Term
| inspection technique used in the examination of the lungs and respiratory system |
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Definition
Inspection
- inspect pt for general appearance, posture, and breathing effort
-observe respirations for rate, breathing pattern and chest expansion
- inspect nails, skin, and lips for color (all should be pink, cyanosis or pallor indicates inadequate oxygen sats.
-inspect the posterior thorax for shape, symmetry and muscle development (ribs should slope downwards at a 45 degree angle and thorax should be symmetrical, spinous process should be in a straight line, muscle development should be equal
- inspect anterior thorax for shape, symmetry, muscle development and costal angle. Ribs should slope down at a 45 degree angle, the thorax should be symmetric, anterior costal angle (area below the sternum and between the ribs) should be less than 90 degrees
- inspect anteroposterior to lateral diameter (1:1 = barrel chest 1:2 = normal)
Note skeletal deformities:
kyphosis
scoliosis
pectus excavatum- breast bone sinks into chest
pectus- carinatum- sternum projects forward |
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Term
| Auscultation of the lungs- what to assess and note |
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Definition
assess normal breath sounds
note any abnormal, or adventitious (additional, not normally heard sounds) - bronchial sounds heard where vesicular sounds should be heard |
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Term
| Auscultation of the posterior thorax |
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Definition
Listen to the posterior and lateral thoraxes for breath sounds. The pt should sit up straight and take deep slow breaths (or whatever is comfortable for pt) move side to side form apex (above the clavicle) to the base (10-11 rib) compare sounds from side to side
Bronchovesicular sounds over the main bronchi, around T4
Vesicular sounds- heard in peripheral lung fields |
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Term
| Ausculation of the anterior thorax |
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Definition
- auscultate the anterior thorax for breath sounds, start above the clavicle (apex of the lungs) to the 11th rib (base of the lungs which is roughly around the bra line). Leave the stethoscope on the skin and compare each lung.
Bronchial sounds- heard over trachea
Bronchialvesicular sounds- first and second intercostal spaces
Vesicular- heard over peripheral lung fields |
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Term
| If there is an indication of consolidation within the lung or if there was an abnormal finding when tactile fremitus was performed, evaluate for ______ |
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Definition
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Term
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Definition
Have patient repeat “ninety nine, e-e-e and one-two-three” while you auscultate the posterior thorax.
Normal : sound is muffled
Abnormal: 99 sounds, clear, distinct and close to ear |
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Term
| 2. Whispered Pertoriloquy |
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Definition
- Perform procedure when there is a positive finding of bronchophony, ask pt to whisper “one-two-three” while auscultating the posterior thorax listening for whisper tones.
Normal: one-two-three is muffled
Abnormal findings is a loud and clear “one-two-three” |
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Term
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Definition
Final test for voice resonance. It evaluates intensity of spoken voice. Instruct to say “e-e-e” as you auscultate the posterior thorax.
Normal findings: would be a muffled “e-e-e”
Abnormal findings: sound changes to "a-a-a" |
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Term
| False adventitious sounds |
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Definition
bumping the stethoscope tubing against something or if pt touches the tubing
- if pt is cold and shivering
- stethoscope is moved on a patients excess chest hair may give a false finding of crackles |
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Term
| palpating posterior thoracic wall |
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Definition
palpate posterior thoracic muscles for tenderness, bulges, and symmetry, palpate for thoracic wall expansion, palpate for vocal tactile fremitus
for tenderness, bulges and symmetry- using palmar surface of fingers, use both hands simultaneously to compare the two sides of the posterior chest wall, identify any areas the patient reports as tender or painful
palpating for Posterior thoracic expansion, stand behind patient and place both thumbs on either side of the spinal process at about the level of T9 and T10. While maintaining the thumb position and instruct the patient to take several deep breaths. Observe for lateral movement of the thumbs
Palpate for tactile femitus, you can feel vibrations using the palmar surface of your hands. Place your hands on the posterior thorax over the left and right lungs, instruct the patient to say “ninety nine” and feel for vibrations |
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Term
| palpate anterior thoracic wall |
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Definition
-Palpate the anterior thoracic muscles for tenderness, bulges, and symmetry use the same procedure for the posterior thorax. Using the palmar surface of hands check for consistency in muscles and skin, tender or painful areas. Use both hand simultaneously for comparison.
- Palpate the anterior chest wall for thoracic expansion - (same technique for posterior thorax) facing the patient place both thumbs up along the costal margin and the xiphoid (solar plexus) and your palms against the anterolateral chest wall. Instruct the pt to take deep breaths, both palms should move apart symmetrically.
