Pulmonary Skills Check

Which side of the stethoscope is used to analyze lung sounds?

diaphragm (big side)

Which side of the stethoscope is used to analyze lung sounds?

bell (small side)

What is the technique for auscultations of the heart?

• optimal seated position

• listen over bare skin

• have pt hold their breath

• listen for 1 min

What is the landmark for auscultating the aortic valve?

right of sternum in 2nd intercostal space

What is the landmark for auscultating the pulmonic valve?

left of sternum in 2nd intercostal space

What is the landmark for auscultating Erb’s point?

left of sternum in 3rd intercostal space

What heart sounds do you hear at Erb’s Point?

S1 & S2

What is the landmark for auscultating the tricuspid valve?

left of sternum in 4th intercostal space

What is the landmark for auscultating the mitral valve?

left of sternum in 5th intercostal space

• midclavicular line

What heart sound do you hear at the mitral valve?

S3 & S4

What sound is heard at the tricuspid and bicuspid (mitral) valves?

S1

What sound is heard at the pulmonic and aortic valves?

S2

What is the technique for auscultating breath sounds?

• optimal seated position

• on bare skin

• anterior to posterior, superior to inferior, right to left side of chest

• patient breaths in and out through mouth

• ask patient to take one normal breath followed by a deep breath

What is the landmark for auscultating the bronchial?

• anteriorly 1st intercostal space

• above the clavicle (or on the neck)

What is the landmark for auscultating the bronchovesicular?

• anteriorly 2nd intercostal space next to sternum

• posteriorly between scapula

What is the landmark for auscultating the vesicular?

periphery of lung anteriorly and posteriorly

What structure is air moving through in the bronchial?

trachea

What structure is air moving through in the bronchovesicular?

mainstem bronchi

What structure is air moving through in the vesicular?

alveoli

What is the landmark for auscultating the upper lobe of the lung posteriorly?

above spine of scapula (near spine)

What is the landmark for auscultating the lower, superior segment lobe of the lung posteriorly?

• T4

• medial to scapula

• have pt cross their arm

What is the landmark for auscultating the lower, basal segment lobe of the lung posteriorly?

• T7

• inferior angle of scapula

What is the landmark for auscultating the lower, lateral basal segment lobe of the lung posteriorly?

mid axillary to inferior angle of scapula

What is the landmark for palpating a cough?

abdomen below the xiphoid process

What is the technique for palpating a cough?

• instruct pt to take a deep breath & turn their head away

• instruct pt to cough normally

• palpate deep inspiratory & strong compression phases

What are the two phases of a cough?

• deep inspiratory phase

• strong compression phase

What is the technique for palpating tracheal deviation?

• both thumbs on the distal ends of the clavicles (in sternal notch)

• gently pushes into space between trachea and SCM muscle on both sides with index fingers

• palpate either side of trachea

What is the normal position of the trachea?

• middle of the throat

• above sternal notch/sternum

When would the trachea shift towards the affected side?

• pressure or volume decreases

• lobectomy, pneumonoectomy

When would the trachea shift away from affected side?

• pressure increased

• something in pleural space pushes lung away from rib cage

• pneumothorax, pleural effusion, empyema, hemothorax, tumor