Physical Assessment of the Respiratory Systemparamed.bpums.ac.ir/UploadedFiles/CourseFiles/... · Physical Assessment of the Respiratory System ﺲﻔﻨﺗ هﺎﮕﺘﺳد ﻲﺳرﺮﺑ

Physical Assessment of the Respiratory System

بررسي دستگاه تنفس

Hajinezhad, Mohammad Esmaiel

History Physical problems Function problems Life style Smoking Family Hx Occupation hx Allergens / environment Recreational exposure Anxiety S&S


Inspection Normal chest

Slight retraction of intercostal spaces

2x as wide as deep Anterior/posterior

diameter 1:2


Inspection

Barrel chest D/t over inflation of

lungs anterior-posterior

diameter 2:2


Inspection Funnel chest

Depression of the lower portion of the sternum

Complications Heart damage Cardiac output

Nrs management Murmurs


Inspection Pigeon chest

Sternum protrudes outward

anterior-posterior diameter


Pigeon Chest


Inspection Scoliosis

Lateral curvature of thoracic spine

Assessment Shoulders elevated?

Complications Lung & heart damage Back problems Body image


Scoliosis


Scoliosis


Quiz? How many hours a day should a child

wear a brace for treating scoliosis?A. 8 hrB. 12 hrC. 23 hrD. 24 hrIt can be removed for 1 hour a day for

hygiene purposes


Inspection Kyphosis

AKA Hunchback

Abnormal curvature of the thoracic spine


Kyphosis


Inspection Lordosis

AKA Sway-back

Abnormal curvature of the lumbar spine


Lordosis


Inspection Uniform expansion

of the chest Pneumonia Pleural effusion Pneumothorax

Bulging intercostal spaces Obstruction Emphysema


Inspection Marked retraction of

intercostal spaces Blockage

Shoulder rise Accessory muscles Posture


Inspection: Breathing patterns Rate Eupnea

Normal 12-20 / min

Tachypnea rate Pnuemonia, pulm edema, acidosis, septicemia,

pain Bradypnea

rate ICP, drug OD


Inspection: Breathing patternsDepth Hyperpnea

depth

Hyperventilation depth & rate

Hypoventilation depth & rate


Inspection: Breathing patternsDepth Kussmaul's

rate & depth Assoc. with sever acidosis

Apneustic Prolonged gasping I following by short


Inspection: Breathing patternsRhythm Apnea

Not breathing

Cheyne-stokes Varying depth f/b apnea Death rattles Death rales


Inspection: Breathing patternsRhythm Biot’s

rate & depth w/ abrupt pauses Assoc w/ ICP


Inspection: Trachea

? Deviation Pleural effusion Tension pneumothorax Atelectasis

Color LOC Emotional state


Palpation TML

Tenderness (T) Masses (M) Lesions (L)

Sinuses Palpate below eyebrow &

Cheekbone Crepitus

Subcutaneous emphysema Air leaks into the sub-c

tissue


PercussionRational To determine if

underlying tissue is filled with air or solidmaterial

Procedure Pt sitting Tap starting at shoulder compare rt to lf


Percussion: results Resonance – drum like

Normal

Hyper-resonance Too much air Emphysema

Flatness / dull Fluid or solid Pleural effusion Pneumonia Tumor


AuscultationPurpose Asses air flow

through bronchial tree

Procedure Diaphragm of

stethoscope Superior inferior Compare rt to lf


Auscultation: ResultsNormal Vesicular

Lung field Soft and low

Bronchial Trachea & bronchi Hollow

Bronchovesicular Mixed Between scapulae Side of sternum 1st & 2nd intercostal space


Auscultation: ResultsAdventitious Crackles

Rales air bronchi with

secretions

Fine crackles Air suddenly

reinflated

Course Crackles Moist


Auscultation: Results Wheezes

Sonorous wheezes Deep low pitched Snoring > E Caused by air

narrowed passages D/t secretions

Sibilant Wheezes High pitched Whistle-like I & E Caused by air

narrowed passages D/t constriction

Asthma


Auscultation: Results Pleural friction rub

D/t inflammation of pleural space

Grating, creaking I & E Best heard

Anterior, Lower, lateral area


Auscultation: Results Stridor

Crowing Partial obstruction of

the larynx or trachea


Quiz? A child with difficulty breathing and a

“barking” cough id displaying signs associated with which condition?

A. AsthmaB. CroupC. Cystic fibrosisD. Epiglottitis


Quiz? When assessing the lung sounds of a

child with asthma, which sound are you most likely to hear?

