Podcast
Questions and Answers
What is the normal respiratory rate range for adults?
What is the normal respiratory rate range for adults?
How many lobes does the right lung have?
How many lobes does the right lung have?
What is the normal inspiration to expiration ratio?
What is the normal inspiration to expiration ratio?
What should be observed during the general inspection of a patient's breathing?
What should be observed during the general inspection of a patient's breathing?
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Where does the upper lobe of the lung begin?
Where does the upper lobe of the lung begin?
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Which of the following is NOT a method of chest assessment?
Which of the following is NOT a method of chest assessment?
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What is the typical number of normal curvatures in the spine?
What is the typical number of normal curvatures in the spine?
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What is NOT a part of the general inspection and observation during chest assessment?
What is NOT a part of the general inspection and observation during chest assessment?
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Where does the base of the lung rest?
Where does the base of the lung rest?
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Which percussion sound is associated with lung hyperinflation?
Which percussion sound is associated with lung hyperinflation?
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What type of breath sound is characterized by a 'blowing' sound created by air movement through larger airways?
What type of breath sound is characterized by a 'blowing' sound created by air movement through larger airways?
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In which condition would you expect to hear flatness upon percussion of the chest?
In which condition would you expect to hear flatness upon percussion of the chest?
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Which breath sound is described as soft-intensity, low-pitched, and heard over most lung fields?
Which breath sound is described as soft-intensity, low-pitched, and heard over most lung fields?
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What percussion sound is associated with a very loud, low-pitched sound and may indicate a Large Pneumothorax?
What percussion sound is associated with a very loud, low-pitched sound and may indicate a Large Pneumothorax?
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Which chest deformity is characterized by lateral curvature or deviation of the spine?
Which chest deformity is characterized by lateral curvature or deviation of the spine?
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In which condition would you expect to hear tympany upon percussion of the chest?
In which condition would you expect to hear tympany upon percussion of the chest?
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"Blowing" breath sounds are usually heard at which location on the chest?
"Blowing" breath sounds are usually heard at which location on the chest?
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What is the normal shape of the chest?
What is the normal shape of the chest?
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In normal findings during palpation of the posterior thorax, what should be the chest expansion like?
In normal findings during palpation of the posterior thorax, what should be the chest expansion like?
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During palpation of the posterior thorax, what should be the normal separation between the thumbs during inspiration?
During palpation of the posterior thorax, what should be the normal separation between the thumbs during inspiration?
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What is the purpose of percussion in medical diagnosis?
What is the purpose of percussion in medical diagnosis?
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What is tactile fremitus?
What is tactile fremitus?
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When palpating the posterior thorax, what should be the temperature of the skin in normal findings?
When palpating the posterior thorax, what should be the temperature of the skin in normal findings?
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What is clubbing of nailbeds indicative of?
What is clubbing of nailbeds indicative of?
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What is the most likely cause of rusty red sputum in a patient?
What is the most likely cause of rusty red sputum in a patient?
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What is the common cause of fine crackles (rales) on auscultation of lungs?
What is the common cause of fine crackles (rales) on auscultation of lungs?
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What condition is associated with continuous, low-pitched, coarse, harsh sounds that have a 'snoring quality'?
What condition is associated with continuous, low-pitched, coarse, harsh sounds that have a 'snoring quality'?
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What is the priority patient problem associated with decreased blood flow due to pulmonary capillary vasoconstriction?
What is the priority patient problem associated with decreased blood flow due to pulmonary capillary vasoconstriction?
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Which lung condition is characterized by a loud, high-pitched crowing sound or harsh honking wheeze with severe broncholaryngeal spasm?
Which lung condition is characterized by a loud, high-pitched crowing sound or harsh honking wheeze with severe broncholaryngeal spasm?
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What causes intermittent, cracking, popping sounds known as fine crackles (rales) in the lungs?
What causes intermittent, cracking, popping sounds known as fine crackles (rales) in the lungs?
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'Barrel-chested appearance' is commonly associated with which lung condition?
'Barrel-chested appearance' is commonly associated with which lung condition?
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'Orange peel' skin texture on the breast may indicate:
'Orange peel' skin texture on the breast may indicate:
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What condition is likely present when a patient has recent inversion of one or both nipples?
What condition is likely present when a patient has recent inversion of one or both nipples?
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What is the primary method used to assess abnormality positions in a breast examination?
What is the primary method used to assess abnormality positions in a breast examination?
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Study Notes
THORAX Assessment
- Objectives: Explain the significance of selected findings in the thorax, lungs, and breast, and identify questions during assessment.