-Palpate the anterior thoracic wall for vocal (tactile) fremitus same procedure as posterior thorax, place palms over the left and right fields of the lungs and instruct the patient to recite “one-two-three, e-e-e, and ninety-nine” while you palpate the chest wall |
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Term
| Percuss posterior and lateral thorax for tone |
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Definition
| when you suspect overinflation of the lung or consolidation in the lung (follow the same pattern as auscultation) compare percussions between left and right lungs. |
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Term
| Percuss the thorax for diaphragmatic respiratory exertion |
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Definition
| measures the diaphragm with maximum inspiration and expiration. Stand behind patient and have them hold their breath, quickly percuss the posterior wall along the midscapular line to determine border of lungs and mark, repeat when pt exhales. |
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Term
| Percuss the anterior thorax for tone |
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Definition
| repeat same procedure as posterior thorax. Systematically percuss the anterior chest wall following the same pattern used for auscultation |
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Term
| percussion of the lungs technique |
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Definition
avoid percussing directly on top of scapulae, vertebrae, and ribs, breast tissue
-should produce a resonant, low-pitched, clear, hollow sound |
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Term
| a hyperresonant sound from the lungs can indicate- |
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Definition
| COPD- airtrapped in the lungs |
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Term
| a dull sound from the lungs can indicate- |
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Definition
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Term
| Normal Breathing sounds and expected findings |
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Definition
Bronchial- heard over trachea,
short inspiration, long expiration
-high pitched, harsh sound like metal
Bronchovesicular- heard near spinal column* posteriorly- near (t4) medial to scapula and anteriorly- in the first and second ICS at sternal border
- inspiration and expiration are equal
-moderate pitched, medium volume
Vesicular- heard in peripheral lung fields
-inspiration is longer than expiration
-low pitched, soft |
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Term
| Describe variations related to age, race, gender, and selected situations that are expected on examination of the lungs and respiratory system. |
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Definition
Infants, Children, Adolescents
-Same sequence as adults
-use pediatric stethoscope for infants
-infants should be in diaper
-examine when child is calm
Older Adults
-same procedures as adult although structural and functional differences may occure
-Kyphosis (posterior thoracic stooping or bending) may alter configuration and make thoracic expansion more difficult. |
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Term
| Crackles (fine vs. coarse) |
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Definition
-Fine crackles: popping open of collapsed alveoli
-Course Crackles: air colliding with secretions |
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Term
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Definition
Superficial, low-pitched, coarse, rubbing or grating sound; sounds like two surfaces rubbing together heard through inspiration and expiration
-Normal lubricating fluid b/t pleurae is lost r/t inflammation and pleurea rub together |
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Term
Wheeze
(sibilant vs. sonorous rhonchi) |
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Definition
Sibilant: high-pitched musical squeaking as hair is pushed through narrow passage (tumor, asthma)
Sonorous Rhonchi: low-pitched, moaning sound r/t airway obstruction; may clear with coughing (bronchitis) |
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Term
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Definition
| -High-pitched inspiratory sound hear louder over the neck signaling airway obstruction (croup) |
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Term
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Definition
| Difficult or labored breathing |
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Term
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Definition
assessed during palpation
air escaping the lungs and air bubbles presenting superficially on the skin |
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Term
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Definition
acute or chronic
common causes of acute cough are viral infection, allergic reactions, acute asthma, bacterial sinusitis or environmental irritants,
Chronic can be caused by GERD, post nasal drip, chronic bronchitis, and ACE |
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Term
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Definition
| Rate & depth of respiration patterns |
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Term
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Definition
is an abnormal pattern of breathing characterized by progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in a temporary stop in breathing called an apnea.
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Term
| Identify common problems and conditions of the lungs and respiratory system (COPD/emphysema, and chronic bronchitis) |
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Definition
| Easily fatigued Frequent RIs Orthopneic(shortness of breath when lying flat) thin in appearance wheezing pursed lip breathing chronic cough barrel chest dyspnea Bronchitis- increased sputum |
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Term
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Definition
| disorder of colapsed alveoli |
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Term
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Definition
| uncontrolled growth of anaplastic cells in the lung |
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Term
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Definition
| blood in the pleural space caused by chest injury |
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Term
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Definition
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Term
| Demonstrate/recognize history-taking (questions) and examination techniques appropriate for the lungs and respiratory system. |
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Definition
Present Health Status
-Any Chronic Illness? Difficulty breathing during your daily activities? Any oral medication for respiratory disorder?
Past Health History
-Ever had any problems with your lungs? Any injury to your chest?
Family History
-family history if lung disease? Emphysema? Asthma?
Personal and Psychosocial
-Do you smoke? Any environmental condition that may affect your breathing? |
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Term
| when listening to the anterior chest you are assessing mostly the __________ |
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Definition
| upper lobes and right middle lobe |
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Term
| when listening to the posterior chest you are assessing mostly the __________ |
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Definition
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