Assessment of Thorax and Lungs Christine M. Wilson Viterbo University.
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Transcript of Assessment of Thorax and Lungs Christine M. Wilson Viterbo University.
Assessment ofAssessment of Thorax and Thorax and
LungsLungsChristine M. WilsonChristine M. Wilson
Viterbo UniversityViterbo University
ObjectivesObjectives
LandmarksLandmarks StructuresStructures Function Function Developmental/transculturalDevelopmental/transcultural Subjective dataSubjective data Objective dataObjective data
Anterior LandmarksAnterior Landmarks
ClavicleClavicle Suprasternal Suprasternal
notchnotch SternumSternum Sternal angleSternal angle Intercostal Intercostal
spacesspaces Xiphod processXiphod process Costal angleCostal angle
Posterior LandmarksPosterior Landmarks
Vertebra Vertebra prominens (C7)prominens (C7)
Spinous Spinous processesprocesses
ScapulaScapula
Reference LinesReference Lines
Anterior ChestAnterior Chest
MidsternalMidsternal
MidclavicularMidclavicular
Reference LinesReference Lines
Posterior WallPosterior Wall
Vertebral Vertebral LineLine
Scapular Scapular LineLine
Reference LinesReference Lines
Axillary AreaAxillary Area
MidaxillaryMidaxillary
Anterior AxillaryAnterior Axillary
Posterior Posterior AxillaryAxillary
Position in ChestPosition in Chest
Lobes of the Lobes of the lunglung
TracheaTrachea
Bronchial Bronchial TreeTree
Functions of RespirationFunctions of Respiration
Major FunctionsMajor Functions Supply oxygen to body for energy Supply oxygen to body for energy
productionproduction Remove carbon dioxide as a waste Remove carbon dioxide as a waste
from energy productionfrom energy production Maintain pH balance of arterial Maintain pH balance of arterial
bloodblood Maintain heat exchangeMaintain heat exchange
Developmental Developmental ConsiderationsConsiderations
Fetal LifeFetal Life At 5 weeks primitive lung buds At 5 weeks primitive lung buds
emergeemerge By 16 weeks there are the same # of By 16 weeks there are the same # of
conducting airways as in the adult.conducting airways as in the adult. At 32 weeks surfactant sufficient to At 32 weeks surfactant sufficient to
sustain lifesustain life At birth 70 million primitive alveoli At birth 70 million primitive alveoli
kick inkick in
Developmental Developmental ConsiderationsConsiderations
The Aging AdultThe Aging Adult Lungs more rigid; harder to inflateLungs more rigid; harder to inflate Less surface available for gas Less surface available for gas
exchangeexchange Common increase in AP diameter Common increase in AP diameter Kyphosis: Front to back curvature Kyphosis: Front to back curvature
spinespine May fatigue more easilyMay fatigue more easily
Transcultural Transcultural ConsiderationsConsiderations
Largest chests (descending Largest chests (descending order): whites, blacks, order): whites, blacks, Asians, Native AmericansAsians, Native Americans
Fetal lung maturity reached Fetal lung maturity reached earlier in black populationearlier in black population
Incidence of TB is higher in Incidence of TB is higher in Asian AmericansAsian Americans
Subjective DataSubjective Data
CoughCough Shortness of breathShortness of breath Chest pain with breathingChest pain with breathing History of respiratory infectionsHistory of respiratory infections Smoking historySmoking history Environmental exposureEnvironmental exposure Self care behaviorSelf care behavior
Objective Data-Posterior Objective Data-Posterior ChestChest
InspectInspect Shape and configurationShape and configuration
A/P diameter should be less A/P diameter should be less than transverse by 1:2than transverse by 1:2
PositionPosition Skin color and conditionSkin color and condition
Posterior ChestPosterior Chest
Symmetric chest Symmetric chest expansionexpansion
Place hands at Place hands at T9-T10T9-T10
Equal Equal movement of movement of thumbs with thumbs with inhalinginhaling
Posterior ChestPosterior Chest
Tactile fremitusTactile fremitus Place ulnar edge on Place ulnar edge on
skin; client repeats skin; client repeats 9999
Symmetry is Symmetry is expectedexpected
Decreases if sound Decreases if sound transmission is transmission is obstructedobstructed
Palpate chest wallPalpate chest wall
Posterior ChestPosterior Chest
PercussionPercussion Find Find
predominant note predominant note over lung fieldsover lung fields
Begin at apicesBegin at apices Use same Use same
pathway side to pathway side to sideside
Lung Percussion SoundsLung Percussion Sounds
ResonanceResonance: non-musical; healthy : non-musical; healthy lunglung
Hyper-resonanceHyper-resonance: slightly musical; : slightly musical; too much air, i.e. too much air, i.e. emphysema/pneumothoraxemphysema/pneumothorax
DullDull: muffled; organ or abnormal : muffled; organ or abnormal density, i.e. pneumoniadensity, i.e. pneumonia
FlatFlat: soft thud; i.e. muscle mass, bone: soft thud; i.e. muscle mass, bone
Posterior ChestPosterior Chest
Diaphragmatic Diaphragmatic ExcursionExcursion
Find lower lung Find lower lung border in border in expiration and expiration and inspirationinspiration
Measure: Should Measure: Should measure 3-5cm, measure 3-5cm, equal distance equal distance bilaterally. bilaterally.
