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Lungs Assessment

Lungs and thorax assessment

Palpation of the posterior Thorax Feel for tenderness.Tenderness or pain may indicate inflammation of the tissue, especially over the intercostal spaces due to pleuritis. Muscle pain may indicate increased work of breathing
Palpation for Crepitus Crepitus = subcutaneous emphysema, Feels like crackling and results from air or fluid trapped under the skin. Occurs with an open chest injury-think bullet wound, stab wound, chest tube, or tracheostomy -mark borders and document.
Plapation for Fremitus Palpate with ball of hand and follow auscultation sequence. As you palpate, have client say “ninety-nine” Abnormals= uneven fremitus, indicative of consolidation (mass or pneumonia), pneumothorax Decreased fremitus= obstruction of tracheobronchial tree
Posterior Thorax expansion Place thumbs at T9 have client breath and observe movement of thumbs. Should normally move 5-10 cm symmetrically. Abnormally- unequal movement- could be atelectasis.
Percussion of posterior Chest Start at scapula and percuss across top of both shoulders, moving downward to intercostal spaces and to lateral areas of lungs
Percussion Abnormal: Hyperresonance Trapped Air- Emphysema, pneumonia
Percussion Abnormal: Bullness fluid or solid tissue- pneumonia or tumor
Auscultation of Posterior Thorax Listen to bare chest-skin to scope Use diaphragm Start at apex C7 and have client breathe through mouth in order to clearly hear inspiration and expiration
Auscultation Abnormals Decreased=little or no air movement Obstruction, secretions, mucus plug, foreign body Pneumothorax, effusion Loud sounds=consolidation/tumor, density
Normal Breath Sounds Bronchial: Bronchial-high pitch, harsh, hollow, loud, short inspiration, long expiration; over trachea and thorax
Normal Breath Sounds: Bronchovesicular: Bronchovesicular-moderate pitch, mixed, moderate sound, inspiration=expiration; heard over major bronchi, posterior between scapulae, anterior around upper sternum at 1-2 intercostal spaces
Normal Breath Sounds: Vesicular Vesicular-low pitch, breezy, soft, long inspiration, short expiration; heard at peripheral lung fields
Abnormal Breath Sounds: Crackles Crackles-popping sound (think “bubble wrap”)-indicates pneumonia, chf, fluid in lungs, asthma, bronchitis May be fine or coarse (pulmonary fibrosis)
Abnormal breath sounds: Pleural Friction Rub Pleural friction rub-grating, dry, harsh sound-pleuritis-”rubber against rubber
Abnormal Breath Sounds: Wheeze- sibilant Wheeze-sibilant=musical, expiration-refers to obstructed or constricted airways-asthma, copd
Abnormal breath sounds: Wheeze- sonorous- Wheeze-sonorous-low pitch, expiration or entire respiratory cycle=bronchitis, sleep apnea with snoring
Abnormal breath sounds: Stridor-barking, harsh wheeze indicative of bronchospasm/croup
Voice Sound Auscultation: Bronchophony Bronchophony-listen with stethoscope to chest as client says “ninety-nine” Normal is muffled and unclear-cannot understand sound Abnormal=clearly heard, indicates solid area in lungs or increased density Tumor, pneumonia, atelectasis
Voice Sound Auscultation: Egophony Egophony-Auscultate as client says “E” Normal=soft, muffled with understandable “E” Abnormal=sounds like “a” over areas of consolidation
Voice Sound Auscultation: Whipered Pectroiloquy Whispered pectoriloquy-Client whispers “1-2-3” Normal is faint and inaudible Abnormal=clear sound over areas of consolidation Sounds as if client is whispering into your stethoscope
Anterior Thorax abnormal physical findings: Pectus Excavatum Sunken sternum and cartilage
Funnel chest Congenital defect, usually asymptomatic
Pectus carinatum Forward protruison of sternum, ribs slope back restrictive chest motions and decreased lung capacity
Pigeon chest restrictive chest motions and decreased lung capacity
Created by: dgreen158