Denise Coffey MSN, RN

Respiratory AssessmentStructure and FunctionSubjective Data—Health History QuestionsObjective Data—The Physical ExamAbnormal Findings

Anterior Thoracic Cage

Slide 18-3

Posterior

Reference LinesMidsternal lineMidclavicular lineScapular lineVertebral lineAnterior, posterior,

midaxillary lines

Reference Lines Anterior

Reference Lines Posterior

Lateral

Structure and FunctionThoracic cavity

Mediastinum defined

Lobes of the lungs Anterior Posterior Lateral

Pleurae

Trachea and bronchial tree Location of trachea

and bronchi Dead space

Structures of the Respiratory System

Mechanics of RespirationFour functions of respiratory system

Changing chest size during respirationInspirationExpirationControl of respiration

Mechanics of Respiration

Subjective DataWhat would you want to know?

Subjective DataCoughShortness of breathChest pain with breathingHistory of respiratory infectionsSmoking historyEnvironmental exposureSelf-care behaviors

Objective Data- The Physical ExamPreparation

PositionDrapingTiming during a complete examinationCleaning stethoscope endpiece

Equipment neededStethoscopeSmall ruler marked in centimetersMarking penAlcohol swab

Objective Data- The Physical ExamPosterior Chest—InspectThoracic cage

Shape and configuration of chest wallAnteroposterior/transverse diameterPosition of personSkin color and condition

Objective Data- The Physical ExamPosterior Chest—PalpateSymmetric expansionTactile (or vocal) fremitus

TechniqueFactors that affect normal intensity of tactile fremitus

Palpate the entire chest wallPosterior Chest—PercussPredominant note over lung fieldsDiaphragmatic excursion

Objective Data- The Physical ExamAnterior Chest—PalpateSymmetric chest expansionTactile fremitus Palpate the anterior chest wall

Anterior Chest—PercussPredominant note over lung fieldsBorders of cardiac dullness

Objective Data- The Physical ExamAnterior Chest—AuscultateBreath sounds Abnormal breath sounds

Objective Data- The Physical ExamAnterior Chest—AuscultateBreath sounds Abnormal breath sounds

Expected Breath SoundsBreath sounds

TechniqueBronchial breath sounds—

characteristicsBronchovesicular breath sounds—

characteristicsVesicular breath sounds—

characteristics

Abnormal Breath SoundsRhonchiWheezesCracklesStridorCroupPleural friction rub

Listenhttp://www.youtube.com/watch?v=NnuaHGW

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Measurement of Pulmonary FunctionPulse oxABGsPulmonary Function Tests

Abnormal Findings Barrel chestScoliosisKyphosis

Barrel Chest

Scoliosis

Kyphosis

Abnormal FindingsCommon Respiratory ConditionsAtelectasisLobar pneumoniaBronchitisEmphysemaAsthma (reactive

airway disease)Pleural effusion thickening

Congestive heart failure

PneumothoraxPneumocystis carinii

pneumoniaTuberculosisPulmonary embolismAcute respiratory

distress syndrome (ARDS)

InterventionsAmbulationIncentive Spirometer ( IS)RepositioningCoughing and Deep BreathingMedicationsEducation

Case scenarioYou are caring for Mrs. Brown, a 75-year-old

retired school teacher who underwent repair of a right fractured femur. This is her first postoperative day on your clinical unit.

Upon auscultation of her posterior lung field bases, you hear a crackling noise upon inspiration. What is this sound, and what does it indicate?