NSG 5512
Assessment of the Chest and Lungs
Patsy Riley, DSN, CRNP, Diane Weed, Ph.D CRNP
Cough: Differential Dx
Environmental irritants
Cigarette, cigar, pipe smoking, Pollutants. Dust, Lack of humidity
Upper respiratory problems
Rhinitis: chronic or acute, Chronic sinusitis, Pharyngitis, Laryngeal cancer
Lower respiratory tract problems
Asthma, Acute bronchitis,Chronic bronchitis, (COPD),Interstitial lung disease
Pneumonia, Bronchiectasis, Congestive heart failure Lung cance, rTB
Medication-induced cough from ACE inhibitors
Extrinsic compression lesions
Adenopathy,Malignancy, Aortic aneurysm
GI problems such as GERD
Genetic problems such as cystic fibrosis
Dyspnea
Subjective sensation of uncomfortable breathing, the feeling of being unable to get
enough air Goolsby, p.162
“I can’t get my breath” “I’m short of breath” “I have trouble getting my wind” I
can’t…………breathe” “I need air”
Dyspnea: Acute
Focus on immediate situation and respiratory assessment:
Onset, Foreign body obstruction Goolsby p.163, History of lung disease, Allergies
Causes:
Foreign body obstruction, Anaphylactic reaction, Dyspnea with chest pain: Spontaneous pneumothorax,
Pulmonary embolus, MI, Severe anemia of acute onset, Anxiety or panic disorder
Dyspnea: HPI
Onset, Quality, Quantity, Location, Precipitating or aggravating factors
Alleviating factors, Associated manifestations
Onset
Acute or Chronic
Work history Smoker - pack year history, exposure History of lung disease
(asthma, croup, COPD) Allergies Time of day (PND, GERD) Travel, exposure
Quantity
Frequency, Does it keep them from going to sleep at night?
Does it wake them up during the night?, Does it interfere with normal activities?
Does it keep them from doing things they want to do?, Progression over time
Precipitating or alleviating factors
Exercise or activity , Cold air, Talking, Environmental irritants (e.g., cigarette
smoking, second-hand smoke), Stress, Beta blockers or calcium channel blockers
Alleviating factors
Getting up, walking around, Sitting up, leaning forward, Rest
3
OTC meds, MDI, Humidifier, Sitting in front of a fan, Heimlich maneuver
Associated manifestations
S/S anaphylactic reaction, S/S congestive heart failure, edema
GERD, Inactivity, fatigue, somnolence, Muscles aches, fever, rhinitis
Chest pain and dyspnea
Hx of thrombophlebitis or taking OCTs
Advanced pregnancy, ascites
Dyspnea: PE
VS including temp, weight
I: cyanosis- mucous membranes, skin, difficulty breathing, use of axillary muscles,
finger clubbing, TMs, JVD, position
P: lymphadenopathy (include supraclavicular nodes)
P: hyperresonance, dullness
A: heart, lungs
Dyspnea: Differential DX
Acute or recurrent
Asthma, Pulmonary emboli, Hyperventilation anxiety, Poor physical conditioning,
Foreign body obstruction, Pulmonary edema, Pneumothorax, Obstructive lung
diseases
Restrictive lung diseases
Chest Pain: PE
Thorough heart and lung assessment
Onset
Chronic
Pulmonary causes:
Micropulmonary emboli, TB, Lung cancer, Costochondritis
Hemoptysis: Differential Dx
Hemoptysis or hematemesis? Pulmonary embolus, Lung cancer, Laryngeal cancer
Congestive heart failure, Pneumonia/ inflammatory process, GI – esophagitis, ulcer,
esophageal varices
Abnormal findings
Tripod position
Cyanosis/ruddy complexion
Asymmetrical expansion
Chest wall deformities: p.368, Colyar 83
Pectus excavatum,
Pectus carinatum
Barrel chest
Kyphoscoliosis
Assessment: Palpation
Symmetry of expansion
Tactile fremitus
Chest wall tenderness
Abnormal findings:
Asymmetrical expansion
Increased tactile fremitus
Decreased tactile fremitus
Tracheal deviation
6
SQ emphysema, crepitus
Assessment: Percussion
Abnormal Findings
Hyperresonance
Decreased resonance
Increased tactile fremitus
Decreased tactile fremitus
Assessment: Auscultation p.381-387
Speech
Audible respiratory sounds
Normal breath sounds
Bronchial
Bronchovesicular
Vesicular
Abnormal breath sounds 384-386
Adventitious sounds
Infants
Apgar score
Acrocyanosis
Stridor
Common abnormalities
p. 397-398 399-413
Older adults
Decreased chest expansion
Infants and Children
Important assessment information Box 12-11 p.394
Clubbing==think about CV or GI disorders
The end!