Respiratory Assessment 2
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Transcript of Respiratory Assessment 2
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Respiratory Assessment
R. Hernandez
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Chest Physical Assessment
Inspection
Palpation
Percussion
Auscultation
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Inspection
Level of Conciousness
Evidence of Respiratory disease
Nasal flaring
Cyanosis Peripheral Circulation
Central - Hypoxemia
Pursed-lip breathing
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Inspection Jugular Neck Vein
Distention Head of bed 45
degrees
Normal
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InspectionThorax Observe for retractions anduse of accessory muscles
(sternomastoids,abdominals).
Retractions
Observe the chest forasymmetry, deformity, orincreased anterior-posterior
(AP) diameter. Confirm that the trachea is
near the midline?
http://www.meddean.luc.edu//lumen/MedEd/medicine/pulmonar/pd/pstep25a.htm
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Inspection Pectus Carinatum
Pectus Excavatum
Kyphosis
Anteroposterios Scoliosis - Lateral
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Inspection
Increased A-P
Diameter
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Chest Physical Assessment
Inspection
Palpation
Percussion
Auscultation
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Palpation
Tracheahttp://www.meddean.luc.edu//lumen/MedEd/medicine/pulmonar/pd/pstep25a.htm
Chest
Repeat ninety-nine
Increased
Consolidation
Decreased
Obstruction
Increase air - fluid
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Palpation Thoracic Expansion
Normal Movement 3-5 cm
Assess expansion andsymmetry of the chest by
placing your hands on thepatient's back, thumbstogether at the midline,and ask them to breath
deeply
http://www.meddean.luc.edu//lumen/MedEd/medicine/pulmonar/pd/pstep26a.htm
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Palpation
Peripheral Edema
+1 - +4
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Chest Physical Assessment
Inspection
Palpation
Percussion
Auscultation
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Percussion Hyperextend the middle finger of one
hand and place the distalinterphalangeal joint firmly againstthe patient's chest.
With the end (not the pad) of the
opposite middle finger, use a quickflick of the wrist to strike first finger.
Categorize what you hear as normal,dull, or hyperresonant.
Practice your technique until you canconsistantly produce a "normal"percussion note on your (presumablynormal) partner before you work with
patients.
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PercussionPosterior Chest
Percuss from side to side andtop to bottom using the patternshown in the illustration. Omit theareas covered by the scapulae.
Compare one side to the otherlooking for asymmetry.
Note the location and quality ofthe percussion sounds you hear.
Find the level of thediaphragmatic dullness on bothsides.
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Percussion Diaphragmatic Excursion
Find the level of thediaphragmatic dullness onboth sides.
Ask the patient to inspiredeeply.
The level of dullness
(diaphragmatic excursion)should go down 3-5cmsymmetrically.
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PercussionAnterior Chest
Percuss from side to sideand top to bottom usingthe pattern shown in theillustration.
Compare one side to theother looking forasymmetry.
Note the location andquality of the percussionsounds you hear.
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Percussion Percussion Notes and Their Meaning
Flat or Dull
Pleural Effusion or Lobar Pneumonia
Normal Healthy Lung or Bronchitis
Hyperresonant
Emphysema or Pneumothorax
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Chest Physical Assessment
Inspection
Palpation
Percussion
Auscultation
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Stethoscope Chest piece
Diaphragm High frequency - Lungs
Bell Low frequency Heart
Tubing 11-16 inches
Ear pieces
Angled Low level disinfection
between patient use
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Chest SegmentsAnterior Posterior
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Normal Breath Sounds Inhalation / Exhalation
Upstroke / Downstroke Length
Duration
Thickness of Stroke
Intensity
Angle
Pitch
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Normal Breath Sounds Vesicular
Low Pitch, Soft Intensity
Peripheral lung areas
Bronchovesicular
Moderate Pitch, Moderate Intensity Medial Chest
Bronchial
High Pitch, Loud Intensity
Trachea
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Adventitious Breath Sounds Crackles
Discontinuous, secretions,atelectasis
Wheezes High Pitched
Obstruction, anatomic,
bronchoconstriction, inflammation
Stridor High pitched
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Localization of Adventitious BS Location
When
Inspiratory / Expiratory
Pitch Prominance / Loudness
Increased / Decreased