Pulmonary Flashcards
Inspection Elements
Chest wall: any deformities? Symmetric expansion AP diameter of the chest is typically < lateral chest diameter 0.70 to 0.75 average for healthy adult AP diameter increases with age Kyphosis Lordosis Scoliosis Barrel chest Lips and fingernails
AP diameter of the chest is typically
lateral chest diameter
0.70 to 0.75 average for healthy adult
AP diameter increases
with age Kyphosis Lordosis Scoliosis Barrel chest
Resp Rate Elements
Respiratory effort Any retraction of muscles Do you hear any sounds? Stridor Wheeze Dyspnea Tachypnea Bradypnea Orthopnea
Cough
Onset Sputum production or dry cough characteristics Frequency Severity Associated symptoms What have they tried Sputum
SOB
Onset Pattern Severity Associated symptoms What have they tried
Chest pain
Onset and duration
Associated symptoms
What have they tried
Palpate thoracic muscles
Tenderness Depressions Masses Bulges Crepitus Crackly sensation Air in subcutaneous tissue Palpated and heard
Thoracic Expansion place thumbs along the
thumbs along the spinal processes at the level of the 10th rib
Tactile fremitus
Palpable vibration
Heard best at the level of bifurcation of the bronchi
Ask patient to recite “99” or “Mickey Mouse”
Compare sides-do both sides feel similar?
Increased fremitus with fluid or a mass
Decreased fremitus with decreased lung tissue density
COPD
Asthma
Percussion two techniques
direct and indirect
Percussion - Resonance is
normal
Percussion - Hyper resoance indictes
hyper inflation
COPD
Percussion - Dullness noted with decreased air exchanges indicates
Pneumonia
Atelectasis
pleural effusion
Measuring Diaphragmatic Excursion
Typically 3 to 5 cm
May be decreased in pulmonary or abdominal diseases
Percuss along the scapular line
Auscultation
Patient in upright position Compare right lung to left lung Start at Apex then proceed to base Listen for Intensity Pitch Quality Duration Use diaphragm of stethoscope High pitched sounds
Vesicular
Heard over most lung fields
Low pitched, low intensity
Bronchovesicular
Heard over the bronchi
Moderate pitch, moderate intensity
Bronchial
Heard over the trachea
High pitched
Crackles
Heard more often during inspiration
Does not clear with a cough
Rhonchi
Loud, low, coarse sound caused by thick secretions, muscular spasm, tumor, external pressure
May clear with a cough
Wheeze
High pitched musical sound heard during inspiration or expiration
Pleural effusion rub
Grating sound caused by inflammation of pleural spaces
Pleural friction rub
Inflammation of the pleural spaces
Heard on inspiration and expiration
Disappears while holding your breath
Pericardial friction rub
Inflammation of the pericardium
Louder on inspiration
Does not disappear while holding your breath
Bronchophony
Recite numbers, names, words
99 or Mickey Mouse
Increased clarity and loudness of spoken words
Occurs with solid mass or lung consolidation with pneumonia
Egophony
“E” changes to “Aaay”
Occurs with lung consolidation
Pneumonia
Fibrosis
Respiratory Abnormalities
Atelectasis Bronchitis Pleural effusion Asthma Pneumonia Pleurisy
Infant A/P diameter
approximately the same as lateral diameter
RR 40-60/min
School aged (6-12 years) RR
RR 18-30/min
Pregnant Patients
Dyspnea is common
Breathing is deeper but not more frequent
Asthma could be affected during pregnancy
Elderly Patients
Chest expansion may be decreased Calcification of ribs Patients may be less able to use respiratory muscles due to muscle weakness general physical disability sedentary lifestyle Bony prominences are marked Less subcutaneous tissue Kyphosis Doral curve of the thoracic spine
RML heard best between
the right midaxillary line to the right axillary line on the anterior portion of the chest
Right bronchus is
wider, shorter, and more vertically placed than left bronchus
More susceptible to aspiration of foreign objects
Diaphragm on the right chest may be
higher than the left chest due to the size and position of the liver
Always compare right to left
ROS
Denies cough, sputum production, shortness of breath
PE
Respiratory rate regular with ease of chest expansion. Breath sounds clear to auscultation bilaterally without wheezes, rhonchi or crackles. AP diameter less than lateral diameter. Lung percussion resonant in all lung fields bilaterally. Thoracic expansion symmetric. Diaphragmatic excursion 3 cm bilaterally. RR documented under VS
Kyphosis
Outward curvature of the back. Elderly women
Lordosis
Sway back. Inward arch
Scoliosis
Sideward curve
Barrel Chest
round bulging chest
Decreased fremitus could indicate
air or fluid in the pleural space or COPD or asthma
Dullness to percussion indicates
denser tissue
Consolidation with pneumonia
solid mass tumor
pleural effusion
Most common lung condition found in surgery
atelectasis
pleurisy
inflmaiton of pleural spaces
