Respiratory Assessment PDF

Preliminary assessment 1. Distress a. Sweating, strained, noisy breathing 2. Position and effort b. Relaxed posture, support own weight with arms in lap or on side 3. Retractions/ bulging of intercostal spaces 4. Accessory muscles c. Sternocleidomastoid, trapezius, abdomina...

Preliminary assessment 1. Distress a. Sweating, strained, noisy breathing 2. Position and effort b. Relaxed posture, support own weight with arms in lap or on side 3. Retractions/ bulging of intercostal spaces 4. Accessory muscles c. Sternocleidomastoid, trapezius, abdominal muscles 5. Level of consciousness d. Assessed by asking questions and inspecting facial expressions i. Is there any problems with your breathing? 6. Hypoxia e. Skin color f. No diaphoresis? Pallor? Cyanosis? 7. Check respiratory rate 8. Pulse oximetry Inspect Configuration of thoracic cage - Slope of ribs (45\* angle) - Bilateral chest wall expansion - Is there - Barrel chest? - Funnel chest? (Pectus excavatum) - Pigeon chest? (pectus carinatum) - Kyphosis - Scoliosis - Lordosis Know how to do scoliosis technique - Have patient stand in front of you and lean forward - Assess scapula for symmetry, "rib hump", hips for symmetry - Start at cervical vertebra and walk fingers down vertebrae checking for curvature ANTERIOR CHEST Inspect - Note for abnormal respiratory patterns - Tachypnea: rate 20/min higher - Bradypnea: rate 12/ min or lower - Apnea: absent - Hyperpnea: increased depth - Hyperventilation: increased rate and depth - Hypoventilation: irregular and shallow - Cheyne-stokes: regular pattern then increase and decrease in rate and depth with periods of apnea - Ataxic/Biots: irregular pattern; normal resps followed by apnea - Kussmauls: panting and labored with increases in rate and depth - Width of costal angle - Google this technique - AP diameter and lateral diameter (need retractable ruler) - Should be 1:2 - Google how to measure Palpate For tenderness, masses, sinus tracts, and crepitus (creaking/grating) Using palm and rotary motions - 1-1,2-2(above boob),3-3 (on boob), 4-4 (lateral and below boob) Percuss Dull sounds in area of breast tissue and over heart (precordium) - 1-1 (slightly above clavicle), 2-2 (above boob), 3-3 (middle boob), 4-4 (between middle of boobs), 5-5 (lateral and under boobs) Auscultate Normal breath sounds \*Note where these are\* - Vesicular: over lungs - Bronchial/tracheal: loud, high pitched over trachea - Bronchovesicular: outside of sternum and 1^st^ and 2^nd^ ics - 1-1(above clavicle) , 2-2 (sternum area), 3-3 (s.a), 4-4(s.a), 5-5(between boobs), 6-6 (laterally under boobs) POSTERIOR CHEST Palpate - Rotary motion palpation procedure using finger pads on posterior and lateral chest - Symmetric respiratory excursion on posterior chest procedure - Place hands sideways with thumbs pointing together at t9-t10 level - pinch up small skin fold between thumbs - Ask patient to inhale deeply - Thumbs should move outward with inhalation - Thumbs move inward with exhalation - Vocal or tactile fremitus procedure - Have pt fold arms across chest - Touch posterior chest with palm surface of hand - Have patient say 99 every time yo move hand - Vibrations should be strong and symmetrical; strongest is between scapula - 1-1,2-2,3-3,4-4,5-5 Percuss Percussion procedure with hammer - 111-111,2-2,3-3,4-4,5-5,6-6,7-7,8-8,9-9 - Checking for: - Resonance- air-filled - Dull- fluid filled - Hyper-resonant- hyper-inflated Auscultate - 111-111,2-2,3-3,4-4,5-5,6-6,7-7,8-8,9-9 - Auscultating for : - Normal breath sounds - Vesicular- soft, low pitched over lungs - Bronchovesicular- moderately pitched between posterior scapula - Decreased or absent breath sounds - Obstruction of bronchial tree - Adventitious breath sounds - Crackles/ rales: air traveling through vessels with abnormal moisture - Wheezes: high pitched sound from air going through constricted/narrow airway passages - Rhonchi: coarse rattling from constricted large airways - Friction rubs: crackling/ grating sound from when 2 rough or inflamed pleural spaces rub against each other while respirating - Stridor: loud high-pitched crowing sound; can be heard without stethoscope Note: Demonstrate locations of normal breath sounds - Bronchovesicular on posterior chest - Superior, Medial section - Vesicular on posterior chest - Starts above scapula near neck - Straight along lateral bronchovesicular area - Going down and laterally out away from spine