SKILLS LAB-Resp Assessment

8/6/2019 SKILLS LAB-Resp Assessment

1/5

SKILLS LAB

SUMMER -2011

HEALTH ASSESSMENT

PROCEDURE IN ASSESSING THE LUNGS AND RESPIRATION

Procedure

INSPECTION1. With the patient sitting, examine thePatient anterior and posterior chest.

2. Assess the front and back, and side ofthe chest for scars, wounds and lesions.

3. Look for the symmetry of the chestMovements. Observe the duration ofinspiratory/expiratory cycle.

4. look to see if the patient uses accessorymuscles of respirations.

5. Inspect the neck for contraction ofsternocleidomastoid or other accessory

muscle during inspiration. Observe forintercosta l retractions , nasal flaring, orpursed lip breathing

6. Observe the patient LOCPALPATION

1. To assess the symmetry of the chestexpansion during breathing, stand behindthe persons, and place your hand withfingers spread apart beneath his or herarms, on the sides of the chest, about 2inches below the axilla. Your finger shouldbe pointing towards the anterior chest.

2. Ask the patient to breath out completely-observe your hand and thumbs to see they

moved equally on both sides.3. After checking chest expansion, feel fortactile fremitus, ask the patient to say 99or blue moon. While the patient isspeaking, palpate the chest from one sideto another.4. Move your hand downward andoutward, fremitus should decrease


2/5

Percussion

1. Percussing the anterior chest is mosteasily done with the patient lyingsupine;the patient should sit whenpercussing the posterior chest. Place the

first partof the middle finger of yournondominant hand firmly on the patient'sskin.Then, strike the finger placed on thepatient's skin with the end of the middlefinger of your dominant hand.

2.Work from the top part of the chestdownward, comparing sounds heard onboth the right and left sides of the chest.Visualize the structures underneath as youproceed.

Auscultation

1.Ask the patient to sit with his arms foldedacross the chest with the hands resting, ifpossible, on the opposite shoulders.

2.Instruct the patient to breathe deeplywith his mouth open. Listen carefully for atleast one full breath in each location.Observe the patient for light-headednessor fatigue and allow the patient to rest asoften as necessary.

3. Start by listening to posterior chest,beginning with the areas above the

scapulae4.Move downward in a stair-step fashion,comparing your findings from one side withthose from the other side.5.If abnormalities are detected, listening tothe sounds of the patient'sspoken or whispered voice as they aretransmitted through the chest wall

6. If you hear adventitious sounds onauscultation, assess how these soundschange as the patient speaks.

Document findings


3/5

THORACIC ANATOMY


4/5

Other terms used to document locations for chest physical assessmentinclude:ySupraclavicular - above the claviclesyInfraclavicular - below the claviclesy

Interscapular - between the scapulaeyInfrascapular - below the scapulae

yBases of the lungs - the lowermost portions

yUpper, middle, and lower lung field


5/5

Resonant sounds are low pitched, hollow

sounds heard over normal lung tissue.

Flat or extremely dull sounds are normallyheard over solid areas such as bones.

Dull or thudlike sounds are normally heard over dense areas such as the heart orliver. Dullness replaces resonance when fluid or solid tissue replaces air-containinglung tissues, such as occurs with pneumonia, pleural effusions, or tumors.

Hyperresonant sounds that are louder and lower pitched than resonant sounds arenormally heard when percussing the chests of children and very thin adults.Hyperresonant sounds may also be heard when percussing lungs hyperinflated withair, such as may occur in patients with COPD, or patients having an acute asthmaticattack. An area of hyperresonance on one side of the chest may indicate apneumothorax.

Tympanic sounds are hollow, high, drumlike sounds. Tympany is normally heardover the stomach, but is not a normal chest sound. Tympanic sounds heard over thechest indicate excessive air in the chest, such as may occur with pneumothorax.

Documents

SKILLS LAB-Resp Assessment