Chest Auscultation FOUR COMPONENTS OF A RESPIRATORY ASSESSMENT

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Chest Auscultation

Chest Auscultation

FOUR COMPONENTS OF A RESPIRATORY ASSESSMENT ¡ INSPECTION ¡ PALPATION ¡ PERCUSSION ¡ AUSCULTATION

FOUR COMPONENTS OF A RESPIRATORY ASSESSMENT ¡ INSPECTION ¡ PALPATION ¡ PERCUSSION ¡ AUSCULTATION

Anterior Chest Landmarks.

Anterior Chest Landmarks.

ACCORDING TO UNDERLYING LUNGS AND LOBES ¡ RIGHT LUNG ¡ LEFT LUNG ¡ UPPER

ACCORDING TO UNDERLYING LUNGS AND LOBES ¡ RIGHT LUNG ¡ LEFT LUNG ¡ UPPER MIDDLE LOWER ¡ UPPER LOWER ¡ ¡ ¡

INSPECTION ¡ ¡ ¡ ¡ ¡ Shape Scars Prominent veins Resp rate and rhythm

INSPECTION ¡ ¡ ¡ ¡ ¡ Shape Scars Prominent veins Resp rate and rhythm Chest wall movement Intercostal recession Added sounds Cyanosis Sputum

PALPATION ¡ Tenderness ¡ Position ¡ Chest of apex beat wall expansion

PALPATION ¡ Tenderness ¡ Position ¡ Chest of apex beat wall expansion

Apex beat

Apex beat

Chest Wall Expansion

Chest Wall Expansion

TRACHEAL POSITION ¡ Central? ¡ Above ¡ ? shift the sternal notch? ? direction

TRACHEAL POSITION ¡ Central? ¡ Above ¡ ? shift the sternal notch? ? direction

Tracheal Deviation ¡ Towards ¡ Away • Atelectasis • Pneumothorax • Pleural fibrosis •

Tracheal Deviation ¡ Towards ¡ Away • Atelectasis • Pneumothorax • Pleural fibrosis • Pleural effusion • Pneumonectomy • Tumors • Lung agenesis/aplasia

Trachea deviated to Right Left lung border

Trachea deviated to Right Left lung border

PERCUSSION ¡ compare both sides ¡ start over the clavicles move down anterior chest,

PERCUSSION ¡ compare both sides ¡ start over the clavicles move down anterior chest, ensure to percuss over lateral chest

Percussion Sounds Sound Description Significance Resonant Long, loud, low pitched, hollow Normal Lung sounds

Percussion Sounds Sound Description Significance Resonant Long, loud, low pitched, hollow Normal Lung sounds Dullness Medium in intensity and pitch, moderate length areas of increased density/decreased air (consolidation, collapse, fibrosis, abscess, neoplasm) Stony dull Thudlike unique for pleural effusion Hyper resonant Very loud, low pitched areas of decreased density-increased air (pneumothorax)

TACTILE FREMITUS ¡ VOCAL FREMITUS – say 99 ¡ INCREASED FREMITUS ¡ DECREASED FREMITUS

TACTILE FREMITUS ¡ VOCAL FREMITUS – say 99 ¡ INCREASED FREMITUS ¡ DECREASED FREMITUS

Auscultation ¡ BREATH SOUNDS • Normal • Absent • Reduced • Bronchial

Auscultation ¡ BREATH SOUNDS • Normal • Absent • Reduced • Bronchial

Added sounds ¡ Wheeze ¡ Crackles ¡ Rub ¡ Stridor

Added sounds ¡ Wheeze ¡ Crackles ¡ Rub ¡ Stridor

Vocal resonance • Bronchophony • Whispering pectoriloquy • Egophony

Vocal resonance • Bronchophony • Whispering pectoriloquy • Egophony

Common Conditions Percussion Breath Sounds Added Sounds Vocal Resonance Consolidation dull Bronchial breathing Crackles

Common Conditions Percussion Breath Sounds Added Sounds Vocal Resonance Consolidation dull Bronchial breathing Crackles (course) Increased Pleural Effusion dull BS Rub? Decreased Pneumothorax Hyperresonant BS Fibrosis Normal Crackles (fine) Pulmonary Oedema Normal Crackles (fine)

Chest sounds ¡ https: //www. youtube. com/watch? v =O 8 OC 7 Eiq. BKQ

Chest sounds ¡ https: //www. youtube. com/watch? v =O 8 OC 7 Eiq. BKQ

References ¡ Breath Sounds Made Incredibly Easy (2005)– Lippincott Williams and Wilkins ¡ Gleadle

References ¡ Breath Sounds Made Incredibly Easy (2005)– Lippincott Williams and Wilkins ¡ Gleadle J(2012)History and Clinical Examination at a Glance Wiley Blackwell ¡ Hogan-Quigley, Palm, Bickley (2012) Bates Nursing Guide to Physical Examination and History Taking Lippincott Williams and Wilkins