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Physical Assessment

Thorax and Lungs-Lower Respiratory

QuestionAnswer
REVIEW OF SYSTEMS THORAX AND LUNGS Do you wheeze? Do you have difficulty breathing/feel short of breath? (if yes, onset at rest or/exertion) Do you have a cough? If yes, sputum production/color/consistency?) Have you noticed any weight loss, fever or night sweats? Do you smoke?
INITIAL SURVEY OF RESPIRATION AND THORAX Inspect chest front, side,back observing: inspir/expir/chest movement"symmetry"/audible breath sounds ie stridor,wheezing Observes and reports the rate, rhythm,depth of breathing "normal 14-20 bs/min" Observe and reports the AP D. "barrel chest"
POSTERIOR CHEST-INSPECTION Patient position upright with arms folded ID Landmarks: scapular line/vetebral line RP: condn. of skin for cyanosis RP: deform. of thoracic spine RP: respir. movement of the chest wall RP: inspir. movement ie retraction "Sym.No delays noted" RP: expir. movement, i.e., bulging INSP/RP:access.
PALPATION - POSTERIOR CHEST Ppts tenderness,masses,sinus tracts (4 areas) “Non tender sinus tracts, masses" Ppts tactile fremitus “I note tactile fremitus” {Pt says “One-One, One”} Test chest expansion Thumbs at 10th, fingers out
PERCUSSION - POSTERIOR CHEST a.Tympany/Gastric Bubble b.Hyperresonance/Not Heardc.Resonance/Throughout d.Dullness/Livere Percusses 5 ars bilaterally, & 2 posterior axillary line bilat cpr R:L ID diaphragmatic level At full expiration/inspiration Distanc btw lv of dullness 5-6 cm
AUSCULTATION – POSTERIOR CHEST RP: in all ars the b sounds as: a.Vesicular/Soft, low pitch fade 1/3 Exp b.Bronchovesicular/Insp./Exp. same c.Bronchial/Louder, higher pitch Exp long Full breath deeply mouth ASCLT in both complete inspir and expir all 7 ars "No advntit lung sounds"
FOR ABNORMAL BREATH SOUNDS Explain and/or demo ONE of following test Auscultate for Egophony – have pt say “ee” State abnormal findings: “Sounds like AY”
INSPECTION - ANTERIOR CHEST Ask patient to lay in supine position Identify landmarks: a.suprasternal notch b.sternal angle c.costal angle d.mid-sternal line e.mid-clavicular line f.anterior axillary line g.mid-axillary line h.posterior axilliary line Reports condition of skin "No cyanosis noted"
INSPECTION - ANTERIOR CHEST Reports use of: a.accessory muscles & nasal flare b.deformities or asymmetry c.retraction d.supraclavicular retraction e.bulging "No deformities noted on inspection"
PALPATION - ANTERIOR CHEST Ppts tenderness, masses and sinus tracts (3 ars anter, 2 ars lat) Test chest expansion: Pinch hands @ stomach, tell pt to take a deep breath. "Lungs are symmetrical no delays noted." Hands should be equidistant. Ppt for tactile fremitus (same ars)
PERCUSSION ANTERIOR CHEST a.Tympany/Gastric Bubble b.Hyperresonance/Not Heard.Resonance/Throughout d.Dullness/Livere Percusses 5 ars bilaterally, & 2 posterior axillary line bilat cpr R:L
AUSCULTATION - ANTERIOR CHEST Specific and complete instruction to pt for breathing Auscultate in both complete inspiration and expiration (deeper then usual) States in all the following areas the breath sounds as: a.Vesicular b.Bronchovesicular c.Bronchial
FOR ABNORMAL BREATH SOUNDS: Explain and/or demo ONE of following test Auscultate for Bronchophony – have pt say “ninety-nine” Auscultate for Whispered pectoriloquy - have pt say “one-two-three” Auscultate for Egophony – have pt say “ee” states abnormal findings
Created by: teyonka on 2006-09-11



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