Podcast
Questions and Answers
To assess lung sounds, the patient should be sitting, leaning slightly forward, with arms resting across the ______.
To assess lung sounds, the patient should be sitting, leaning slightly forward, with arms resting across the ______.
lap
It is imperative that you know how to determine which ______ of the lung you are listening to!
It is imperative that you know how to determine which ______ of the lung you are listening to!
lobe
To auscultate the lungs, you will use the ______ of your stethoscope!
To auscultate the lungs, you will use the ______ of your stethoscope!
diaphragm
Auscultation should be performed in a sequential manner – at ______ spaces, comparing bilaterally throughout the lung fields.
Auscultation should be performed in a sequential manner – at ______ spaces, comparing bilaterally throughout the lung fields.
Signup and view all the answers
The ______ breath sounds are heard on inspiration and expiration, and sounds like wind rustling in the trees.
The ______ breath sounds are heard on inspiration and expiration, and sounds like wind rustling in the trees.
Signup and view all the answers
Adventitious sounds are also known as ______ sounds.
Adventitious sounds are also known as ______ sounds.
Signup and view all the answers
If you do hear an adventitious sound, have the patient ______ and listen again to determine if sound has cleared with coughing.
If you do hear an adventitious sound, have the patient ______ and listen again to determine if sound has cleared with coughing.
Signup and view all the answers
Do not listen over ______ but rather the intercostal spaces.
Do not listen over ______ but rather the intercostal spaces.
Signup and view all the answers
Assess for S/S of respiratory alterations including ______________, restlessness, confusion, and pain during inspiration.
Assess for S/S of respiratory alterations including ______________, restlessness, confusion, and pain during inspiration.
Signup and view all the answers
Factors that influence characteristics of respirations include ______________, anxiety, and acute pain.
Factors that influence characteristics of respirations include ______________, anxiety, and acute pain.
Signup and view all the answers
Pertinent lab values to assess in respiratory assessment include ABG’s, ______________, and CBC.
Pertinent lab values to assess in respiratory assessment include ABG’s, ______________, and CBC.
Signup and view all the answers
The ______________ line is an important anterior thoracic landmark.
The ______________ line is an important anterior thoracic landmark.
Signup and view all the answers
The ______________ line is a significant lateral thoracic landmark.
The ______________ line is a significant lateral thoracic landmark.
Signup and view all the answers
A ______________ disease is a significant aspect of the patient's history.
A ______________ disease is a significant aspect of the patient's history.
Signup and view all the answers
Lifestyle choices such as ______________ use can affect respiratory health.
Lifestyle choices such as ______________ use can affect respiratory health.
Signup and view all the answers
In respiratory assessment, a ______________ cough is a significant aspect of the patient's history.
In respiratory assessment, a ______________ cough is a significant aspect of the patient's history.
Signup and view all the answers
Palpation of the chest wall helps in assessing ______ tenderness.
Palpation of the chest wall helps in assessing ______ tenderness.
Signup and view all the answers
Tactile fremitus is a palpation ______ that can be felt using the palmar aspect of the hand.
Tactile fremitus is a palpation ______ that can be felt using the palmar aspect of the hand.
Signup and view all the answers
During chest expansion assessment, the patient should be asked to ______ and then inhale.
During chest expansion assessment, the patient should be asked to ______ and then inhale.
Signup and view all the answers
Unequal expansion of the chest during inhalation may be indicative of ______ or trauma.
Unequal expansion of the chest during inhalation may be indicative of ______ or trauma.
Signup and view all the answers
Breath sounds can be classified into three types: bronchial, bronchovesicular, and ______ sounds.
Breath sounds can be classified into three types: bronchial, bronchovesicular, and ______ sounds.
Signup and view all the answers
Auscultation of the chest helps in identifying ______ breath sounds, such as wheezes or crackles.
Auscultation of the chest helps in identifying ______ breath sounds, such as wheezes or crackles.
Signup and view all the answers
When assessing tactile fremitus, the patient should be asked to say ______ to detect changes in the intensity of the vibration.
When assessing tactile fremitus, the patient should be asked to say ______ to detect changes in the intensity of the vibration.
Signup and view all the answers
During auscultation, breath sounds can be heard over the ______ and larynx.
During auscultation, breath sounds can be heard over the ______ and larynx.
Signup and view all the answers
Decreased tactile fremitus may occur when there is an ______ or emphysema.
Decreased tactile fremitus may occur when there is an ______ or emphysema.
Signup and view all the answers
The anterolateral assessment of chest expansion involves placing hands along the ______ margins.
The anterolateral assessment of chest expansion involves placing hands along the ______ margins.
Signup and view all the answers
What is the primary purpose of understanding the anterior thoracic landmarks in respiratory assessment?
What is the primary purpose of understanding the anterior thoracic landmarks in respiratory assessment?
Signup and view all the answers
Which of the following factors can influence the characteristics of respirations?
Which of the following factors can influence the characteristics of respirations?
Signup and view all the answers
What is the significance of assessing the posterior axillary line in respiratory assessment?
