Assessment

of the

Thorax and Lungs

spring 2012 1

Review of Respiratory Function

• Pleura• Bronchi• Alveoli• Diaphragm• Accessory Muscles

spring 2012 2

HEALTH HISTORY

• History of Disease• Common Respiratory Symptoms• Self Care Behaviors• Environmental Exposure• Smoking History• Functional Health Patterns

spring 2012 3

INSPECTION

1. Shape of Thorax2. Symmetry of Chest Wall3. Accessory Muscle Use4. Rate5. Pattern6. Depth7. Patient Position / Mode

spring 2012 4

Costal Angles

spring 2012 5

Respiratory Patterns

spring 2012 6

Patient Positions and Modes

• …Orthopnea• ….Paroxysmal Nocturnal Dyspnea • …..Tripod position• ……Normal mode• ……..Pursed lip• ……….Stomal

spring 2012 7

Auscultation

HOW to USE Stethoscope

WHERE on Chest

WHAT Instructions

FOR What Length of Time

WHICH Pattern

EXPECTED Findingsspring 2012 8

An Individual Breath

.

spring 2012 9

Bronchial Bronchovesicular Vesicular

Factors Affecting Auscultation

• . Chest Hair• . Clothing• . Ventilator tubing• . Shivering• . Shallow breaths

spring 2012 10

Voice Sounds

• Normal Voice Transmission• Bronchopony• Egophony• Whispered Pectoriloquy

spring 2012 11

Palpation

1. Tracheal Position2. Tactile Fremitus3. Thoracic Expansion (3-5)4. Thoracic Tenderness5. Crepitus6. Masses

spring 2012 12

www.rale.ca/Repository.htm

spring 2012 13

• Adventitious Breath Sounds–Rales–Rhonchi–Wheezes–Pleural Friction Rub–Stridor

What would these patients look like?spring 2012 14

Assessing Patients with Respiratory Assistive Devices

– Oxygen– Incentive Spirometer– Endotracheal tube (ETT)– Tracheotomy Tube – Mechanical Ventilation– Pulse Oximeter

spring 2012 15

Developmental Considerations

• Older Adults

• Children

• Infants

spring 2012 16

Common Abnormalities

• Asthma• Atelectasis• Bronchitis• COPD• Croup • Emphysema• Pneumonia with Lobar consolidation• Tuberculosis• Lung Cancer• Pneumothorax

spring 2012 17

Nursing Diagnoses

• Ineffective airway clearance• Ineffective breathing pattern• Impaired gas exchange• Anxiety

spring 2012 18

spring 2012 19

Cultural Considerations

Health Promotion

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

spring 2012 20