web thorax and lungs
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Assessment of theThorax and Lungs
NUR123 Spring 2009K. Burger, MSEd, MSN, RN, CNE
PPP by:
Victoria Siegel RN, MSN, CNS
Sharon Niggemeier RN, MSN
Revised by: Kathleen Burger
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Anatomy of Lungs
Organs of respiration Located in thoracic cavity
Right lung-3 lobes
Left lung- 2 lobes
Important to know landmarks ofthorax
Composed of trachea, bronchioles &alveoli
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Anatomical Landmarks
Anteriorly: Apex of lung -1 and (2-4cm) above clavicle.
Anteriorly: Base to 6
th
ribmidclavicular, 8th rib midaxillary.
Posterior: Apex- first thoracic
vertebrae. Posterior: Base T-10 expiration and T-12 deep inspiration.
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Subjective Data
Cough
Sputum
Shortness of Breath (SOB) Smoking
Past Hx respiratory disorders Environmental factors
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Inspection of Thorax and
Lungs With patient sitting up- uncovered
Observe for lesions, chest symmetry,
ventilatory pattern, depth, rate andrhythm, muscles used & skin color
Note both posterior view and anterior
view.
Note spinal deformities
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Palpation of Posterior Thorax
Using fingers palpate chest wall note: Tenderness
Alignment
Any Bulging or retractions Palpate for masses
Palpate for any crepitus- coarse,crackling sensation palpable over skinsurface in subcutaneous emphysema.May follow thoracic injury or surgery.
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Palpate Tactile Fremitus
First say ahhhh and feel own neck =
fremitus.
Palpate the patients back to right andleft of spine as the pt. says 99 and
examiner palpates with palm of hand,
compare bilaterally.
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Palpate ChestExpansion/Excursion
Posterior- place hands along outer
edge of costal margin with thumbstoward middle of spine
Have patient take a deep breath
Should observe yours hands movingequally far apart.
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Percuss the Thorax
Apices to bases
Anterior
Lateral Posterior- fold arms across chest
Hear resonance and dullness alternately
with lung or ribs. Avoid percussion over scapulae and ribs.
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Diaphragmatic Excursion
Distance between deepinspiration and full expiration.
Normally ranges from 3-6 cm Exhale and hold, percuss and
mark location of diaphragm:
change dull-resonance
Deep inspiration and hold it,
percuss + mark change again
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Auscultation
Beginning at apices to base, comparebilaterally.
Listen for full cycle, note quality and
intensity Instruct patient to breathe throughmouth, a little deeper (but not faster)
than usual Use stethoscope diaphragm firmly vschest wall
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Normal Breath Sounds
Bronchial- heard over trachea and larynx.High pitch, loud, harsh. Inspiration expiration
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Adventitious sounds
Crackles- (rales) rub hair between fingerscracking/popping sound. Secondary to fluid inairway or to opening of collapsed alveoli inatelectasis.
Wheezes- continuous musical and high pitched,due to constricted bronchi.
Rhonchi- lower pitched, coarse, snoring, due to
thick secretions. Pleural friction rub- rough, grating, inflamed
surfaces, as in pleurisy.
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Assess Lungs
Note:decreased or absent breath sounds
Bronchial tree obstructed at some point by
secretions, mucus plug or foreign body
Emphysema
Anything that obstructs sound
transmission: pleurisy, pleural thickening,air (pneumothorax), fluid (pleural effusion),
in pleural space.
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Increased Breath Sounds
Sounds are louder than they shouldbe, e.g., bronchial sounds heard overperipheral lung fields.
They occur when consolidation e.g.,pneumonia or compression creates adenser lung area that enhancessound transmission.
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Further Assessment
Bronchophony- say 99, if heard loudand distinct, it is abnormal
Whispered pectoriloquy- whisper1,2,3should be muffled. Abnormal= loud
&distinct means there is consolidation.
Egophonysay E, the E changes to anA sound over area of consolidation,
pleural effusion or abscess.
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