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Respiratory Exam Health Assessment
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- Denver School Of Nursing
Respiratory Exam Study Notes based off lecture notes.
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Respiratory Chapter 19Lung Lobes
-Left: 2 lobes/ more narrow -Right: 3 lobes/larger but shorter -RUL: supraclavicular down to the 4th rib -LUL: supraclavicular to the 5th rib -RML: 4th and 5th ICS anteriorly/laterally -RLL/LLL: T3 (scapular area)-T10
Sternal angle: continuous with 2nd rib, trachea bifurcates here (angle of louis)
-Between manubrium and sternal body Costal angle: 90 degrees
Suprasternal Notch: top of sternum, between clavicles Lung Boarders
-Anteriorly: supraclavicular (apices) down to 5th ICS
-Posteriorly: C7(apices) down to T10
Breathing Patterns
-Tachypnea: Fast and Shallow: pain, fever, hypoxemia
-Bradypnea: Slow and Regular: sleep, CNS depressants, increased ICP
-Hypoventilation: Irregular, Slow & Shallow: CNS depressants, DKA
-Hyperventilation: Fast and Deep: panic DKA
Acute/Chronic Respiratory Disease
-Acute olabored breathing (retractions, accessory muscle use, tripod)
oAcute hypoxemia – changes in LOC (restlessness, anxiety), cyanosis
-Chronic: oAP = or > T (barrel chest)
ocostal angle widened.
onail clubbing (angle of nail base >180°)
ohypertrophy of accessory muscles
Sputum
-Frothy: pulmonary edema (HF, ARDS)
-Clear/white: viral or chronic bronchitis
-Purulent: acute infection
Adventitious breath sounds
-Crackles (rales): discontinuous, high pitched popping sounds (fluid-filled alveoli)
-Rhonchi: continuous, low-pitched snoring (secretions in bronchi, COPD)
-Wheeze: continuous, expiratory, high-pitched squeak (air moving through narrowed airways)
-Pleural Friction rub: grating, low-pitched and pain w/ breathing (pleural inflammation)
-Stridor: high pitched crowing sounds, louder in neck (upper airway obstruction)
Voice Sounds (perform if you suspect consolidation)
-Bronchophony: “99 or 1-2-3” Normal: muffled Abnormal: clear
-Whispered Pectoriloquy: whisper 1-2-3 Normal: faint & indistinct Abnormal: clear & distinct. -Egophony: “eeee” Normal: “eeee” Abnormal: “aaaaa” Palpation
-Crepitus: subcutaneous emphysema (air under skin) -Tactile fremitus
oConsolidation increases fremitus. (replacement of alveolar air with fluid, blood, pus)
oStronger near clavicles/between shoulder blades Percussion -Resonance = Normal finding over lungs -Dullness = abnormal density (fluid, mass) *Liver
-Hyperresonance = abnormal air (pneumothorax, COPD) *Muscle or Bone
Auscultation: -Appropriate technique: diaphragm, side-to-side, mouth breathing (not nose), listen from apices to bases, can moisten chest hair.
-Bronchial vs bronchovesicular vs. vesicular lung sounds: what do they sound like and where do you normally hear them?
-
Respiratory Disorders
-Asthma oBronchoconstriction, inflammation, mucus production
oTriggers: allergy, exercise, pollutants, upper/lower resp
oS/S: cough, dyspnea, chest tightness, wheezing and accessory muscle use
-ARDS
oResults from trauma or shock, rapid onset, increased capillary permeability leads to significant pulmonary edema
oS/S: rapid onset, restlessness, severe dyspnea, persistent hypoxemia, frothy sputum -Atelectasis
oSmall airways collapse due to hypo-inflation.
oCaused: tumor, fluid, foreign body, general surgery oS/S: dyspnea, hypoxia, diminished breath sounds, mediastinal shift towards unaffected side
-Pneumothorax
oPartial or complete lung collapse, resulting in air in pleural spaces. oSpontaneous: no trauma but pressure changed (at risk: tall people)
oTraumatic: trauma or chest or lungs
•S/S: dyspnea, anxiety, decreased breath sounds, tracheal displacement,
absent lung sounds.
-Pleural effusion
oFluid in pleural space (not air) commonly caused by HF or cancer. •S/S: dyspnea, sharp pain when cough or breathing, decreased fremitus,
dullness, decreased breath sounds.
-Pleuritis oPleura becomes inflamed
oS/S: Pain in chest, persistent cough, dyspnea, fatigue and fever
-COPD
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