Posterior ChestPosterior Chest
AuscultationAuscultation
Use diaphragm Use diaphragm of stethoscope; of stethoscope; place firmlyplace firmly
One full breath One full breath at each positionat each position
Use same Use same pathway pathway side to side side to side
comparisoncomparison
Breath SoundsBreath Sounds
BronchialBronchialLoud, harsh sounds over tracheaLoud, harsh sounds over trachea
BronchovesicularBronchovesicularModerate, mixed sounds over Moderate, mixed sounds over
bronchibronchi VesicularVesicular
Soft, rustling sounds over Soft, rustling sounds over peripheryperiphery
Decreased or AbsentDecreased or Absent
ObstructionObstructionSecretions, mucus plug, foreign Secretions, mucus plug, foreign
bodybody
EmphysemaEmphysemaLoss of elasticity; air already in Loss of elasticity; air already in
lungslungs
Silent chestSilent chestNo air is moving in or out of lungs; No air is moving in or out of lungs;
ominous signominous sign
Increased SoundsIncreased Sounds
Bronchial sounds heard over Bronchial sounds heard over wrong areawrong area
Solid tissue conducts sounds Solid tissue conducts sounds to surface betterto surface better
Found in pneumonia with Found in pneumonia with consolidation or fluid in intra-consolidation or fluid in intra-pleural spacepleural space
Adventitious SoundsAdventitious Sounds
Crackles (Rales): FineCrackles (Rales): Fine
Fine, discontinuous high-pitched, Fine, discontinuous high-pitched, short crackling sound on short crackling sound on
inspiration inspiration which are not which are not cleared by coughing. cleared by coughing. (Roll a (Roll a strand of hair at ear) strand of hair at ear)
Found in pneumonia and heart Found in pneumonia and heart failurefailure
Adventitious SoundsAdventitious Sounds
Crackles: CoarseCrackles: Coarse Loud, low-pitched bubbling or gurgling Loud, low-pitched bubbling or gurgling
soundssounds Start in inspiration, may be in Start in inspiration, may be in
expiration expiration Decrease with coughing, but comes Decrease with coughing, but comes
backback Found in pulmonary edema and Found in pulmonary edema and
terminally ill with suppressed cough terminally ill with suppressed cough reflexreflex
Adventitious SoundsAdventitious Sounds
Wheeze: High pitchWheeze: High pitch High-pitched, musical squeaking High-pitched, musical squeaking
sound that predominates sound that predominates with with expirationexpiration
Indicates narrowed passagewayIndicates narrowed passageway Obstruction from acute asthma Obstruction from acute asthma
or chronic emphysemaor chronic emphysema
Adventitious SoundsAdventitious Sounds
Wheeze Low-pitchWheeze Low-pitch Single note which is more Single note which is more
prominent on prominent on expirationexpiration Air flow obstructionAir flow obstruction
bronchitis or tumorbronchitis or tumor
Adventitious SoundsAdventitious Sounds
StridorStridor High-pitched, crowing sound High-pitched, crowing sound
with with inspirationinspiration Louder in neckLouder in neck Upper airway obstructionUpper airway obstruction Croup, acute epiglottis, or Croup, acute epiglottis, or
foreign foreign body inhalationbody inhalation
Objective Data-Anterior Objective Data-Anterior ChestChest
InspectInspect Shape and configurationShape and configuration Facial expressionFacial expression Level of consciousnessLevel of consciousness Color and conditionColor and condition Respiration rate/qualityRespiration rate/quality
Anterior ChestAnterior Chest
Symmetric chest Symmetric chest expansionexpansion
Place hands at Place hands at costal margins costal margins
Equal movement Equal movement of thumbs with of thumbs with inhalinginhaling
Anterior ChestAnterior Chest
Tactile fremitusTactile fremitus Apices to MCLApices to MCL Side to sideSide to side Symmetry Symmetry
expectedexpected
Palpate chest Palpate chest wallwall
Objective Data-Anterior Objective Data-Anterior ChestChest
PercussionPercussion Dullness over Dullness over
breast tissue, liver, breast tissue, liver, cardiac borderscardiac borders
Tympany over Tympany over gastricgastric
AuscultationAuscultation Displace breast Displace breast
and listen over and listen over chest wallchest wall
Visualize lungs beneath Visualize lungs beneath skinskin