1. Patient Assessment
Inspection
LOG # 4

2. Patient Assessment

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

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

5. Face
Pursed lip breathing
Nasal flaring
Grunting
Cyanosis

6. Fingers
Clubbing
Cyanosis

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

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

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

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

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

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

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

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

15. Surface Markings
Identify location of underlying structures and location of abnormalities

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

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

18. 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

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

20. 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

21. Pediatric Inspection

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