Pulmonary Assessment

Lungs sounds: 3 lobes in the right lung, 2 lobes in the left (one less due to the cardiac notch)

Focused interview: Inquire about respiratory conditions such as asthma or emphysema

Inspection: Observe for signs of visible respiratory distress, breathing patterns, chest wall abnormalities

Respirations: Assess rate (breaths/minute), note characteristics, including depth, quality, and use of accessory muscles.
Normal respirations are usually between 12-20 breaths per minute in adults
Abnormal respirations: Tachypnea (rapid respiration rate), bradypnea (slow respiration rate)
Abnormal lung sounds/patterns: Diminished lung sounds, Kussmauls respirations (deep, exaggerated respirations with
increased tidal volume), Cheyne-Stokes respirations (periodic breathing or deep respirations followed by diminished breathing or
apneic episodes), tripoding, use of accessory muscles, pursed-lip breathing
Signs respiratory distress in infants: Nasal flaring, substernal and intercostal retractions, paradoxical breathing

Long-standing/chronic hypoxia: Clubbing of the fingernails (digital clubbing) with spongy appearance in nail beds, barrel
chest, and cyanosis of the lips, nose, oral mucosa, and nail beds

Adventitious lung sounds: Crackles (fine- high-pitched/short, or course- low-pitched/longer-lasting), rales (synonymous to
crackles), rhonchi (low-pitched), wheezes (whistling sound, heard in asthma), stridor (high-pitched, predominantly inspiratory,
may be indicative of emergency)

Breath sounds: Apical (heard up high, above the clavicles), bronchovesicular (heard hear major airways, including the trachea
and bronchi), tracheal or bronchial/tubular (heard in the upper airway, have a harsh and tubular quality with the same intensity on
both inspiration and expiration and a distinct gap between each, presenting as air blowing through a hollow tube), vesicular or
alveolar (auscultated in the posterior lower lobes and present as low-pitched, soft breath sounds)

Abnormal vocal sounds: Egophony (vocalization of the letter E sounds like an A to the examiner), bronchophony (sound
is clearly transmitted through the chest wall), whispered pectoriloquy (whispering sound is clearly transmitted through the chest
wall)

Other abnormal sounds: Crepitation (sounds like saran wrap being crinkled), pleural rub (grating or creaking)

Lung Palpation
Chest expansion: Should be symmetrical and even on both anteriorly and posteriorly, 3-5cm upon inspiration
Trachea: Palpate for any lumps, masses, or tenderness
Tactile fremitus: Palpate with the palm or ulnar surface of the hand for vibratory tremors, should be felt over the main stem
bronchi and progressively decrease toward the periphery
Whispered pectoriloquy: The hand is paced on the back and the patient is asked to whisper in order to detect a vibration
Abnormal Lung Palpation Findings
Loud tactile fremitus or vibration
Crepitus: a coarse, crackling sensation over the skin surface heard over the anterior chest wall
Subcutaneous emphysema: a crackling sensation is produced rom air in the tissues under the skin
Point tenderness: may suggest rib fracture or pleural inflammation
Adventitious (Abnormal) Lung Sounds
Crackles, fine or course, discontinuous. Fine: High pithed and short. Course: Low-pitched, longer-lasting
Rhonchi: Low-pitched, both inspiratory and expiratory. Possible cause: Obstruction from secretions such as bronchitis
Rales: Synonymous to crackles
Stridor: High-pitched, predominantly inspiratory
Wheezes: Whistling. Possible cause: Asthma