- Methods of assessment:
- General inspection and patient history
- Inspection
- Palpation
- Percussion
- Auscultation
Chest Landmarks
- First rib: Accurate localization and count
- First intercostal space: Accurate localization and count
- Second rib: Accurate localization and count
- Second intercostal space: Accurate localization and count
Anterior View of the Viscera of Thorax
- Shows the various parts of the heart, lungs, and ribs
- Apex: where the upper lobe begins
- Base: broad, concave, and rests upon the convex surface of the diaphragm
- Three lobes to the right
- Two lobes to the left
Methods and Order of Chest Assessment
- General inspection and patient history
- Inspection
- Palpation
- Percussion
- Auscultation
General Inspection and Observation
- Count respiratory rate for a full minute
- Normal respiratory rate: 12 to 20 BPM for adults
- Observe the rhythm, depth, and effort of breathing
- Respiratory pattern should be even, coordinated, and regular
- Inspiration to expiration ratio: 1:2
Palpation
- Normal findings:
- Skin intact
- Uniform temperature
- Use the back of hands
- No tenderness
- No masses
- No pain
- Tactile fremitus:
- Definition: the faintly perceptible vibration felt through the chest wall when the client speaks
- Procedure:
- Place palm on landmarks
- Have client repeat “ninety-nine”
- Normal finding: Bilaterally symmetrical
Percussion
- A method of medical diagnosis to determine the condition of internal organs
- Interpreting percussion sounds:
- Normal lung tissue: Long, loud, low-pitched, hollow sound
- Hyperresonance: Lung hyperinflation, COPD, Pneumothorax
- Tympany: Gastric air bubble, Large Pneumothorax
- Dullness: Medium intensity, pitch, and length, thud-like
- Flatness: Short, high-pitched, extremely dull sound
Auscultation
- Use the bell of the stethoscope to detect low-pitched sounds
- Use the diaphragm of the stethoscope to detect high-pitched sounds
- Systematic side-to-side approach
- Ask client to take slow, deep breaths through the mouth
Normal Breath Sounds
- Vesicular:
- Soft-intensity
- Low-pitched (gentle sighing)
- Heard over most lung fields
- Best location: Peripheral lung, base of lung
- Bronchovesicular:
- Moderate intensity and pitch
- “Blowing” sound created by air movement through larger airway
- Location: Between scapulae and lateral to sternum, first and second intercostal spaces
- Bronchial:
- High-pitched, loud, harsh sounds
- Created by air moving through trachea
- Location: Over trachea
Chest Deformities
- Barrel Chest:
- Ratio of AP to transverse diameter is 1:1
- Increased AP diameter is normal for COPD patients
- Caused by chronic lung diseases (emphysema)
- Scoliosis:
- Lateral curvature or deviation of the spine
- Caused by trauma, present since birth, or idiopathic scoliosis
- Kyphosis:
- Excessive curve in lumbar spine
- Slack tummy muscles
- Protruding buttocks
Abnormal Breath Sounds
- Crackles (rales):
- Fine crackles:
- High-pitched, intermittent, cracking, popping sound
- Common cause: Air passing through fluid
- Commonly heard at the bases on inspiration
- Disease process: Bronchitis, Pneumonia, Emphysema, Heart Failure
- Coarse crackles:
- Continuous, low-pitched, coarse, harsh sounds
- “Snoring quality”
- May disappear or decrease with coughing
- Occurs when air passes through narrowed air passages due to secretions, swelling, or tumors
- Fine crackles:
- Wheezes:
- Continuous, high-pitched, squeaky musical sounds
- Happens when airflow is blocked
- Occurs because of airway inflammation or narrowing (asthma or infection)
- Can also occur because of airway obstruction related to tumor or foreign body
- Not cleared by coughing
- Rhonchi:
- Continuous, low-pitched, coarse, harsh sounds
- “Snoring quality”
- May disappear or decrease with coughing
- Occurs when air passes through narrowed air passages due to secretions, swelling, or tumors
- Stridor:
- Loud, high-pitched crowing sound or harsh honking wheeze with severe broncholaryngeal spasm
- Can be heard loudest over the neck, usually without a stethoscope, when a patient inhales
- Caused by an upper airway obstruction
- REQUIRES IMMEDIATE ATTENTION
Health Promotion
- Promotion of health screening, health maintenance, and self-care teaching
- Health promotion plans need to be developed according to the needs, desires, and priorities of the client
- The client decides on the health promotional goals
- Early detection and vaccinations
Breast Assessment
- Location: Between the 2nd and 6th ribs, between the sternal edge and mid-axillary line
- Methods of breast assessment:
- Inspection
- Palpation
- Divided into four quadrants, using the “clock” for abnormality position
- Tail of Spence:
- Contains largest portion of glandular tissue
- Most common site for female breast cancer
- Preparation:
- Introduce self
- Include your professional title
- Verify/identify client
- Use two identifiers
- Assess allergy status
- Explain procedure
- Reason for examination
- Provide privacy
- Door
- Curtain
- Sheet
- Expose ONLY the part that needs to be assessed
- Wash and warm hands
- Assessment of the breast:
- Observe and inspect:
- Size/Symmetry
- Shape
- Skin discoloration
- Nipple discharge, integrity, and retraction
- Tenderness and masses, dimpling
- Palpation of the breast:
- Use the flat surface of the middle three fingertips
- Making gentle rotating motion on the breast
- Position of choice:
- Client supine
- Breasts flatten evenly against the chest wall
- High-risk patients examine in both supine and sitting positions
- Observe and inspect:
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Description
This quiz covers the interpretation of percussion sounds using a stethoscope in lung assessment. Learn to recognize and differentiate between normal and abnormal sounds like hyperresonance, tympany, dullness, and flatness.
