Pulmonary Assessment

• Determine impairments and how it limits physical function

• Determine adequate ventilatory mechanisms

• Establish patient’s suitability for pulmonary PT

• Develop and appropriate PT plan for a pt

• Establish baseline to measure patient’s progress and effectiveness of treatment

• Determine when to discontinue intervention and implement home program for self management

purpose of pt pulmonary assessment.

Productive Cough

- “wet cough”

- (+) secretions

Non Productive Cough

- “dry cough”

- (+) pathology

Hemoptysis

blood in cough.

Dyspnea

difficulty breathing or shortness of breath.

Cachectic

body type characterized by weakness and wasting of the body.

Cyanosis

bluish color of the skin due to lack of oxygen in the blood.

Peripheral Cyanosis

cyanosis which presents in the distal extremities (e.g. fingers)

Central Cyanosis

cyanosis which presents in mouth, head, and torso.

Nasal Flaring

- nostrils widen to inhale more

- a sign of difficulty in breathing

Diaphoresis

sweating.

T

T/F If pt is distressed due to difficulty breathing, adjust your assessment accordingly.

• Pt seated in 45°

• Contract SCM

position wherein jugular vein is visible.

Jugular Vein Engorgement

happens when there is a backup of blood in the superior vena cava due to congestion.

• Sternocleidomastoid

• Trapezius

accessory muscles of ventilation commonly hypertrophied.

Hypertrophy

increase of the size of individual muscle fiber.

Hyperplasia

increase in the number of muscle fibers.

Retractions

often due to increased respiratory effort.

• Supraclavicular

• Intercostal

retractions.

Pursed Lip Breathing

- used to control inhalation/exhalation of air

- use of almost closed lips during expiration to maintain positive pressure within the bronchioles and thus prevent premature collapse of the weakened airways

Clubbing

- tips of the fingers enlarge and the nails become extremely curved from front to back

- due to low oxygen supply

160°

normal angle of nail.

180°

angle of clubbed nail.

Peripheral Edema

- caused by liquid retention in the legs

- gravity plays a role in this

1:2

normal ratio of AP and lateral dimensions of chest.

Barrel Chest

- circumference: upper chest > lower chest

- AP diameter of chest: >normal

- upper chest breathers

Pectus Excavatum

- lower part of sternum is depressed

- lower ribs are flare out

- diaphragmatic breathers with excessive abdominal protusion and little upper chest movement during breathing

Pectus Carinatum

sternum is prominent and protrudes anteriorly.

T

T/F Symmetry of chest is observed anteriorly, posteriorly, and laterally.

Slouched Position

- posture which helps abdominal muscles for lungs to expand easier

- helps with the accessory muscles

Leaning forward on hands or forearm

ideal position/posture.

Belly Breathers

uses diaphragm when breathing.

Chest Breathers

- uses accessory muscles when breathing

- more rib action

12-20 cpm

normal respiratory rate for adults.

20-40 cpm

normal respiratory rate for children

40-60 cpm

normal respiratory rate for infants

1:2

ratio of inspiration at rest

1:1

ratio of inspiration during activity

1:4

ratio of inspiration of COPD patients.

Eupnea

normal rate, depth, and rhythm of breathing.

Tachypnea

fast, increased RR even without activity.

Bradypnea

decreased RR.

Apnea

absence of breathing.

Hyperpnea

normal rate but deep respirations.

Cheyne Stokes

gradual increase or gradual decrease with period of apnea.

Biot’s Breathing

rapid, deep respiration (gasps), with shorts pauses between sets.

Kussmaul’s Breathing

tachypnea and hyperpnea.

Apneustic

prolonged inspiratory phase with shortened expiratory phase.

Dyspnea

distressed and labored breath.

Hyperventilation

deep and rapid breathing.

Orthopnea

difficulty breathing in supine position.

Apneusis

cessation of breathing in inspiratory phase.

• Diaphragm contacts and descends; abdomen rises

• Lateral costal expansion as ribs elevate and move out

• Upper chest rises

normal sequence of inspiration.

Auscultation

process of listening to breath sounds

• T2

• T6

• T10

landmarks for auscultation.

• Vesicular

• Bronchial

• Bronchovesicular

normal breath sounds.

Vesicular

soft low-pitched faint.

Brochial

loud, hollow, tubular high pitched.

Brochovesicular

softer than bronchial.

• Crackles

• Wheezing

abnormal breath sounds

Crackles

- fine or course

- fine, discontinuous sounds

Wheezing

continuous high or low pitched.

Mediastinal Shift

is the deviation of the mediastinal structures towards one side of the chest cavity.

Tracheal Deviation

happens when your trachea is pushed to one side of your neck by abnormal pressure in your chest cavity or neck.

• Anteriorly: Sternal angle

• Posteriorly: T4 spinous process

bifurcation of trachea.

• Axilla

• Xiphoid

• Lower Costals

3 levels wherein symmetry is measured.

2-3 cm

normal chest expansion.

Tactile Fremitus

- concerned with vibrations

- ast pt to say “99” or “tres tres tres” and feel using palms/sensitive areas

Increase mucus production/secretion

increase vibration.

Air traffic

decrease/absent vibration

Mediate Percussion

- used to assess lung density

- tapping of the lungs/intercostals

- air to solid ration

Normal

air = solid

Dull and Flat

solid > air

Hyper-resonant

air > solid (present in emphysema)

Normal Cough

sharp and deep.

Chronic Bronchitis

2-3 months of productive cough.

Pulmonary Dysfunction

weak, shallow, and frothy secretions.

Chronic Bronchitis

copius but clear secretions.

Infection

yellow, green, purulent secretions.

Hemorrhage of Lungs

hemoptysis.

Pulmonary Edema or Heart Failure

white frothy secretions.