Assessment Week 4: Respiratory Assessment Fundamentals

Respiratory Assessment Landmarking

• Intercostal spaces identified by counting ribs; anterior chest counts top down, posterior counts bottom up.
• The 12th rib serves as a reference point; the inferior tip of the scapula normally aligns with the 7th rib or intercostal space.
• Sternal notch located at the top of the sternum; the Angle of Louis is 5cm below it, at the 2nd intercostal space.
• T1 indicates the site of the first rib.

Lung Position

• Anterior lung position covers the upper front portion of the chest, while the posterior view encompasses the back upper regions.
• The right lung may be differentiated from the left based on anatomical features in lateral views.

Muscles of Respiration

• Diaphragm: Essential for inspiration by contracting and descending, allowing chest expansion, and compressing abdominal contents. During expiration, it relaxes and rises passively.
• Scalene and Intercostal Muscles: Assist in chest wall expansion during inspiration and recoil during expiration.
• Accessory Muscles: Include sternocleidomastoid, scalene, and increased abdominal muscle use, involved in forced inspiration or expiration.

Symptom Assessment (PQRST)

• P: Provocation/Palliative - factors that trigger or alleviate symptoms.
• Q: Quality - description of the symptom feel.
• R: Region/Radiation - location and potential spread of symptoms.
• S: Severity - subjective severity rating on a scale.
• T: Timing - specific time or context when symptoms arise.

Common Respiratory Symptoms

• Dyspnea (shortness of breath) and cough are primary concerns.
• Hemoptysis (coughing up blood) and chest pain warrant further examination.
• History of infections, smoking, environmental exposures, and known lung diseases inform risk assessment.
• Daytime sleepiness and sleep disorders may relate to respiratory health.

Inspection

• Observe breathing for rate, rhythm, depth, and effort.
• Examine the anterior and posterior chest for skin color, condition, accessory muscle use, and chest deformities.
• Assess chest symmetry and diameter; note the patient's breathing position.

Signs of Hypoxia

• Acute Hypoxia: May present as cyanosis or pallor; patients may exhibit signs of anemia.
• Chronic Hypoxia: Characterized by clubbing of fingers and persistent fatigue.
• Heart Failure Indicators: Peripheral edema and jugular venous distension (JVD).

Palpation

• Palpate the chest to identify lumps, tenderness, bruising, respiratory expansion, and tactile fremitus.

Percussion

• Not routinely used but useful for identifying areas of consolidation in the lungs.
• Normal percussion is resonant; abnormal findings include flat, dull, hyper-resonant, or tympanic sounds.
• Technique involves applying pressure with the non-dominant middle finger and tapping with the dominant hand.

Auscultation

• Use the diaphragm of the stethoscope, comparing sounds on both sides.
• Listen for at least one full breath cycle at each site, avoiding bony areas.

Abnormal Breath Sounds

• Crackles (Rales): Intermittent fine or coarse sounds, indicating fluid in the airways.
• Wheezes: High-pitched sounds indicate narrowed airways.
• Rhonchi: Low-pitched, snoring sounds suggest mucus in larger airways.
• Stridor: A harsh sound indicating upper airway obstruction.
• Rubs: Pleuritic sounds from friction between inflamed pleural layers.

Special Tests

• Egophony: Positive if 'eee' sounds like 'aaa', indicating fluid accumulation or scar tissue.
• Bronchophony: Positive if '99' can be heard clearly, suggesting denser lung tissue due to fluid or masses.
• Whispered Pectoriloquy: Positive if whispered sounds are heard distinctly, indicating tissue abnormalities affecting sound transmission.

Normal vs. Abnormal Breath Sounds

• Normal breath sounds include tracheal, bronchial, and vesicular.
• Abnormal findings consist of crackles, wheezes, and stridor, which indicate underlying respiratory conditions.

This quiz focuses on the essential techniques for assessing respiratory landmarks, particularly the intercostal spaces in both the anterior and posterior chest. You'll learn how to count intercostal spaces accurately and identify anatomical references such as the sternal notch and the angle of Louis. Test your understanding and enhance your clinical skills in respiratory assessments.