Physical Assessment: Chest + Lungs

Question 1

Chest and Lungs

Answer 1

• The chest or thorax is the bony cage that protects the heart, and great vessels
• The ribs, sternum and vertebrae form the chest

Question 2

Basic Assessment: Lungs

Answer 2

Describe:

• size + shape of chest
• relate findings to landmarks
• adventitious sounds
• diminished lung sounds
• abnormal vocal sounds

Question 3

Chest Shape + Size

Answer 3

Normal:
-symmetrical
-rises + falls with respiration
-musculoskeletal changes associated with aging result in a gradual increase in the anteroposterior diameter
>change is also seen in clients who have COPD, a disorder associated with long-term smoking

Question 4

Interview: Nursing History For Lung Assessment

Answer 4

• smoking (years + packs per day)
• number of pillows patient sleeps with at night
• persistent cough: productive or non-productive color, consistency, amount, odor, expectoration
• dyspnea on exertion (DOE)
• works/lives in environment with pollutants
• history of allergies to pollen, dust, drugs
• patient/family history of Lung Disease or allergies
• frequent or chronic respiratory infection

Question 5

Assessing Oxygenation Status

Answer 5

Physical examination

• breathing pattern
• respiratory effort
• pulse oximetry
• IPPA, Inspect, Palpate, Percuss, Auscultate

Question 6

Breathing Pattern

Answer 6

• Eupnea
• Tachypnea
• Bradypnea
• Apnea or periodic breathing
• Kussmauls breathing
• Biots breathing
• Cheyne-stokes respirations

Question 7

Respiratory Effort

Answer 7

a patient experiencing shortness of breath or dyspnea requires a thorough assessment

• ask closed questions
• ask whether the shortness of breath began suddenly or gradually, how severe it is right now, and whether it is getting better or worse

Question 8

Inspection: Contour + Shape of Chest

Answer 8

Normal Thorax: 
-oval in shape
-anterior/ posterior is half the transverse diameter and is described as 1:2
Abnormal:
-barrel chest
-round
-1:1 anteroposterior diameter

Question 9

Palpate: tactile fremitus

Answer 9

palpates posterior (back) thorax for vocal or tactile fremitus
-faintly perceptible vibrations felt through the chest wall when the client speaks
-ask to say “99”
Normal:
-bilateral symmetry
Abnormal:
-asymmetrical
-decreased, absent, or increased fremitus

Question 10

Percussion

Answer 10

process of tapping on a surface to evaluate the size + density of the underlying structures
-performed by placing the distal portion of the middle finger of the non-dominant hand firmly on the chest wall, using fingers of the dominant hand to strike the middle finger behind the nail bed, and evaluate the sound emitted

Question 11

Sounds Produced by Percussion

Answer 11

• resonance
• hyperresonance
• dullness
• flatness

Question 12

Percussion Sounds: Resonance

Answer 12

normal sound heard on percussion over healthy lung tissue

Question 13

Percussion Sounds: Hyperresonance

Answer 13

a long low-pitched hollow sound heard over areas with trapped gas, of increased air such as pneumothorax or emphysema

Question 14

Percussion Sounds: Dullness

Answer 14

a dull sound usually heard over solid mass, such as a tumor

Question 15

Percussion Sounds: Flatness

Answer 15

heard over dense tissue

Question 16

Assessing Lung Sounds

Answer 16

-compare bilaterally
-auscultate one full respiratory cycle
3 Sounds:
>Bronchial
>Bronchovesicular
>Vesicular

Question 17

Lung/Breath Sounds: Bronchial

Answer 17

• loud
• high-pitched
• tubular sounds
• expiration is longer
• air moving through the trachea produces these sounds, which you hear best over the trachea on the anterior chest and below the nape of the neck on the posterior chest

Question 18

Lung/ Breath Sounds: Bronchovesicular

Answer 18

• medium pitched
• equal inspiratory + expiratory phase
• air moving through the large airways of the bronchi produces these sounds
• best heard over 1 + 2 ICS adjacent to the sternum on the anterior chest and between the scapulae on the posterior chest

Question 19

Lung/ Breath Sounds: Vesicular

Answer 19

• soft
• low-pitched
• breezy sound
• inspiratory phase is longer
• air moving through the smaller airways produces these sounds
• best heard over the lung fields

Question 20

Abnormal or Adventitious Sounds (Breath)

Answer 20

• adventitious
• diminished or misplaced
• abnormal vocal sounds

Question 21

Adventitious

Answer 21

abnormal breath sounds:
-wheezes
-rhonchi
-rales
if abnormal sound is heard, have client cough and listen again

Question 22

Abnormal Breath Sounds: Diminished or Misplaced

Answer 22

heard with poor inspiratory effort

• in very muscular or obese or
• with restricted airflow

Question 23

Abnormal Breath Sounds: Abnormal Vocal Sounds

Answer 23

-bronchophony
-whispered pectoriloquy
-andegophony
these result from consodilation of lung tissue