpates for muscle tension
what sound will normal lung parenchyma produce upon percussion
low pitched resonant sound
what does solid tissue produce upon percussion
high pitched sound with dull to flat note
what pathologies would cause increased solid tissue to be found in parenchyma
atelectasis
fibrosis
fluid consolidation in pleural space
what will percussion of the diaphragm sound like
abrupt
flat note
what causes rhonchus / wheezes anatomically
lumen of the tracheobronchial tree becomes narrowed
resistance to airflow is increased
what phase of respiration are wheezes most pronounced in? what will pitch of the wheeze tell us?
expiration
high pitched = originate in small bronchi/bronchioles
low pitched = originate in large bronchi/bronchioles
crackles / rales are most pronounced during which phase of respiration
inspiration
course rales
- originate from where?
- are produced during what phase of respiration?
larger or medium sized bronchi
initial part of inspiration
medium rales
- originate from where?
- are produced during what phase of respiration?
smaller bronchi
middle phase of inspiration
fine rales
- originate from where?
- are produced during what phase of respiration?
terminal bronchi
last part of inspiration
explain cardiac rales
bilateral involvement
explain stridor
high pitched sound during inspiration
— indicating blockage in upper airway
explain pleural rub
loud, dry, creaking sound
pleural irritation during latter part of inspiration and early expiration
most detected in lower areas of chest wall
bronchophony
- what is it?
- where is it found?
- what causes it to be heard?
increased clarity and loudness of words
large bronchus
consolidation or compression of lung tissue
whispered pectoriloquy
- what is it?
- where is it found?
- what causes it to be heard?
increased clarity of whispered words
large bronchus
consolidation or compression of lung tissue
–> will occur before bronchophony
egophony
- what is it?
- where to find it?
- what causes it
when the letter E is said, the letter A is heard
lobes of the lung posteriorly
consolidation or compression of lung tissue
auscultated fremitus
- what is it?
- where to find it?
- what causes it?
when patient says “99” the sound becomes increased in intensity
right upper lobe
consolidation of lung tissue
explain auscultated vs vocal fremitus
auscultated = due to consolidation and increased intensity of sound
vocal = due to fluid/air being in the pleural space and decreased intensity of sound
tactile fremitus
- what is it?
- what causes it?
patient says 99 or blue balloon and vibrations are more or less intense
increased = pneumonia / lung consolidation
decreased = pleural effusion, pneumothorax, emphysema
