Respiratory Assessment 2

8/2/2019 Respiratory Assessment 2

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Respiratory Assessment

R. Hernandez


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Chest Physical Assessment

Inspection

Palpation

Percussion

Auscultation


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Inspection

Level of Conciousness

Evidence of Respiratory disease

Nasal flaring

Cyanosis Peripheral Circulation

Central - Hypoxemia

Pursed-lip breathing


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Inspection Jugular Neck Vein

Distention Head of bed 45

degrees

Normal


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InspectionThorax Observe for retractions anduse of accessory muscles

(sternomastoids,abdominals).

Retractions

Observe the chest forasymmetry, deformity, orincreased anterior-posterior

(AP) diameter. Confirm that the trachea is

near the midline?

http://www.meddean.luc.edu//lumen/MedEd/medicine/pulmonar/pd/pstep25a.htm


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Inspection Pectus Carinatum

Pectus Excavatum

Kyphosis

Anteroposterios Scoliosis - Lateral


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Inspection

Increased A-P

Diameter


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Inspection

Palpation

Percussion

Auscultation


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Palpation

Tracheahttp://www.meddean.luc.edu//lumen/MedEd/medicine/pulmonar/pd/pstep25a.htm

Chest

Repeat ninety-nine

Increased

Consolidation

Decreased

Obstruction

Increase air - fluid


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Palpation Thoracic Expansion

Normal Movement 3-5 cm

Assess expansion andsymmetry of the chest by

placing your hands on thepatient's back, thumbstogether at the midline,and ask them to breath

deeply

http://www.meddean.luc.edu//lumen/MedEd/medicine/pulmonar/pd/pstep26a.htm


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Palpation

Peripheral Edema

+1 - +4


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Inspection

Palpation

Percussion

Auscultation


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Percussion Hyperextend the middle finger of one

hand and place the distalinterphalangeal joint firmly againstthe patient's chest.

With the end (not the pad) of the

opposite middle finger, use a quickflick of the wrist to strike first finger.

Categorize what you hear as normal,dull, or hyperresonant.

Practice your technique until you canconsistantly produce a "normal"percussion note on your (presumablynormal) partner before you work with

patients.


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PercussionPosterior Chest

Percuss from side to side andtop to bottom using the patternshown in the illustration. Omit theareas covered by the scapulae.

Compare one side to the otherlooking for asymmetry.

Note the location and quality ofthe percussion sounds you hear.

Find the level of thediaphragmatic dullness on bothsides.


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Percussion Diaphragmatic Excursion

Find the level of thediaphragmatic dullness onboth sides.

Ask the patient to inspiredeeply.

The level of dullness

(diaphragmatic excursion)should go down 3-5cmsymmetrically.


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PercussionAnterior Chest

Percuss from side to sideand top to bottom usingthe pattern shown in theillustration.

Compare one side to theother looking forasymmetry.

Note the location andquality of the percussionsounds you hear.


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Percussion Percussion Notes and Their Meaning

Flat or Dull

Pleural Effusion or Lobar Pneumonia

Normal Healthy Lung or Bronchitis

Hyperresonant

Emphysema or Pneumothorax


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Inspection

Palpation

Percussion

Auscultation


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Stethoscope Chest piece

Diaphragm High frequency - Lungs

Bell Low frequency Heart

Tubing 11-16 inches

Ear pieces

Angled Low level disinfection

between patient use


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Chest SegmentsAnterior Posterior


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Normal Breath Sounds Inhalation / Exhalation

Upstroke / Downstroke Length

Duration

Thickness of Stroke

Intensity

Angle

Pitch


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Normal Breath Sounds Vesicular

Low Pitch, Soft Intensity

Peripheral lung areas

Bronchovesicular

Moderate Pitch, Moderate Intensity Medial Chest

Bronchial

High Pitch, Loud Intensity

Trachea


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Adventitious Breath Sounds Crackles

Discontinuous, secretions,atelectasis

Wheezes High Pitched

Obstruction, anatomic,

bronchoconstriction, inflammation

Stridor High pitched


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Localization of Adventitious BS Location

When

Inspiratory / Expiratory

Pitch Prominance / Loudness

Increased / Decreased

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Respiratory Assessment 2