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منت خدای را عزوجل که طاعتش موجب قربت است و به شکراندرش مزید نعمت . PowerPoint Presentation
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منت خدای را عزوجل که طاعتش موجب قربت است و به شکراندرش مزید نعمت .

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منت خدای را عزوجل که طاعتش موجب قربت است و به شکراندرش مزید نعمت . - PowerPoint PPT Presentation


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منت خدای را عزوجل که طاعتش موجب قربت است و به شکراندرش مزید نعمت . هر نفسی که فرو می رود ممد حیات است و چون بر می آید مفرح ذات. پس در هر نفسی دو نعمت موجود است و بر هر نعمت شکری واجب .

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slide2

منت خدای را عزوجل که طاعتش موجب قربت استوبه شکراندرش مزید نعمت.

هر نفسی که فرو می رود ممد حیات است و چون بر می آید مفرح ذات. پس در هر نفسی دو نعمت موجود است و بر هر نعمت شکری واجب.

laudation to the theGOD of majesty and glory obedience to him is cause of approach and gratitude in increase of benefits.Every inhalation of the breath prolongs life and every expiration of it gladdens our nature. wherefore every breath confers two benefits and for every benefit gratitiude is due.

گلستان سعدي

assessment of the respiratory system

ASSESSMENT OF THE RESPIRATORY SYSTEM

M.MOHSENABADI

STUDENT OF CRITICAL CARE NURSING(MSC)

objectives
Objectives:

The students will be able to:

  • Discuss assessment of Respiratory system
  • Discuss important points of assessment of Respiratory system
  • Obtain health history about respiratory system
  • Demonstrate physical examination
  • Differentiate between normal and abnormal findings
patient history
Patient History
  • Respiratory infections or diseases(URI)
  • Trauma
  • Surgery
  • Chronic conditions of other systems
  • Irritation of airway
  • Signs of infectious process
  • History of TB, when treated?
  • Presence of cough ,Sputum?
    • Last PPD and/or chest x-ray
    • Allergies
    • Medication use

URDEN, L. D. 2010. diagnosis and management. Thelan's critical care nursing, 567-595.

patient history cont
Patient History (cont,)
  • Any risk factors for respiratory disease
  • smoking
  • lifestyle, immobilization
  • Age
  • Environmental exposure
    • Dust, chemicals, asbestos, air pollution
  • Obesity

URDEN, L. D. 2010. diagnosis and management. Thelan's critical care nursing, 567-595.

patient history cont1
Patient History (cont,)

Family Health History:

  • Tuberculosis
  • Emphysema
  • Lung Cancer
  • Allergies
  • Asthma

URDEN, L. D. 2010. diagnosis and management. Thelan's critical care nursing, 567-595.

shortness of breath or dyspnea
Shortness of Breath or Dyspnea
  • Onset – sudden,….
  • Duration
  • Severity – disrupts activities
  • Associated symptoms – night sweats, pain, chest pressure, discomfort, ankle edema, diaphoresis, cyanosis
  • What brings it on? – position, time of day, exercise, allergens, emotions
  • What makes it better?
  • What has been tried? – medications, inhalers, oxygen

URDEN, L. D. 2010. diagnosis and management. Thelan's critical care nursing, 567-595.

cough
Cough
  • Type
    • dry, moist, wet, productive,……
  • Onset
  • Duration
  • Pattern
    • activities, time of day, weather
  • Severity
  • Wheezing
  • Associated symptoms
  • Treatment and effectiveness

URDEN, L. D. 2010. diagnosis and management. Thelan's critical care nursing, 567-595.

sputum
sputum
  • amount
  • color
  • presence of blood (hemoptysis)
  • odor
  • consistency
  • pattern of production

URDEN, L. D. 2010. diagnosis and management. Thelan's critical care nursing, 567-595.

listen to the patient

Listen to the patient…

…they will tell exactly what is wrong!

the basic steps of the examination
The basic steps of the examination
  • Inspection
  • Palpation
  • Percussion
  • Auscultation

URDEN, L. D. 2010. diagnosis and management. Thelan's critical care nursing, 567-595.

inspection
Inspection
  • General
    • Appearance
    • Posturing
    • Breathing effort
    • Trachea position
      • Midline

