Physical Assessment: Chest + Lungs Flashcards
Chest and Lungs
- The chest or thorax is the bony cage that protects the heart, and great vessels
- The ribs, sternum and vertebrae form the chest
Basic Assessment: Lungs
Describe:
- size + shape of chest
- relate findings to landmarks
- adventitious sounds
- diminished lung sounds
- abnormal vocal sounds
Chest Shape + Size
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
Interview: Nursing History For Lung Assessment
- 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
Assessing Oxygenation Status
Physical examination
- breathing pattern
- respiratory effort
- pulse oximetry
- IPPA, Inspect, Palpate, Percuss, Auscultate
Breathing Pattern
- Eupnea
- Tachypnea
- Bradypnea
- Apnea or periodic breathing
- Kussmauls breathing
- Biots breathing
- Cheyne-stokes respirations
Respiratory Effort
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
Inspection: Contour + Shape of Chest
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
Palpate: tactile fremitus
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
Percussion
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
Sounds Produced by Percussion
- resonance
- hyperresonance
- dullness
- flatness
Percussion Sounds: Resonance
normal sound heard on percussion over healthy lung tissue
Percussion Sounds: Hyperresonance
a long low-pitched hollow sound heard over areas with trapped gas, of increased air such as pneumothorax or emphysema
Percussion Sounds: Dullness
a dull sound usually heard over solid mass, such as a tumor
Percussion Sounds: Flatness
heard over dense tissue
Assessing Lung Sounds
-compare bilaterally
-auscultate one full respiratory cycle
3 Sounds:
>Bronchial
>Bronchovesicular
>Vesicular
Lung/Breath Sounds: Bronchial
- 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
Lung/ Breath Sounds: Bronchovesicular
- 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
Lung/ Breath Sounds: Vesicular
- soft
- low-pitched
- breezy sound
- inspiratory phase is longer
- air moving through the smaller airways produces these sounds
- best heard over the lung fields
Abnormal or Adventitious Sounds (Breath)
- adventitious
- diminished or misplaced
- abnormal vocal sounds
Adventitious
abnormal breath sounds: -wheezes -rhonchi -rales if abnormal sound is heard, have client cough and listen again
Abnormal Breath Sounds: Diminished or Misplaced
heard with poor inspiratory effort
- in very muscular or obese or
- with restricted airflow
Abnormal Breath Sounds: Abnormal Vocal Sounds
-bronchophony
-whispered pectoriloquy
-andegophony
these result from consodilation of lung tissue
