Health assessment review chapter 19

Voice sound tests

bronchophony: Ask the person to repeat 99 while you listen with the stethoscope over the chest wall, listen especially if you suspect pathology: Egophony: voice of a goat, auscultate the chest while the person phonates a long "ee-ee-ee-ee" sound. Whispered pectoriloquy: ask the person to whisper a phrase such as "1-2-3-4...." As you auscultate.

Auscultation of the right middle lobe

the right middle lobe is auscultated with the stethoscope where Anteriorly on the right at the 4th intercostal space

Adventitious breath sounds—definition and the types of sounds that may be auscultated

Adventitious sounds are added sounds that are not normally heard in lungs. If present they are heard as being superimposed on the breath sounds. Crackles(rales) and wheeze(rhonchi) can be auscultated.

History taking for respiratory ailments:

Any history of breathing trouble or lung diseases, such as bronchitis, emphysema, asthma, or pneumonia? Ask about any unusually frequent or unusually severe colds. Any family history of allergies, tuberculosis, or asthma. Smoking history Onset, duration. and pattern of smoking Secondhand exposure to smoke Smoking cessation Counseling using the five A's: Ask, Advise, Assess, Assist and Arrange.

guidelines to correctly listen to breath sounds:

Auscultate the lung fields over the anterior chest from the apices in the supraclavicular areas down to the 6th rib. Progress from side to side as you move downward and listen to one full respiration in each location use the sequence indicated for percussion.

barrel-chest" assessment findings:

Barrel chest: The chest appears as if held in continuous inspiration. The ribs appear to be horizontal and coastal angle >90 degrees in relation to the spine. The anteroposterior diameter is equal to the transverse diameter

Bronchial, vesicular, Broncho vesicular breath sounds

Bronchial(tracheal): pitch: high, amplitude: loud, duration: inspiration < expiration, quality: harsh, hollow tubular, normal location: trachea and larynx. Broncho vesicular: pitch: moderate, amplitude: moderate, duration: inspiration= expiration, quality: mixed, normal location: over bronchi where alveoli are located: posterior, between scapulae especially right; anterior, around upper sternum in 1st and 2nd intercoastal spaces Vesicular: pitch: low, amplitude: soft, duration: inspiration> expiration quality: rusting, like the sound of the wind in the trees, normal location: over peripheral lung fields where air flows through smaller bronchioles and alveoli

Various abnormal lung sounds and their descriptions

Crackles- fine (formally called rales): discontinuous, high-pitched, short crackling, popping sounds heard during inspiration that are not cleared by coughing. Crackles- coarse: loud, low-pitched bubbling and gurling sounds that start in early inspiration and may be present in expiration. May decreased by suctioning or coughing but reappear short sounds like opening a Velcro fastener. Atelectatic crackles: sound like fine crackles but do not last and are not pathologic: disappear after the first few breath, heard in axillae and bases (usually dependent of lungs). Pleural friction: A very superficial sound that is coarse and low pitched; it has a grating quality as if two pieces of leather are being rubbed together, sounds just like crackles but close to the ear; sounds louder if you push the stethoscope harder onto the chest wall sound is inspiration and expiratory. Wheeze- high pitched(sibilant): musical squeaking sounds that sound polyphonic (multiple notes as in musical chord); predominate in expiration but may occur in both expiration and inspiration. Wheeze-low pitched (sonorous rhonchi): low-pitched; monophonic, single note, musical snoring, moaning sounds; they are heard throughout the cycle, although they are more prominent on expiration; may clear somewhat by coughing. Stridor: high-pitched, monophonic inspiration, crowing sound; louder in the neck than chest wall.

Describe the symptoms associated with dyspnea:

Dyspnea is difficulty breathing or labored breathing. Symptoms: shortness of breath (SOB) lasing one month or more (chronic Dyspnea). May have neurogenic, respiration or cardiac origin. It also occurs with anemia, anxiety, and deconditioning, chest pain or tightness.

Expected findings in the normal adult lung:

Muffled voice sounds and symmetric tactile fremitus. Normal lung findings include symmetric chest expansion, resonant percussion tones, vesicular breath sounds over the peripheral lung fields, muffled voice sounds, and no adventitious sounds.

Important factors to observe and document when assessing the adult anterior chest:

Note shape and configuration of the chest wall. The ribs are sloping downward with symmetric interspaces. The coastal angle is within 90 degrees. The person's facial expression: the facial expression should be relaxed and benign indicating an unconscious effect of breathing. Also access level of consciousness. The level of consciousness should be alert and cooperative. Note the skin color and condition: the lips and nail beds are free of cyanosis or unusual pallor(whiteness). The skin is normal configuration and explore any skin lesions. Lastly, assess the quality of respirations. Normal relaxed breathing is automatic and effortless, regular, and even and produces on noise. The chest expands symmetrically with each respiration. Note any localized lag on inspiration.

Most important technique when auscultating lung sounds:

Posterior: clean diaphragm, hold diaphragm firmly on the person's chest wall, listen for at least 1 full respiration on each location.

Symptoms associated with orthopnea and what may cause the symptoms:

Shortness of breath when a person is lying down (supine) - need to sit up to breathe. Needs more pillow to sleep or feel comfort let them state number of pillows needed to achieve that comfort. Common in heart failure, possible causes, edema, severe pneumonia, obesity, ascites, (fluid buildup in abdomen) diaphragm paralysis. Symptoms include fatigue, nausea, confusion, coughing or wheezing, increased heart rate.