Denise Coffey MSN, RN
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
1cwU
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?