Assessing The Chest And Lungs PDF

*[Procedure 11]* **Assessing the Chest and Lungs** **[Equipment]** Stethoscope and antiseptic wipe Felt-tipped marker and ruler Pen and record form **[Positioning]** Have the client sitting, if possible, and leaning forward for the posterior approach. If the client is unable to sit up, fi...

*[Procedure 11]* **Assessing the Chest and Lungs** **[Equipment]** Stethoscope and antiseptic wipe Felt-tipped marker and ruler Pen and record form **[Positioning]** Have the client sitting, if possible, and leaning forward for the posterior approach. If the client is unable to sit up, findings will be distorted. If the client is lying down, findings are more evident on the dependent side; help her change positions so that you can assess with each side dependent. **[IMPLEMENTATION]** **Performance** 1\. Prior to performing the procedure, introduce self and verify the client's identity using agency protocol. Explain to the client what you are going to do, why it is necessary, and how he or she can participate. Discuss how the results will be used in planning further care or treatments. 2\. Perform hand hygiene 3\. Provide for client privacy. In women, drape the anterior thorax when it is not being examined. 4\. Inquire if the client has any history of the following: family history of illness, including cancer, allergies, tuberculosis; lifestyle habits such as smoking and occupational hazards (e.g., inhaling fumes); medications being taken; current problems (e.g., swellings, coughs, wheezing, pain). +-----------------------------------+-----------------------------------+ | **Procedure Steps** | **Expected and Abnormal | | | Findings** | +===================================+===================================+ | 1\. Count the respiratory rate, | **Expected findings:** | | and observe the rhythm and | Respirations are quiet with a | | depth; observe the symmetry of | regular rhythm and depth; rate | | chest and respiratory | 12--20 breaths/min for adults. | | movements. | Chest movement is symmetrical. | | | | | | **Abnormal findings**: Chest | | | asymmetry may be seen | +-----------------------------------+-----------------------------------+ | 2\. Inspect the chest. | **a. Expected findings**: The | | | normal adult AP:lateral ratio is | | a\. Inspect the anteroposterior | 1:2. | | (AP):lateral ratio. | | | | **b. Expected findings:** The | | b\. Inspect the costal angle. | costal angle is \< 90°. | | | | | c\. Identify any spinal | **Abnormal findings:** Costal | | deformities. | angle is \> 90° in COPD | | | | | d\. Observe the effort required | **c. Expected findings**: The | | to breathe. | spine is straight without lateral | | | curvatures or deformity. | | e\. Note the color and condition | | | of skin. | **d. Expected findings:** | | | Respirations appear effortless. | | | | | | **Abnormal findings:** Sternal | | | and intercostal retractions are | | | seen in severe hypoxia or | | | respiratory distress. | | | | | | **Abnormal findings:** Cyanosis | | | of the chest wall (due to extreme | | | hypoxia or cold temperature). | +-----------------------------------+-----------------------------------+ | | | +-----------------------------------+-----------------------------------+ | 3\. Palpate the trachea. Place | **Expected findings:** Trachea is | | your fingers and thumb on | in the midline. | | either side of the trachea and | | | note its position. | **Abnormal findings**: Tracheal | | | deviation may occur from a mass | | | in the neck | +-----------------------------------+-----------------------------------+ | 4\. Palpate the chest. Observe | **Expected findings:** The chest | | for tenderness, masses by | is nontender or masses | | placing | | | | **Abnormal findings**: Pain in | | your hands on the chest wall. | the chest wall may be due to | | | fracture, inflammation, or | | | trauma. | +-----------------------------------+-----------------------------------+ | 5\. Palpate chest excursion | **Expected findings:** Chest | | (expandability). | excursion is symmetrical on the | | | anterior and posterior aspect of | | a\. Places hands at the base of | the chest | | the chest with fingers spread | | | and thumbs about 2 inches (5 | **Abnormal findings:** Limited | | cm) apart (at the costal margin | chest excursion may occur with | | anteriorly and at the 8th to | shallow breathing, restrictive | | 10th rib posteriorly). | clothing, or restrictive airway | | | disease. | | b\. Presses thumbs toward the | | | spine to create a small | | | skinfold between them. | | | | | | c\. Has the client take a deep | | | breath and feels for chest | | | expansion. | | +-----------------------------------+-----------------------------------+ | | | +-----------------------------------+-----------------------------------+ | **Follow the same pattern and | | | sequence for palpating fremitus, | | | percussing, and auscultating the | | | chest**. | | +-----------------------------------+-----------------------------------+ | | | +-----------------------------------+-----------------------------------+ | 6\. Palpates chest for tactile | **Expected Findings:** Tactile | | fremitus, using palms only. but | fremitus is equal bilaterally | | raise the fingers | | | | **Abnormal findings**: Increased | | off the client's chest | fremitus occurs with conditions | | | that cause fluid in the lungs | | Palpate for vibrations as the | (e.g., pulmonary edema). | | client says "99." | | +-----------------------------------+-----------------------------------+ | 7\. Percusses chest. | **Expected findings:** | | | | | a\. Percusses over intercostal | The anterior chest is resonant | | spaces rather than over bones. | to the 2nd ICS on the left and to | | | the 4th ICS on the right. | | b\. Uses indirect method of | | | percussion. | The lateral chest is resonant | | | to the 8th ICS. | | c\. Percusses anterior, | | | posterior, and lateral. | The posterior chest is resonant | | | to T12. | | d\. Compares right side to left | | | side. | **Abnormal findings**: Dullness | | | is heard with fluid or masses in | | | the lungs. Hyperresonance is | | | heard with air trapping that | | | occurs with emphysema. | +-----------------------------------+-----------------------------------+ | **Sequence for anterior thorax | **Normal percussion sounds on the | | percussion.** | anterior thorax**. | +-----------------------------------+-----------------------------------+ | 8\. Percusses posterior chest | **Expected findings:** | | for diaphragmatic excursion | Diaphragmatic excursion (the | | | distance between the two marks) | | a\. Percusses diaphragm level on | is normally 3--6 cm. **see figure | | full expiration; beginning just | bellow** | | below the scapula The sound | | | will become dull at the | **Abnormal findings:** Decreased | | diaphragm. Mark the area with a | excursion may indicate paralysis, | | pen | atelectasis, or COPD with | | | overinflated lungs. | | b\. Percusses diaphragm level on | | | full inspiration; marks level. | | | | | | c\. Measures distance between | | | the two marks. | | +-----------------------------------+-----------------------------------+ | **Palpate for vibrations as the | **Measures distance between the | | client says "99** | two marks to measure | | | Diaphragmatic excursion** | +-----------------------------------+-----------------------------------+ | 9\. Auscultates the chest. | **Expected findings**: No | | | abnormal or adventitious sounds | | a\. Using same pattern as for | are heard. Lung fields are clear | | percussion. | to auscultation. | | | | | b\. Using diaphragm of | **Abnormal findings:** Crackles | | stethoscope. | or rales, rhonchi, wheezing, | | | stridor, friction rub, grunting | | c\. Has client take slow, deep | | | breaths through his mouth while | | | listening at each site through | | | one full respiratory cycle. | | +-----------------------------------+-----------------------------------+ | 11\. Auscultate for abnormal | **Expected findings:** No | | voice sounds if there is | abnormal voice sounds are heard. | | evidence of lung congestion. | | | Follow the pattern in Step6. | **Abnormal findings:** | | | | | a\. Assess for bronchophony by | a\. Bronchophony is present if | | having the client say "1, 2, 3" | the words are clearly heard | | as you listen over the lung | over the lungs. | | fields. | | | | b\. Egophony is present if the | | b\. Assess for egophony by | sound you hear is "ay." | | having your client say "eee" as | | | you listen over the lung | c\. Whispered pectoriloquy is | | fields. | present if you hear, "One, two, | | | three" clearly. | | c\. Assess for whispered | | | pectoriloquy by having your | | | client whisper "1, 2, 3" as you | | | listen over the lung fields. | | +-----------------------------------+-----------------------------------+ | Document findings in the client | | | record using printed or | | | Electronic forms or checklists | | | supplemented by narrative notes | | | when appropriate. | | +-----------------------------------+-----------------------------------+ **[Patient Teaching]** Instruct the patient about the dangers of tobacco use, especially smoking; exposure to air pollutants and environmental pollutants, such as radon or asbestos; and the signs *and symptoms of lung cancer.*