Download - N 295 lecture 7 respiratory student copy
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Assessment
of the
Thorax and Lungs
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Review of Respiratory Function
• Pleura• Bronchi• Alveoli• Diaphragm• Accessory Muscles
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HEALTH HISTORY
• History of Disease• Common Respiratory Symptoms• Self Care Behaviors• Environmental Exposure• Smoking History• Functional Health Patterns
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INSPECTION
1. Shape of Thorax2. Symmetry of Chest Wall3. Accessory Muscle Use4. Rate5. Pattern6. Depth7. Patient Position / Mode
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Costal Angles
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Respiratory Patterns
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Patient Positions and Modes
• …Orthopnea• ….Paroxysmal Nocturnal Dyspnea • …..Tripod position• ……Normal mode• ……..Pursed lip• ……….Stomal
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Auscultation
HOW to USE Stethoscope
WHERE on Chest
WHAT Instructions
FOR What Length of Time
WHICH Pattern
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An Individual Breath
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Bronchial Bronchovesicular Vesicular
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Factors Affecting Auscultation
• . Chest Hair• . Clothing• . Ventilator tubing• . Shivering• . Shallow breaths
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Voice Sounds
• Normal Voice Transmission• Bronchopony• Egophony• Whispered Pectoriloquy
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Palpation
1. Tracheal Position2. Tactile Fremitus3. Thoracic Expansion (3-5)4. Thoracic Tenderness5. Crepitus6. Masses
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www.rale.ca/Repository.htm
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• Adventitious Breath Sounds–Rales–Rhonchi–Wheezes–Pleural Friction Rub–Stridor
What would these patients look like?spring 2012 14
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Assessing Patients with Respiratory Assistive Devices
– Oxygen– Incentive Spirometer– Endotracheal tube (ETT)– Tracheotomy Tube – Mechanical Ventilation– Pulse Oximeter
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Developmental Considerations
• Older Adults
• Children
• Infants
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Common Abnormalities
• Asthma• Atelectasis• Bronchitis• COPD• Croup • Emphysema• Pneumonia with Lobar consolidation• Tuberculosis• Lung Cancer• Pneumothorax
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Nursing Diagnoses
• Ineffective airway clearance• Ineffective breathing pattern• Impaired gas exchange• Anxiety
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Cultural Considerations
Health Promotion
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Risk for Pneumonia• Smoking• Advance age• Underlying lung disease• Malnutrition• Intoxication• Bedridden• Postoperative status• Immunosuppressed status• Decreased cough reflex• Sedated or decreased consciousness• Oxygen therapy that is harboring bacteria
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