What is the significance of assessing the posterior axillary line in respiratory assessment?
Signup and view all the answers
What is the significance of assessing the midsternal line in respiratory assessment?
What is the significance of assessing the midsternal line in respiratory assessment?
Signup and view all the answers
Which of the following is a risk factor for respiratory alterations?
Which of the following is a risk factor for respiratory alterations?
Signup and view all the answers
What is the significance of assessing the scapular line in respiratory assessment?
What is the significance of assessing the scapular line in respiratory assessment?
Signup and view all the answers
Which of the following lab values is important to assess in respiratory assessment?
Which of the following lab values is important to assess in respiratory assessment?
Signup and view all the answers
What is the significance of assessing factors that influence characteristics of respirations?
What is the significance of assessing factors that influence characteristics of respirations?
Signup and view all the answers
What is the most prominent area where tactile fremitus is palpable?
What is the most prominent area where tactile fremitus is palpable?
Signup and view all the answers
What is the significance of unequal chest expansion during inhalation?
What is the significance of unequal chest expansion during inhalation?
Signup and view all the answers
What is the normal respiratory rate and effort for an adult?
What is the normal respiratory rate and effort for an adult?
Signup and view all the answers
What is the purpose of palpating the chest wall?
What is the purpose of palpating the chest wall?
Signup and view all the answers
What is the significance of anteroposterior diameter in adults with chronic lung disease?
What is the significance of anteroposterior diameter in adults with chronic lung disease?
Signup and view all the answers
What is the normal type of breath sound heard on inspiration and expiration over the trachea and larynx?
What is the normal type of breath sound heard on inspiration and expiration over the trachea and larynx?
Signup and view all the answers
What is the purpose of assessing the patient's family history in respiratory assessment?
What is the purpose of assessing the patient's family history in respiratory assessment?
Signup and view all the answers
What is the significance of crepitus in respiratory assessment?
What is the significance of crepitus in respiratory assessment?
Signup and view all the answers
What is the purpose of the anterolateral assessment of chest expansion?
What is the purpose of the anterolateral assessment of chest expansion?
Signup and view all the answers
What is the significance of assessing for reoccurring attacks of bronchitis or pneumonia in the patient's history?
What is the significance of assessing for reoccurring attacks of bronchitis or pneumonia in the patient's history?
Signup and view all the answers
What is the best location to hear bronchovesicular sounds?
What is the best location to hear bronchovesicular sounds?
Signup and view all the answers
What is the purpose of having the patient cough during auscultation?
What is the purpose of having the patient cough during auscultation?
Signup and view all the answers
What should be avoided when positioning the stethoscope during auscultation?
What should be avoided when positioning the stethoscope during auscultation?
Signup and view all the answers
What type of breath sound is characterized by a low pitched, soft sound heard on inspiration and expiration?
What type of breath sound is characterized by a low pitched, soft sound heard on inspiration and expiration?
Signup and view all the answers
What is the importance of landmarking the lobes of the lungs during auscultation?
What is the importance of landmarking the lobes of the lungs during auscultation?
Signup and view all the answers
What is the purpose of having the patient sit leaning slightly forward during auscultation?
What is the purpose of having the patient sit leaning slightly forward during auscultation?
Signup and view all the answers
What is the significance of comparing breath sounds bilaterally during auscultation?
What is the significance of comparing breath sounds bilaterally during auscultation?
Signup and view all the answers
What should be avoided during auscultation to prevent misinterpretation of lung sounds?
What should be avoided during auscultation to prevent misinterpretation of lung sounds?