ودياليز،عسگری،محمدرضا، 1390. ICU,CCUمراقبتهاي پرستاري ويژه در بخش های

inspection cont
Inspection (cont,)
  • Tracheal deviation (can suggest oftension pneumothorax)
  • Chest wall deformities
  • Kyphosis - curvature of the spine - anterior-posterior
  • Scoliosis - curvature of the spine - lateral
  • Barrel chest - chest wall increased anterior-posterior; normal in children; typical of hyperinflation seen inCOPD

URDEN, L. D. 2010. diagnosis and management. Thelan's critical care nursing, 567-595.

inspection cont1
Inspection (cont,)
  • Chest Wall Configuration
    • Form
    • Symmetry
    • Muscle development
    • Anterior-Posterior (AP) diameter
    • Costal angle

ودياليز،عسگری،محمدرضا، 1390. ICU,CCUمراقبتهاي پرستاري ويژه در بخش های

inspection cont2
Inspection (cont,)
  • Oxygenation: cyanosis
    • Nails
    • Skin
    • Lips
  • Respiratory Effort
    • Respiratory rate and depth
    • Breathing pattern
    • Chest expansion

URDEN, L. D. 2010. diagnosis and management. Thelan's critical care nursing, 567-595.

slide18

Thoracoplasty

with secondary

changes in the spine.

Tension

Pneumothorax

FLAIL CHEST

Kyphosis

reference lines
Reference Lines
  • Anterior Chest
    • Midsternal line
    • Anterior axillary lines
    • Midclavicular lines
  • Posterior Chest
    • Vertebral line
    • Midscapularlines
  • Axilla
    • Anterior axillary lines
    • Midaxillary lines
    • Posterior axillary lines

BURGHARD.J ,2011,Critical care nursing made incredibly easy.

palpation
Palpation
  • Thoracic Expansion (Excursion)
    • Place both thumbs at about 7th rib posteriorly along the spinal process
    • Extend the fingers of both hands outward over the posterior chest wall
    • Have the person take a deep breath and observe for bilateral outward movement of thumbs
      • Normal: bilateral, symmetric expansion
      • Abnormal: unilateral or unequal

URDEN, L. D. 2010. diagnosis and management. Thelan's critical care nursing, 567-595.

palpation cont
Palpation(cont,)
  • Vocal Fremitus
    • Use palmar surfaces of hands
    • Systematically position hands over both sides of posterior chest
    • Have person repeat “1 – 2 – 3” or “99” as you move from the apices to the bases
      • Normal: bilaterally symmetrical vibrations
      • Decreased or absent: obstruction of transmission 0bronchitis, emphysema)
      • Increased: consolidation (compression) of lung tissue (pneumonia)
percussion
Percussion
  • Helps to identify if underlying tissues are air-filled, fluid-filled, or solid
    • Hyperextend middle finger of either hand and press against chest wall
    • Strike with flexed middle finger of opposite hand
  • Always percuss symmetrically on chest wall
percussion cont
Percussion(cont,)
  • Flatness
    • Thigh
  • Dullness
    • Liver
  • Resonance
    • Lung
  • Hyperresonance
    • None
  • Tympani
    • Stomach, puffed cheek

URDEN, L. D. 2010. diagnosis and management. Thelan's critical care nursing, 567-595.

percussion cont1
Percussion(cont,)
  • Dullness replaces resonance when fluid or solid tissue replaces air containing lung
    • Pleural Effusions
    • Hemothorax
    • Tumor
  • Unilateral Hyper resonance
    • Pneumothorax
  • Generalized Hyperresonance
    • COPD

URDEN, L. D. 2010. diagnosis and management. Thelan's critical care nursing, 567-595.

auscultation
Auscultation
  • Auscultate in a systematic manner
  • Compare one side to the other
  • Listen one full respiration at each spot
  • Displace breast tissue to listen directly over chest wall
  • DO NOT listen through gowns, clothes, etc.
    • Place your stethoscope over bare skin

URDEN, L. D. 2010. diagnosis and management. Thelan's critical care nursing, 567-595.

auscultation cont
Auscultation(cont,)
  • Evaluate posterior, lateral, and anterior chest
  • Instruct person to sit upright and breathe in and out slowly through the mouth
    • This makes it easier to hear the air movement
  • Use the diaphragm of the stethoscope
  • To assess breath sounds, ask the patient to breathe in and out slowly and deeply through the mouth.

