Respiratory Assessment

Documentation of inspection

Anterior and posterior chest wall symmetrical , no deformities or lesions

Focus Areas Outlined in Healthy People 2020

Asthma Chronic obstructive pulmonary disease Chronic sleep apnea Tobacco use Reduce the number of asthma deaths. Reduce the number of hospitalizations for asthma. Increase the number of people with asthma who receive care according to national asthma education and prevention program guidelines. Reduce activity limitations among persons with current asthma. Reduce the number of deaths. Reduce the proportion of adults who have limited activity because of the disease. COPD:Reduce the number of deaths. Reduce the proportion of adults who have limited activity because of the disease. Sleep Apnea: Increase the number of persons with symptoms that are medically managed. Reduce vehicular accidents related to drowsy driving. Reduce tobacco use and exposure to secondhand smoke

Areas of the Respiratory Assessment:Auscultation

Auscultation of voice sounds Bronchophony Egophony Whispered pectoriloquy Bronchophony is asking the client to say "99" and listening to the chest with a stethoscope. Normal sounds are muffled. Egophony is asking the client to repeat "E". normal soud hear "eeee",and an abnormal sound likes"Aaaay" Whispered pectoriloquy is asking the client to whisper 1-2-33. In normal sounds the practitioner will hear faint sounds. A louder sound indicates an underlying consolidation. cultate a very faint sound.

Abnormalities in Chest Configuration

Barrel chest (the anteroposterior diameter is equal to the lateral diameter, and the ribs are horizontal) Pectus excavatum or funnel chest (depression of the sternum and adjacent costal cartilage) Pectus carnivatum or pigeon chest (forward displacement of the sternum with depression of the adjacent costal cartilage)

Wheezing

Continuous High pitched Musical sound Created by narrowing airway (edema, secretions, mass) Located all lung fields Often heard with asthma

Rhonchi

Continuous low pitched snoring sounds Caused by airway obstruction ( thick secretions, muscle constriction, mass) Often heard in bronchi

Abnormal Breath Sounds

Decrease in intensity Wrong place Absent

Percussion of lungs

Explain to the client you will be tapping on areas of the chest and back. Tapping is done between each rib. Percussion produces a sound. Normal sounds over health lungs is resonance, a low pitched hollow sound. An abnormal sound, from over-inflation of the lungs, such as in emphysema is hyperresonance. Dullness is heard over a sold and a flat sound over a bone.

healthy adult chest measurement

Healthy adult transverse diameter is twice the anteroposterior diameter.

Posterior thorax

Imaginary vertical lines Vertebral Scapular Posterior axillary

Areas of the respiratory assessment

Inspection of skin color Inspection of the anterior and posterior thorax Shape Symmetry Configuration Respiratory rate Muscle use Levels of oxygenation will influence skin color. Abnormal color such a s pallor, jaundice, erythyema, grayness need further evaluation Asymmetry may indicate an underlying respiratory problem

Stridor

Loud continuous sound High pitched Caused by upper airway obstruction Most serious and needs immediate intervention Location Trachea Tip: often heard without a stethoscope

Coarse Crackles

Low pitched Bubbling sound Air meeting secretions Large airways (trachea and large bronchi) Sounds like: separating velcro

Normal:Vesicular Sounds

Lower bronchi Lower lobes Soft sound Low pitch

Normal: Bronchovesicular Sounds

Main bronchi Medium loudness Medium pitch

Normal: Bronchial Sounds:

Over trachea Harsh High pitched Loud

Palpating of the thorax

Palpation of the anterior thorax Sternum Ribs Intercostal spaces Palpation of the posterior thorax Ribs Intercostal spaces Respiratory expansion Tactile fremitus Explain what you are doing to the client. Use light palpation and ask the client to report any tenderness or pain. Assess for any growths or lesions. Documentation of normal findings are muscles of thorax smooth upon palpation, no tenderness or pain, no masses or lesions. Palpation of the anterior chest includes assessing the sternum, ribs,intercostal spaces. Palpation of the posterior chest includes the ribs, ICS, respiratory expansion and tactile fremitus. The numbers on the pictured are in the order in which the examiner will move t=their hands. Start at the top of the shoulders, move side to side until lower, lateral portion of the thorax are palpated. Expansion: Explain to the client you will be assessing movement of the chest. Using the palms of hands, with thumb close to the vertebrae, ask the client to take a deep breath. With a breath, movement of your thumb should be smooth and even. Unilateral decrease or a delay in movement may indicate obstructive lung disease. Tactile fremitis is palpating vibrations of the chest when the client speaks. Vibrations are strongest over the trachea and diminishes over bronchi and not palpable over lungsDecrease fremitis can be from a thick chest wall , an increase from fluid .

Abnormal breathing patterns

Tachypnea (rapid, shallow breathing) Bradypnea (slow, regular respirations) Hyperventilation (rapid, deep respirations) Hypoventilation (irregular, shallow respirations) Cheyne-Stokes (periods of deep breathing alternating with periods of apnea) Biot's or ataxic (shallow and deep respirations with periods of apnea) Frequent sighs Obstructive breathing (prolonged expiration) Normal breathing pattern is even and smooth, with symmetrical chest movements. The right side should look like the left side. Asymmetry could indicate a problem. The normal resp. rate in adults is 12-20 breaths/minute. Men tend to breath with their abdomen, women with costal muscles. .

Thorax

When assessing and documenting a respiratory assessment, the thorax is divided into anterior, posterior, and lateral sections. This is a picture of the anterior thorax. When describing and documenting use imaginary lines of mid-sternal, left or right midclavicular, and left or right axillary. For example, the correct documentation would be" wheeze audible anteriorly, 5th midclavicular , or 2nd intercostal space on the right mid-sternal line. Using landmarks and imaginary lines help identify lobes of the lungs. Remember anterior at mid-axillary line the base of the lung is at the 8th ICS Divided into anterior, posterior, and lateral sections Anterior Imaginary vertical lines Sternal Midclavicular Anterior axillary lines

Fine crackles

Why? Inhaled air meets deflated alveoli, causing them to "pop"open High pitched popping sound Sounds like: hair rolling between fingers