Podcast
Questions and Answers
What is the normal respiratory rate range for adults according to the text?
What is the normal respiratory rate range for adults according to the text?
How many lobes does the right lung have according to the text?
How many lobes does the right lung have according to the text?
What is the appropriate ratio of inspiration to expiration in a normal respiratory pattern as per the text?
What is the appropriate ratio of inspiration to expiration in a normal respiratory pattern as per the text?
Which of the following is NOT mentioned as a component of the general inspection and observation during chest assessment?
Which of the following is NOT mentioned as a component of the general inspection and observation during chest assessment?
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What does tracheal position refer to in chest assessment?
What does tracheal position refer to in chest assessment?
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What is the characteristic of tympany percussion sound?
What is the characteristic of tympany percussion sound?
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When using a stethoscope, what type of sounds should be detected using the bell?
When using a stethoscope, what type of sounds should be detected using the bell?
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Which breath sound is described as 'blowing' and located between the scapulae and lateral to the sternum?
Which breath sound is described as 'blowing' and located between the scapulae and lateral to the sternum?
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What is the cause of barrel chest deformity?
What is the cause of barrel chest deformity?
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Which spine deformity is characterized by an excessive curve in the lumbar spine, slack tummy muscles, and protruding buttocks?
Which spine deformity is characterized by an excessive curve in the lumbar spine, slack tummy muscles, and protruding buttocks?
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What is the significance of an increased Anterior-Posterior Diameter in the thorax?
What is the significance of an increased Anterior-Posterior Diameter in the thorax?
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During thorax palpation, what is considered an abnormal finding?
During thorax palpation, what is considered an abnormal finding?
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What is the purpose of Tactile Fremitus during thorax assessment?
What is the purpose of Tactile Fremitus during thorax assessment?
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How is Percussion used in medical diagnosis during a thorax assessment?
How is Percussion used in medical diagnosis during a thorax assessment?
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What does it suggest if the Anterior-Posterior Diameter in the thorax equals the transverse diameter?
What does it suggest if the Anterior-Posterior Diameter in the thorax equals the transverse diameter?
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Which patient problem is associated with rusty red sputum in the text?
Which patient problem is associated with rusty red sputum in the text?
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What condition may present with fine crackles (rales) as described in the text?
What condition may present with fine crackles (rales) as described in the text?
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What common issue is associated with continuous, low-pitched, coarse, harsh sounds described as having a 'snoring quality'?
What common issue is associated with continuous, low-pitched, coarse, harsh sounds described as having a 'snoring quality'?
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Which assessment finding is indicative of a problem with decreased gas exchange due to alveolar-capillary membrane changes?
Which assessment finding is indicative of a problem with decreased gas exchange due to alveolar-capillary membrane changes?
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What condition is characterized by continuous, high-pitched, squeaky musical sounds when airflow is blocked?
What condition is characterized by continuous, high-pitched, squeaky musical sounds when airflow is blocked?
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Study Notes
Thorax Assessment
- Objectives:
- Explain significance of selected findings in the thorax, lungs, and breast
- Identify questions during thorax, lungs, and breast assessment
- Methods of assessment, characteristics, cultural variations, age variations, health promotion, and patient/family teaching
Health Assessment Obtain
- Family history
- Occupational history
- Country of origin
- Exposure
The Respiratory System
- Chest landmarks:
- First rib
- First intercostal space
- Second rib
- Second intercostal space
Medical and Surgical History
- Trauma or surgery
- Chest pain with deep breathing
- Cough
- Smoking
- Allergies
- Environmental exposures
- Lung disease
- Respiratory infections
- Pillow use
Anterior View of the Thorax
- 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
Thoracic/Chest Landmark
- Methods and order of chest assessment:
- General inspection
- Patient history
- Inspection
- Palpation
- Percussion
- Auscultation
General Inspection and Observation
- Count respiratory rate for a full minute – longer if there’s any abnormalities
- 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
- Posterior thorax:
- 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
- Normal findings:
Percussion
- Definition: a method of medical diagnosis in which various areas of the body, especially the chest, back, and abdomen, are tapped to determine by resonance 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 flat disc of the diaphragm for high-frequency sounds
- Use the bell of the stethoscope for low-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, idiopathic scoliosis
- Kyphosis:
- Excessive curve in lumbar spine
- Slack tummy muscles
- Protruding buttocks
Abnormal Breath Sounds
- Adventitious breath sounds:
- Crackles (rales)
- Wheezes
- Pleural friction rubs
- Rhonchi (gurgles)
- Stridor
- Fine crackles:
- High-pitched, intermittent, cracking, popping sound
- Heard at the bases on inspiration
- Common cause: air passing through fluid
- 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
- Predominantly heard over trachea and bronchi
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 and assessment:
- Between the 2nd and 6th ribs
- Between the sternal edge and mid-axillary line
- Methods of breast assessment:
- Inspection
- Palpation
Breast Assessment Divided
- Divided into four quadrants, using the “clock” for abnormality position
- Tail of Spence:
- Contains the largest portion of glandular tissue
- Most common site for female breast cancer
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Description
Learn how to interpret different percussion sounds heard through a stethoscope. Understand the characteristics of normal lung tissue sound, hyperresonance, tympany, dullness, and flatness. Identify potential conditions associated with each type of sound.