URDEN, L. D. 2010. diagnosis and management. Thelan's critical care nursing, 567-595.

auscultation cont1
Auscultation(cont,)
  • 12 anterior locations
  • 14 posterior locations
  • Auscultate symmetrically
  • Should listen to at least 6 locations anteriorly and posteriorly
breath sounds
Normal

Tracheal

Bronchial

Bronchovesicular

Vesicular

Abnormal

Absent/Decreased

Bronchial

Adventitious

Crackles (Rales)

Wheeze

Rhonchi

Stridor

Pleural Rub

Breath Sounds

URDEN, L. D. 2010. diagnosis and management. Thelan's critical care nursing, 567-595.

normal breath sounds
Normal Breath Sounds
  • Tracheal
    • Very loud, high pitched sound
    • Inspiratory = Expiratory sound duration
    • Heard over trachea
  • Bronchial
    • Loud, high pitched sound
    • Expiratory sounds > Inspiratory sounds
    • Heard over manubrium of sternum
    • If heard in any other location suggestive of consolidation
normal breath sounds cont
Normal Breath Sounds (cont,)
  • Bronchovesicular
    • Intermediate intensity
    • Inspiratory = Expiratory sound duration
    • Heard best 1st and 2nd ICS anteriorly, and between scapula posteriorly
    • If heard in any other location suggestive of consolidation
  • Vesicular
    • Soft, low pitched sound
    • Inspiratory > Expiratory sounds
    • Major normal BS, heard over most of lungs
adventitious breath sounds
Adventitious Breath Sounds
  • Crackles (Rales)
    • Discontinuous, intermittent, nonmusical, brief sounds
    • Heard more commonly with inspiration
    • Classified as fine or coarse
    • Crackles caused by air moving through secretions and collapsed alveoli
    • Associated conditions
      • pulmonary edema, early CHF,…

URDEN, L. D. 2010. diagnosis and management. Thelan's critical care nursing, 567-595.

adventitious breath sounds1
Adventitious Breath Sounds
  • Wheeze
    • Continuous, high pitched, musical sound, longer than crackles
    • Hissing quality, heard > with expiration, however, can be heard on inspiration
    • Produced when air flows through narrowed airways
    • Associated conditions
      • asthma, COPD

URDEN, L. D. 2010. diagnosis and management. Thelan's critical care nursing, 567-595.

adventitious breath sounds2
Adventitious Breath Sounds
  • Rhonchi
    • Similar to wheezes
    • Low pitched
    • continuous, musical sounds
    • Implies obstruction of larger airways by secretions
    • Associated condition
      • acute bronchitis

URDEN, L. D. 2010. diagnosis and management. Thelan's critical care nursing, 567-595.

adventitious breath sounds3
Adventitious Breath Sounds
  • Stridor
    • Inspiratory musical wheeze
    • Loudest over trachea
    • Suggests obstructed trachea or larynx
    • Medical emergency requiring immediate attention
    • Associated condition
      • inhaled foreign body

URDEN, L. D. 2010. diagnosis and management. Thelan's critical care nursing, 567-595.

adventitious breath sounds4
Adventitious Breath Sounds
  • Pleural Rub
    • Discontinuous or continuous brushing sounds
    • Heard during both inspiratory and expiratory phases
    • Occurs when pleural surfaces are inflamed and rub against each other
    • Associated conditions
      • pleural effusion, PTX

URDEN, L. D. 2010. diagnosis and management. Thelan's critical care nursing, 567-595.

adventitious breath sounds5
Crackles (Rales)

CHF

Pneumonia

Rhonchi

Pneumonia

Aspiration

COPD

Sometimes Asthma

Stridor

FBAO

Croup

Anaphylaxis

Epiglottitis

Airway burn

Wheezing

Asthma

CHF

COPD

Adventitious Breath Sounds
summary
Summary

Laryngeal-tracheal

Stridor,Grunting,SubQ,Wheezing

Tracheal-bronchiole

Rhonci,Wheezing

Bronchiol-alveoli

Rales

slide41

Refrences:

  • Urden, Linda D, 2010, Thelan's critical care nursing: diagnosis and management, St.Louis,Mosby - Elsevier, 5th
  • Burghard.J,2011, Critical care nursing made incredibly easy,3rd ed.Williams & Wilkins.
  • ذاكري مقدم م،علي اصغر پورم، 1381، مراقبتهاي پرستاري ويژه در بخش هاي ICU,CCU, ودياليز،انديشه رفيع.
  • عسگری،محمدرضا،1377، مراقبتهاي پرستاري ويژه در بخش هاي ICU,CCU, ودياليز،بشری.