thorax assessment Flashcards
where do the lungs lie?
by the costals
subjective data for ROS can include?
cough, dyspnea, chest pain w/ breathing, history of respiratory infections, smoking history, environmental exposure
how long do you auscultate the lungs?
for a full inspiration and expiration
thorax equipment needed
stethoscope, alcohol wipes, patient gown
inspection of anterior chest
landmarks, shape and symmetry, skin color and condition, note patient’s facial expression, assess level of consciousness, assess quality of respirations, count rate obtrusively
what should you inspect FOR?
airway obstruction (prolonged expiration, stridor, cough)
what should you do if a patient complains of dyspnea?
take SPO2, it porvides valuable information about the effectiveness of respirations
when do you usually require supplemental oxygen
when pulse ox is under 93%
tachypnea
rapid breaths, over 24 breaths per minute
bradypnea
rate of 10 or less per minute
hypoventilation
often at a rate less than the expected range
hyperventilation
rapid, deep breathing at a rate of greater than 24 breaths per minute
cheyne stokes breathing
usually a sign of death, start-stop pattern
ataxic breathing
periods of apnea, irregular breathing with varying depths of respiration and periods of apnea
anteroposterior diameter
compare transverse and AP diameter; should be 2:1 ratio
expected findings of inspections
symmetrical thorax; AP diameter 2:1, downward facing ribs, no cyanosis or pallor, eupneic, comfortale, trachea midline
unexpected findings
skeletal deformities; barrel chest, AP diameter 1:1, ribs horizontal, cyanosis, brady/tachypnea, work of breathing, trachea deviated
barrel chest
caused from hyperinflation of lungs due to COPD
funnel chest
marked sunken sternum and costal cartilage, does not cause any respiratory distress
pigeon chest
protrusion of sternum, should not cause respiratory distress
palpation tactics
symmetric expansion, tactile fremitus, checking for tenderness/crepitus
tactile fremitus
vibration of chest wall, result of sound transmitting through lung tissue, repeated phrase
causes of decreased fremitus
excess air in lungs, increased thickness of chest wall
cause of increased fremitus
lung consolidation, air in healthy lung replaced with something else (exudate, blood, pus, cells, etc.)
expected findings of palpation
equal chest expansion, symmetrical vibrations with tactile fremitus
unexpected findings of palpation
unequal chest expansion, pain with inspiration, unsymmetrical vibrations, decreased fremitus, increased fremitus, crepitus
percussion of thorax
tapping chest to determine consistency, predominant note should be resonance, dullness or hyperresonance can occur
auscultation of thorax
evaluate presence and quality of normal breath sounds both anterior and posterior; note description of characteristics and location of breath sounds
types of breath sounds
bronchial/tracheal, bronchovesicular, vesicular
what are the loudest breath sounds
bronchial and tracheal, closest to airway
what are the quietest breath sounds
vesicular, farthest from airway
adventitious lung sounds
crackles - fine or course
atelectatic crackles
pleural friction rub
wheeze - sibilant or sonorous rhonchi
stridor
stridor
medical emergency, signifies upper airway obstruction
common abnormalities of physical findings
asthma, atelectasis (alveoli are collapsed), bronchitis, pleurisy, COPD, pneumonia
what is pleurisy
sharp chest pain with inspiration
what are signs of COPD in physical findings
barrel chest, accessory muscle use, reduced vesicular sounds
pneumonia physical findings
crackles, dyspnea, cough with sputum
abnormal respiration patterns
sigh, tachypnea, hyper/hypoventilation, bradypnea, biot’s repiration, cheyne stokes, chronic obstructive breathing
adventitious breath sounds (similar to lung sounds)
crackles, rhonchi, wheezes, friction rub, stridor
summary checklist thorax and lungs
inspect thoracic cage, respirations, skin color, condition
palpate and confirm symmetric expansion and tactile fremitus, detect lumps, masses, or tenderness
percuss lung fields and estimate diaphragmatic excursion
ausculate and assess breath sounds, not any abnormal/adventitiouss breath sounds
common diagnostic tests
white blood cell count, sputum culture, arterial blood gas, chest x-ray, pulmonary function tests, V/Q scan
white blood cell count
blood tells us that there is an infection, not specific
sputum culture test
in petri dish, tells us what bacteria is growing, helps determine which antibiotic
arterial blood gas test
gives us blood pH, amount of CO2, and amount of bicarbon, tells us how well we are oxygenating
chest x-ray
pneumonia, collapsed lungs, image that gives us air and bone
pulmonary function test
helps diagnose asthma, COPD
V/Q scan
gold standard for pulmonary embolisms, ventilation and perfusion
red flags in pulmonary exam
- respiratory distress, cyanosis, severe wheezing, stridor, hypoxia
- vital signs and pulse ox, auscultate lungs, administer oxygen, elevate HOB, limit converstaion to conserve energy
acute respiratory symptoms
tripod position, nasal flaring, cyanosis (peripheral or central)
chronic respiratory symptoms
tripod position, barrel chest, clubbed fingernails, pursed lip breathing
