Assessment of the Chest and Lungs Respiratory Assessment
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Assessment of the Chest and Lungs (Respiratory Assessment) Health Assessment Across the Lifespan NRS 102 Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 18: Thorax and Lungs Structure and Function Subjective Data—Health History Questions Objective Data—The Physical Exam Abnormal Findings Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 18 -2
Chapter 18: Thorax and Lungs Structure and Function Position and Surface Landmarks Thoracic cage—borders Anterior thoracic landmarks Posterior thoracic landmarks Ø Vertebra prominens Ø Suprasternal notch Ø Spinous processes Ø Sternum Ø Inferior border of scapula Ø Manubriosternal angle Ø Twelfth rib Ø Costal angle Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 18 -3
Chapter 18: Thorax and Lungs Anterior Thoracic Cage Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 18 -4
Chapter 18: Thorax and Lungs Posterior Thoracic Cage Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 18 -5
Chapter 18: Thorax and Lungs Reference lines Midsternal line Midclavicular line Scapular line Vertebral line Anterior, posterior, midaxillary lines Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 18 -6
Chapter 18: Thorax and Lungs Reference Lines (Anterior) Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 18 -7
Chapter 18: Thorax and Lungs Reference Lines (Posterior) Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 18 -8
Chapter 18: Thorax and Lungs Reference Lines (Lateral) Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 18 -9
Chapter 18: Thorax and Lungs Structure and Function (cont. ) Thoracic cavity Ø Mediastinum defined Ø Lobes of the lungs • Anterior Ø Ø Trachea and bronchial tree • Location of trachea and bronchi • Posterior • Dead space • Lateral • Function of acinus Pleurae Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 18 -10
Chapter 18: Thorax and Lungs Structures of the Respiratory System Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 18 -11
Chapter 18: Thorax and Lungs Mechanics of respiration Four functions of respiratory system Ø Changing chest size during respiration Ø Inspiration Ø Expiration Ø Control of respiration Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 18 -12
Chapter 18: Thorax and Lungs Mechanics of Respiration (cont. ) © Pat Thomas, 2006. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 18 -13
Chapter 18: Thorax and Lungs Subjective Data— Health History Questions Cough Shortness of breath Chest pain with breathing History of respiratory infections Smoking history Environmental exposure Self-care behaviors Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 18 -14
Chapter 18: Thorax and Lungs Objective Data—The Physical Exam Preparation Ø Position Ø Draping Ø Timing during a complete examination Ø Cleaning stethoscope endpiece Equipment needed Ø Stethoscope Ø Small ruler marked in centimeters Ø Marking pen Ø Alcohol swab Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 18 -15
Chapter 18: Thorax and Lungs Objective Data—The Physical Exam (cont. ) Posterior Chest—Inspect Thoracic cage Ø Shape and configuration of chest wall Ø Anteroposterior/transverse diameter Ø Position of person Ø Skin color and condition Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 18 -16
Chapter 18: Thorax and Lungs Objective Data—The Physical Exam (cont. ) Posterior Chest—Palpate Symmetric expansion Tactile (or vocal) fremitus Ø Technique Ø Factors that affect normal intensity of tactile fremitus Palpate the entire chest wall Posterior Chest—Percuss Predominant note over lung fields Diaphragmatic excursion Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 18 -17
Chapter 18: Thorax and Lungs Objective Data—The Physical Exam (cont. ) Posterior Chest—Auscultate Breath sounds Technique Bronchial breath sounds—characteristics Ø Bronchovesicular breath sounds—characteristics Ø Vesicular breath sounds—characteristics Ø Ø Adventitious sounds Crackles Wheeze Ø Atelectatic crackles Ø Ø Voice sounds Bronchophony Egophony Ø Whispered pectoriloquy Ø Ø Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 18 -18
Chapter 18: Thorax and Lungs Objective Data—The Physical Exam (cont. ) Anterior Chest—Inspect Shape and configuration of chest wall Facial expression Level of consciousness Skin color and condition Quality of respirations Rib interspaces Accessory muscles Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 18 -19
Chapter 18: Thorax and Lungs Objective Data—The Physical Exam (cont. ) Anterior Chest—Palpate Symmetric chest expansion Tactile fremitus Palpate the anterior chest wall Anterior Chest—Percuss Predominant note over lung fields Borders of cardiac dullness Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 18 -20
Chapter 18: Thorax and Lungs Objective Data—The Physical Exam (cont. ) Anterior Chest—Auscultate Breath sounds Abnormal breath sounds Adventitious sounds Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 18 -21
Chapter 18: Thorax and Lungs Objective Data—The Physical Exam (cont. ) Measurement of pulmonary function status Ø Forced expiratory time Ø Pulse oximeter Ø 6 -Minute distance walk Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 18 -22
Chapter 18: Thorax and Lungs Sample Charting Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 18 -23
Chapter 18: Thorax and Lungs Sample Charting (cont. ) Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 18 -24
Chapter 18: Thorax and Lungs Abnormal Findings Configurations of the Thorax Barrel chest Pectus excavatum Pectus carinatum Scoliosis Kyphosis Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 18 -25
Chapter 18: Thorax and Lungs Barrel Chest Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 18 -26
Chapter 18: Thorax and Lungs Scoliosis Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 18 -27
Chapter 18: Thorax and Lungs Kyphosis Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 18 -28
Chapter 18: Thorax and Lungs Abnormal Findings Respiration Patterns Sigh Tachypnea Bradypnea Hyperventilation Hypoventilation Cheyne-Stokes respiration Biot’s respiration Chronic obstructive breathing Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 18 -29
Chapter 18: Thorax and Lungs Abnormal Findings Abnormal Tactile Fremitus Increased tactile fremitus Decreased tactile fremitus Rhonchial fremitus Pleural friction fremitus Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 18 -30
Chapter 18: Thorax and Lungs Abnormal Findings Adventitious Lung Sounds Discontinuous sounds Ø Crackles—fine Ø Crackles—course Ø Atelectatic crackles Ø Pleural friction rub Continuous sounds Ø Wheeze—sibilant Ø Wheeze—sonorous rhonchi Ø Stridor Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 18 -31
Chapter 18: Thorax and Lungs Abnormal Findings Common Respiratory Conditions Atelectasis Lobar pneumonia Bronchitis Emphysema Asthma (reactive airway disease) Pleural effusion thickening Congestive heart failure Pneumothorax Pneumocystis carinii pneumonia Tuberculosis Pulmonary embolism Acute respiratory distress syndrome (ARDS) Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 18 -32
What is the conducting zone of the respiratory system
Chest assessment
Chest assessment
Respiratory control centre
Lizard dichotomous classification key
Homeostatic responses to respiratory acidosis
Purulent diseases of lungs and pleura
Lobes and fissures of lungs
Tactile fremitus.
Nottingham city hospital respiratory assessment unit
Fremitus lungs
Tactile fremitus.
Sce medical abbreviation lungs
Upper respiratory tract consists of
3 lobes of lungs
Pathway of air in respiratory system
Respiration definition
Lung lobes
Conducting zone lungs
Pleural recesses
Cervical pleura
Back view of lungs in body
Root of the lung vs hilum
Types of percussion sounds
Barotrauma lungs
Left lung segments
Reticonodular
Excretory function of lungs
2 hours
Path of air into the lungs
Body planes and cavities
Tactile fremitus location
Gross anatomy of the lungs