Signup and view all the answers
Study Notes
Respiratory Assessment
Auscultation
- Use the diaphragm of the stethoscope to listen to lung sounds
- Patient should be sitting, leaning slightly forward, with arms resting across the lap
- Instruct patient to breathe slowly in through the mouth, deeper than usual
- Auscultate the posterior, lateral, and anterior areas in a sequential manner, comparing bilaterally throughout the lung fields
- Place the diaphragm of the stethoscope firmly on the chest wall over intercostal spaces
- Listen to an entire inspiration and expiration at each stethoscope position
Normal Breath Sounds
- Bronchial: high-pitched, loud, heard on inspiration and expiration over the trachea and larynx
- Bronchovesicular: medium-pitched, blowing sounds of medium intensity, heard on inspiration and expiration over the major bronchi
- Vesicular: low-pitched, soft sounds, heard on inspiration and expiration, best heard over peripheral lung fields
Adventitious Sounds
- Also known as abnormal sounds
- May be caused by various conditions, such as pneumonia, bronchitis, or pulmonary edema
- If an adventitious sound is heard, have the patient cough and listen again to determine if the sound has cleared with coughing
Landmarking the Lungs
- It is essential to know how to determine which lobe of the lung you are listening to
- Use landmarks to identify the different areas of the lung
Posterior, Lateral, and Anterior Breath Sounds
- Posterior: sounds heard on the back of the chest
- Lateral: sounds heard on the sides of the chest
- Anterior: sounds heard on the front of the chest
Respiratory Assessment
- Inspection: observe size, shape, and configuration of the chest, respiratory rate and effort, positioning, and skin color
- Palpation: note tenderness, temperature, moisture, texture, and superficial lumps or bumps
- Auscultation: listen to breath sounds, noting any adventitious sounds
Palpation - Confirming Symmetrical Chest Expansion
- Stand behind the patient and place warmed hands at T10/Tenth rib with thumbs pointed toward the spine
- Ask the patient to exhale and then inhale, noting movement between the thumbs
- Unequal expansion is indicative of pneumothorax, # ribs, pneumonia, or trauma
Palpation - Assessing Tactile Fremitus
- Tactile fremitus is a palpation vibration that can be felt using the palmar aspect of the hand
- Most prominent between the scapulae and around the sternum
- Decreased fremitus occurs when anything obstructs transmission of vibrations - effusions, pneumothorax, emphysema
- Increased fremitus occurs with compression or consolidation of lung tissue - pneumonia
Assessment of Respiratory Alterations
- Assess for signs and symptoms of respiratory alterations, such as cyanosis, restlessness, confusion, pain during inspiration, laboured/difficult breathing, orthopnea, use of accessory muscles, adventitious breath sounds, and thick frothy blood-tinged sputum/copious sputum
- Assess factors that influence characteristics of respirations, such as exercise, anxiety, acute pain, smoking, medications, positioning, and neuro injury
- Assess pertinent lab values, such as ABG's, SpO2, and CBC
Chest Landmarks
- Anterior thoracic landmarks: nipple line, angle of Louis, suprasternal notch, costal angle, midsternal line, midclavicular line, and anterior axillary line
- Lateral thoracic landmarks: midaxillary line
- Posterior thoracic landmarks: posterior axillary line, vertebral line, and scapular line
Respiratory Assessment
- Importance of assessing respiratory alterations, including cyanosis, restlessness, confusion, pain during inspiration, labored/difficult breathing, orthopnea, use of accessory muscles, adventitious breath sounds, and thick frothy blood-tinged sputum/copious sputum.
Factors Influencing Respiratory Characteristics
- Exercise, anxiety, acute pain, smoking, medications, and positioning as factors that influence respiratory characteristics.
Laboratory Values
- Importance of assessing pertinent laboratory values, including ABG's, SpO2, and CBC.
Landmarks of the Chest and Lungs
- Anterior thoracic landmarks:
- Nipple line
- Angle of Louis
- Suprasternal notch
- Costal angle
- Midsternal line
- Midclavicular line
- Anterior axillary line
- Lateral thoracic landmarks:
- Midaxillary line
- Posterior thoracic landmarks:
- Posterior axillary line
- Vertebral line
- Scapular line
Respiratory History
- Importance of reviewing significant history, including:
- Disease
- Lifestyle choices (tobacco/marijuana use)
- Cough (chronic/productive/non-productive)
- Activity intolerance
- Chest pain and SOB
- Recurring attacks of bronchitis or pneumonia
- Work environment containing pollutants
- Chronic hoarseness
- Hx of HIV or TB
- Family history
Positioning the Patient
- Importance of positioning the patient correctly for assessment, including elevating the head of bed (HOB) 45-90 degrees, using supine and side-lying positions, and ensuring side-to-side comparison.
Inspection
- Importance of inspecting the chest, including:
- Size, shape, and configuration
- Respiratory rate and effort
- Positioning (normal/tripod)
- Use of pursed lip breathing/accessory muscles
- Skin color (pink, ashen, gray, cyanotic)
- Symmetrical expansion
- AP diameter (1/3 to ½ of side-to-side diameter)
Palpation
- Importance of palpating the entire chest wall, including:
- Tenderness
- Temperature
- Moisture
- Texture
- Superficial lumps or bumps
- Masses or pulsations/unusual movement
- Crepitus (a coarse crackling sensation)
- Confirming symmetrical chest expansion using palpation, including:
- Posterior and anterolateral assessment
- Pinching skin between thumbs to assess movement
Tactile Fremitus
- Importance of assessing tactile fremitus, including:
- Palpation vibration using the palmar aspect of the hand
- Decreased fremitus with effusions, pneumothorax, or emphysema
- Increased fremitus with compression or consolidation of lung tissue
Breath Sounds
- Importance of assessing breath sounds, including:
- Normal breath sounds (bronchial, bronchovesicular, and vesicular)
- Decreased or absent breath sounds with obstruction or loss of lung elasticity
- Increased breath sounds with consolidation or fluid
Auscultation
- Importance of auscultating the lungs, including:
- Using the diaphragm of the stethoscope
- Assessing lung sounds in a sequential manner (posterior, lateral, and anterior)
- Comparing bilaterally throughout the lung fields
- Ensuring the patient breathes slowly and deeply through the mouth
- Avoiding background noise and confusion with lung sounds
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
Learn the steps and best practices for conducting a respiratory assessment, including auscultation techniques and patient positioning.