A. MurmursB. Sonorous WheezingC. Sibilant WheezingD. CracklesE. Pleural friction rub


Early & late signs of hypoxia Anxiety Bradycardia Cyanosis Depressed

respirations Diaphoresis Disorientation Dyspnea

Restlessness Headache Agitation Poor judgment Retraction Tachycardia Tachypnea


Early & late signs of hypoxia Anxiety Bradycardia Cyanosis Depressed

respirations Diaphoresis Disorientation Dyspnea

Restlessness Headache Agitation Poor judgment Retraction Tachycardia Tachypnea


Dyspnea Definition

SOB ��


Dyspnea Significance

Common with cardiac & resp. disease Sudden onset – healthy person

Pneumothorax

Sudden onset ill, post-op or injury Pulmonary emboli


Dyspnea Orthopnea

Sit up to breath COPD CHF


Dyspnea Right ventricle

If chronic airway resistance pressure Rt ventricle work Rt. Vent damage


Dyspnea Nrs Management

Find cause Give O2

HOB Communication

KISS


Cough Definition

To expel air from the lungs suddenly Irritation of mucous membrane


Cough Significance

Infection Irritants Protective mechanism Dry, irritating

URT

Cough + chest pain Pleural or musculoskeletal


Cough Nrs management

Assess Describe Directed Pain control

Splinting

Infection control Suppressants / Anti-tussives


Sputum ProductionDefinition Matter discharged

from resp. track that contains mucus and pus, blood, fibrin, or bacteria


Sputum ProductionSignificance Purulent

Thick, yellow/green Bacteria

Rusty Strep or staph

Thin, mucous Viral


Sputum Production Pink-tinged

Lung CA TB

Pink tinged, profuse, frothy Pulmonary edema

Malodorous Lung abscess


Sputum ProductionNrs Management Thick

Hydrate water Nebulizer Humidifier

TCDB No smoking Oral care Appetite


Do You Know?????What breath sound would you expect to

head on a patient with increased sputum production?

A. VesicularB. CracklesC. Sonorous wheezesD. Sibilant wheezes


Obtaining a sputum specimen Explain

From lungs Sterile cup Deep breath x 3 Cough deeply Expectorate Best time for

specimen collection? AM


Chest painDefinition Cardiac or

pulmonary


Chest painSignificance CA (late stage) Pneumonia Pulmonary embolism Pleurisy


Chest pain Pleurisy

Inflammation of pleura

Sharp with breath breath sounds


What?????What breath sound would you expect to

hear on a patient suffering from pleurisy?

A. CracklesB. Sonorous wheezesC. Sibilant wheezesD. Pleural Friction Rub


Chest painNrs Management Assess Analgesics OK,

but… Position for pain

Affected side Splint


Clubbed fingersDefinition Sponginess of the

nail bed Loss of the nail bed

angle Finger tip is round

and bulbous


Clubbed fingers


Clubbed FingerSignificance chronic hypoxiaNrs Management Marker


Mr. Caveman:

Mr. Caveman enters the ER unconscious following an Automobile accident. The paramedics report that his O2 sats are 86%. You note that Mr. Caveman has clubbed fingers. What does this tell you?


HemoptysisDefinition Expectoration of

blood from the respiratory tract


HemoptysisSignificance Pulm or cardiac Common causes

Pulm infection CA of lungs Pulm. Emboli Pulm. Infarction TB


Hemoptysis Hemoptysis

Definition? Coughed up blood

From? Pulm hemorrhage

Description Pink, red, mixed with

sputum

Blood pH Alkaline blood

Hematemesis Definition?

Vomited blood

From? Stomach / GI

Description “Coffee ground”

Blood ph Acidic blood


HemoptysisNrs Management Determine source Serious


CyanosisDefinition Bluish coloring of

skin


CyanosisSignificance Very late indicator of

hypoxia Appears when O2

sats < 85% NOT a reliable sign

of hypoxia Esp. with anemia


Cyanosis O2 sat definition

% of hemoglobin carrying oxygen compared to total # of hemoglobin


Cyanosis NormalBreath 100 O2 molecules 98 cross into blood

Blood: 100 Hgb O2 SATS

98% No cyanosis


Cyanosis HypoxiaBreath 100 O2 molecules 75 cross into blood


75% Cyanosis


Cyanosis Anemic and hypoxicBreath 100 O2 molecules 75 cross into blood


100% No Cyanosis


CyanosisNrs. Management Know color of Pt. skin Assess color of tongue

& lips Fingernail polish African-American Vasoconstriction (cold

weather) peripheral cyanosis


Documents

Physical Assessment of the Respiratory Systemparamed.bpums.ac.ir/UploadedFiles/CourseFiles/... · Physical Assessment of the Respiratory System ﺲﻔﻨﺗ هﺎﮕﺘﺳد ﻲﺳرﺮﺑ