Respiratory Assessment

R. Hernandez

Chest Physical Assessment

Inspection Palpation Percussion Auscultation

Inspection
Level of Conciousness Evidence of Respiratory disease
Nasal flaring Cyanosis
Peripheral Circulation Central - Hypoxemia

Pursed-lip breathing

Inspection
Jugular Neck Vein Distention Head of bed 45 degrees
Normal
<3-4 cm above sternal angle

Increased Markedly increased

Use of Accessory muscles Enlarged lymph

Thorax

Inspection

Observe for retractions and use of accessory muscles (sternomastoids, abdominals). Retractions Observe the chest for asymmetry, deformity, or increased anterior-posterior (AP) diameter. Confirm that the trachea is near the midline?
http://www.meddean.luc.edu//lumen/MedEd/medicin e/pulmonar/pd/pstep25a.htm

Inspection
Pectus Carinatum Pectus Excavatum Kyphosis
Anteroposterios

Scoliosis - Lateral

Inspection
Increased A-P Diameter

Chest Physical Assessment

Inspection Palpation Percussion Auscultation

Palpation
Trachea
http://www.meddean.luc.edu//lumen/MedEd/medicine/pulmonar/pd/pstep25a.htm

Chest
Repeat ninety-nine Increased
Consolidation

Decreased
Obstruction Increase air - fluid

Palpation
Thoracic Expansion Normal Movement
3-5 cm

Assess expansion and symmetry of the chest by placing your hands on the patient's back, thumbs together at the midline, and ask them to breath deeply
http://www.meddean.luc.edu//lumen/MedEd/ medicine/pulmonar/pd/pstep26a.htm

Palpation
Peripheral Edema +1 - +4

Chest Physical Assessment

Inspection Palpation Percussion Auscultation

Percussion
Hyperextend the middle finger of one hand and place the distal interphalangeal joint firmly against the patient's chest. With the end (not the pad) of the opposite middle finger, use a quick flick of the wrist to strike first finger. Categorize what you hear as normal, dull, or hyperresonant. Practice your technique until you can consistantly produce a "normal" percussion note on your (presumably normal) partner before you work with patients.

Percussion
Posterior Chest
Percuss from side to side and top to bottom using the pattern shown in the illustration. Omit the areas covered by the scapulae. Compare one side to the other looking for asymmetry. Note the location and quality of the percussion sounds you hear. Find the level of the diaphragmatic dullness on both sides.

Percussion
Diaphragmatic Excursion Find the level of the diaphragmatic dullness on both sides. Ask the patient to inspire deeply. The level of dullness (diaphragmatic excursion) should go down 3-5cm symmetrically.

Percussion
Anterior Chest
Percuss from side to side and top to bottom using the pattern shown in the illustration. Compare one side to the other looking for asymmetry. Note the location and quality of the percussion sounds you hear.

Percussion
Percussion Notes and Their Meaning Flat or Dull
Pleural Effusion or Lobar Pneumonia

Normal
Healthy Lung or Bronchitis

Hyperresonant
Emphysema or Pneumothorax

Chest Physical Assessment

Inspection Palpation Percussion Auscultation

Stethoscope
Chest piece
Diaphragm
High frequency - Lungs

Bell
Low frequency Heart

Tubing
11-16 inches

Ear pieces
Angled

Low level disinfection between patient use

Chest Segments
Anterior Posterior

Normal Breath Sounds

Inhalation / Exhalation Upstroke / Downstroke Length
Duration

Thickness of Stroke
Intensity

Angle
Pitch

Normal Breath Sounds

Vesicular
Low Pitch, Soft Intensity Peripheral lung areas

Bronchovesicular
Moderate Pitch, Moderate Intensity Medial Chest

Bronchial
High Pitch, Loud Intensity Trachea

Adventitious Breath Sounds

Crackles
Discontinuous, secretions, atelectasis

Wheezes
High Pitched Obstruction, anatomic, bronchoconstriction, inflammation

Stridor
High pitched

Localization of Adventitious BS
Location When
Inspiratory / Expiratory

Pitch Prominance / Loudness

Increased / Decreased