THORACIC (PULMONARY) by xkQT8l4

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									THORACIC (PULMONARY)
ASSESSMENT
HISTORY
   Smoke? What? Live With?
    Pack History

   Occupational Hazards
   Last CXR     PPD
   Dyspnea
   Orthopnea

HISTORY
   Cough, Sputum

   Hemoptysis

   Chest Pain

 Past Disease
Risk Factors for Respiratory Disability in Older Adults
   History of Smoking
   History of Frequent Respiratory Infections
   Immobilized or Sedentary
   Hx of Chronic Exposure to Environmental Pollutants/Toxic Inhalants
   Difficulty Swallowing (dysphagia)
   Weak Chest Muscles
 Family History
Exam Preparation
   Client undressed to waist
   Posterior: Client sitting, slightly bent forward
   Anterior: Client lying down
   Good Light
   Compare Side to Side

Look for
Chest Wall Landmarks
NORMAL RESPIRATIONS
   RATE
    Adult:                      10-24 per minute
    6-9 y.o.Child:    18-26
     2-6 y.o.Child:   20-30
    Newborn:          30-60

NORMAL RESPIRATIONS
   PATTERN Smooth, Even
   DEPTH             Even with occasional sighs
   QUALITY Quiet, Non-Labored
   TYPE              Male: Diaphragmatic          (abdominal)
                      Female: Thoracic

ALTERED BREATHING
PATTERNS
ALTERED RATE
 Tachypnea
 Bradypnea
ALTERED VOLUME
 Hyperventilation
     Kussmaul’s Respirations

 Hypoventilation
ALTERED RHYTHM


 Cheyne-Stokes
ALTERED EASE
 SOB
 Dyspnea
     DOE

 Orthopnea
INSPECTION
   Color: Face, Lips (Circumoral)
               Pallor
               Cyanosis
   Position
   Use of Accessory Muscles
INSPECTION

   Chest Shape
        Normal =
        AP(Anterioposterior):Lateral
                                1:2

     Abnormal = Barrel Chest
             AP = Lateral
INSPECTION

SYMMETRY
   Equal Musculature
   Straight Spine
   Downward slope of Ribs
   No bulging, retraction of interspaces

PALPATION
   ID tenderness, pain,masses, lesions, scars, subcutaneous emphysema

   Assess Thoracic Expansion
    Place hands on lower posterior chest wall with thumbs toward spine. Assess
    expansion of chest as thumbs move


PALPATION
   Elicit Tactile Fremitus

 Assess Trachea for deviation in sternal notch
PERCUSSION
   Resonance over lungs

   Hyperresonance over emphysemic lungs

   Flat over bones

 Dull over organs
AUSCULTATION
   Have Client Seated Comfortably
   Breathing Through Mouth
   Use Diaphragm
   Listen for one full Inspiration/Expiration
 Listen Symmetrially and                          Systematically
NORMAL SOUNDS
VESICULAR
   Heard Over Most of Lung Fields

   Low Pitch

   Long Inspiration, Soft Short Expiration

 I>E
BRONCHIAL
   Heard over Trachea

   High Pitch

   Long and Loud Expiration

 E>I
BRONCHOVESICULAR
   Heard over Main Bronchus, Below Clavicles & Between Scapulae

   Medium Pitch

 I=E
ADVENTITIOUS SOUNDS
   Crackles
      Fine
      Coarse

   Wheezes

   Rhonchi

   Friction Rubs

ADVENTITIOUS SOUNDS
NOTE:
   Location

   Timing (in Respiratory Cycle)

   Loudness, Pitch, Duration

   Persistence, Any Changes

                          TRANSMITTED VOICE SOUNDS

 Bronchophony

 Egophony

 Whispered Pectroliloquy

								
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