Patient Assessment Inspection LOG # 4

Patient Assessment

Posture Sitting vs. lying Tense vs. relaxed Accessory muscles? Supine Prone Semi-fowlers Fowlers High fowlers Trendelenburg

Neck Jugular venous distention Reflects volume and pressure of venous blood “R heart” Accessory muscles Supra clavicular Supra sternal Tracheostomy scars

Face Pursed lip breathing Nasal flaring Grunting Cyanosis

Fingers Clubbing Cyanosis

Fingers cont. – Clubbing Painless enlargement of terminal phalanges (Angle greater than 180 degrees) May indicate Carcinoma Chronic pulmonary infection Cardiac disease Chronic lung disease

Chest Configuration Expansion Accessory muscle usage Rate and depth Paradoxical movement Surface markings

Chest cont. – Configuration Symmetry A-P Ratio Abnormalities Barrel chest Scoliosis Kyphosis Kyphoscoliosis Pectus Excavatum Pectus Carinatum

Chest cont. – Expansion Equal bilateral excursion Decreased bilateral Hyperinflation Air trapping Diffuse restrictive limitation of chest expansion Neuromuscular

Expansion cont. Decreased unilateral Atelectasis Pleural effusion Pneumothorax Pain (splinting)

Chest cont. Accessory Muscle Usage Muscles used External Internal Intercostals Diaphragm Scalenes Sternocleidomastoid Abdominals Indrawing and tracheal tug

Chest cont. – Rate and Depth A) Abnormal pattern Cheyne-stokes Biots Kussmauls Apneustic B) I:E Ratio

Chest cont. Paradoxical Movement “Opposite” Chest and abdomen (abd. in while chest out) Ventilatory failure Flail chest Fatigue

Surface Markings Identify location of underlying structures and location of abnormalities

Surface Mark – Imaginary Lines Anterior Mid sternal line Mid clavicular line Lateral Mid axillary Anterior axillary Posterior axillary Posterior Mid spinal Mid scapular

Surface Markings cont. Thoracic cage landmarks Suprasternal notch Sternal angle (Angle of Louis) Ribs Vertebrae

Surface Marking – Lung Fissures Between the lobes of the lungs are interlobular fissures 1. Oblique Both lungs Anterior chest (6th rib) at midclavicular line Extends laterally and upward until it crosses the 5th rib on the lateral chest to T3

Lung Fissures cont. Transverse/horizontal/minor Separates the RUL from RML Extends from 4th rib around to the 5th rib mid axillary

Other Surface Markings Carina Sternal angle Diaphragm 5th and 6th rib and T9/T10 Apex 2 - 4 cm above inner third of clavicle Bottom edge Crosses the 6th and 8th ribs

Pediatric Inspection

Pediatric Inspection Skin Resp. pattern Precordium Cyanosis Acrocyanosis Resp. pattern Regularity Tachypnea Retractions Nasal flaring Grunting Precordium Increased motion