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The Respiratory System. Jean M. Wilson, BSN, RN, CCE. Assessment of the Chest and Lungs. Equipment needed: Tape measure Stethoscope Blanket or drape Ruler. A & P. Position of the Patient:

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the respiratory system

The Respiratory System

Jean M. Wilson, BSN, RN, CCE

assessment of the chest and lungs
Assessment of the Chest and Lungs
  • Equipment needed:

Tape measure

Stethoscope

Blanket or drape

Ruler

slide3
A & P
  • Position of the Patient:

Sitting = best; Allows for inspection of both the back and the chest for: the 3 S’s

Size

Shape

Symmetry

landmarks
Landmarks
  • Landmarks:

Clavicle

Trachea

Intercostal spaces (ICS)

Midclavicular lines

Axillary lines

landmarks continued
Landmarks Continued

Midsternal line

Sternum

Xiphoid process

anterior chest
Anterior Chest
  • Lungs:

Right upper lobe Left upper lobe

Right middle lobe Left lower lobe

Right lower lobe

posterior chest
Posterior Chest
  • Vertebral line
  • Right and left lobes
  • Scapula
  • Scapula line
assesessment
Assesessment
  • Anteroposterior Diameter = half of the transverse diameter
  • Unexpected findings:

Barrel chest

Pigeon chest

Funnel chest

Deviations

assessment
Assessment
  • Assess the patient’s;

Lips: color, pursed lips

Nails: clubbing, cyanosis

Nares: flaring

Oxygen saturation

Breath: odor

Patients overall color

respirations
Respirations
  • Expected:

Rhythm and pattern: even & easy with no distress

Repiration rate: 12-20 breaths per minute

Ratio of HR/RR: 1 to 4

respirations1
Respirations
  • Unexpected:

Shortness of Breath (SOB)

Tachypnea

Orthopnea

Use of accessory muscles

Retractions

patterns of respirations
Patterns of Respirations
  • Normal: regular 12-20 per minute
  • Bradypnea: slow, < 12
  • Tachypena: fast, > 20
  • Hyperpnea (hyperventilation) faster, >20 and deep
  • Sighing: sigh/deep breath
patterns of respirations1
Patterns of Respirations
  • Air trapping: increase difference in the air getting out
  • Cheyne Stokes: increase in depth with periods of apnea
  • Kussmauls: rapid, deep, and labored
  • Biots: apnea and disorganized breathing
patterns of respirations2
Patterns of Respirations
  • Ataxic: irregular, with varying depths
listening
Listening
  • Two types of breath sounds; normal and abnormal
  • Normal are called; bronchial, bronchial vesicular, and vesicular
  • Abnormal are also called; adventitious
listening1
Listening
  • Review the proper use of the stethoscope
normal breath sounds
Normal Breath Sounds
  • Bronchial: trachea, anterior only, and high pitch
  • Bronchovesicular: main bronchus, anterior and posterior, medium pitch
  • Vesicular: heard over most of the lung fields, bases, low pitch
adventicious breath sounds
Adventicious Breath Sounds
  • Crackles: fine, medium, and coarse

Fine: not cleared by coughing, heard at the end of inspiration

Medium: lower, moist, heard during inspiration, not cleared by cough

Coarse: loud, bubbly, heard on inspiration, can be cleared by coughing

adventicious breath sounds1
Adventicious Breath Sounds
  • Wheezes: musical note, squeaky, heard on inspiration or expiration
  • Rhonci: sunorous wheeze, loud, low, inspiration or expiration, coughing may clear, due to mucous accumulation
  • Stridor: bark, no air exchange
  • Pleural friction rub: rubbing, dry, grating sound, inspiration or expiration, anterior
abnormalities
Abnormalities
  • Pulsations
  • Tenderness
  • Bulges
  • Depressions
  • Unusual movement
  • Unusual positions
thoracic expansion
Thoracic Expansion
  • Stand behind the patient
  • Place palms lightly on patient’s back with thumbs at the 10th rib
  • Have patient breathe & watch thumbs with each breath
  • Symmetric expantions should be seen
  • Repeat anteriorly under the xiphoid process
trachea
Trachea
  • Midline
  • Palpate gently with index finger about suprasternal notch
  • A slight deviation to the right is normal
  • Should be non-tender
  • Pulsations = abnormal
chest percussion
Chest Percussion
  • Direct:
  • Indirect:
  • Percuss all areas anteriorly and posteriorly
percussion tones
Percussion Tones
  • Resonant: low pitch, hollow, loud, long
  • Flat: soft, extremely dull, short, high pitch
  • Dull: medium, medium-high pitch, thudlike
  • Tympanic: loud, high pitch, drumlike
  • Hyperresonant: very loud, very low pitch, long, booming sound
vocal resonance
Vocal Resonance
  • Have patient recite numbers or words as you listen to all lung fields (99)
  • Muffled sound should be heard
abnormalities1
Abnormalities
  • Cancer
  • Infections: upper respiratory, sputum production
  • Asthma
  • Chronic Obstructive Pulmonary Disease (COPD)
abnormalities continued
Abnormalities Continued
  • Emphysema
  • Pneumonai
  • Barrel Chest
  • Productive (sputum)/non-productive coughing
  • Long expirations
cough descriptions
Cough Descriptions
  • Dry
  • Moist
  • Non-productive
  • Productive: assess sputum color; yellow, green, rust, clear, purrulent, blood streaked, thick(viscous) or thin
coughs
Coughs
  • Assess:

Onset

Frequency

Regularity; certain time of day or activities

Postural changes

Smoker/non-smoker

Environmental/work related issues

references
References

Schilling, J. A. et al (2007). Health

assessment made incredibly visual!

Philadelphia: Lippincott, Williams,

& Williams.

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