Thorax and Lungs-Lower Respiratory
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| 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?
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| 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"
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| 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.
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| 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
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| 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
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| 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"
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| 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”
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| 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"
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| 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"
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| 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)
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| 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
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| 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
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| 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
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