Denise Coffey MSN, RN

Respiratory Assessment Structure and Function Subjective Data—Health History Questions Objective Data—The Physical Exam Abnormal Findings

Anterior Thoracic Cage Slide 18-3

Posterior

Reference Lines Midsternal line Midclavicular line Scapular line Vertebral line Anterior, posterior, midaxillary lines

Reference Lines Anterior

Reference Lines Posterior

Lateral

Structure and Function Thoracic cavity Mediastinum defined Lobes of the lungs Anterior Posterior Lateral Pleurae Trachea and bronchial tree Location of trachea and bronchi Dead space

Structures of the Respiratory System

Mechanics of Respiration Four functions of respiratory system Changing chest size during respiration Inspiration Expiration Control of respiration

Mechanics of Respiration

Subjective Data What would you want to know?

Subjective Data Cough Shortness of breath Chest pain with breathing History of respiratory infections Smoking history Environmental exposure Self-care behaviors

Objective Data- The Physical Exam Preparation Position Draping Timing during a complete examination Cleaning stethoscope endpiece Equipment needed Stethoscope Small ruler marked in centimeters Marking pen Alcohol swab

Objective Data- The Physical Exam Posterior Chest—Inspect Thoracic cage Shape and configuration of chest wall Anteroposterior/transverse diameter Position of person Skin color and condition

Objective Data- The Physical Exam Posterior Chest—Palpate Symmetric expansion Tactile (or vocal) fremitus Technique Factors that affect normal intensity of tactile fremitus Palpate the entire chest wall Posterior Chest—Percuss Predominant note over lung fields Diaphragmatic excursion

Objective Data- The Physical Exam Anterior Chest—Palpate Symmetric chest expansion Tactile fremitus Palpate the anterior chest wall Anterior Chest—Percuss Predominant note over lung fields Borders of cardiac dullness

Objective Data- The Physical Exam Anterior Chest—Auscultate Breath sounds Abnormal breath sounds

Objective Data- The Physical Exam Anterior Chest—Auscultate Breath sounds Abnormal breath sounds

Expected Breath Sounds Breath sounds Technique Bronchial breath sounds—characteristics Bronchovesicular breath sounds— characteristics Vesicular breath sounds—characteristics

Abnormal Breath Sounds Rhonchi Wheezes Crackles Stridor Croup Pleural friction rub

Listen

Measurement of Pulmonary Function Pulse ox ABGs Pulmonary Function Tests

Abnormal Findings Barrel chest Scoliosis Kyphosis

Barrel Chest

Scoliosis

Kyphosis Slide

Abnormal Findings Common Respiratory Conditions Atelectasis Lobar pneumonia Bronchitis Emphysema Asthma (reactive airway disease) Pleural effusion thickening Congestive heart failure Pneumothorax Pneumocystis carinii pneumonia Tuberculosis Pulmonary embolism Acute respiratory distress syndrome (ARDS)

Interventions Ambulation Incentive Spirometer ( IS) Repositioning Coughing and Deep Breathing Medications Education

Case scenario You are caring for Mrs. Brown, a 75-year-old retired school teacher who underwent repair of a right fractured femur. This is her first postoperative day on your clinical unit. Upon auscultation of her posterior lung field bases, you hear a crackling noise upon inspiration. What is this sound, and what does it indicate?