Lecture 2: Pulmonary Assessment Techniques

What is the 1st step in performing a pulmonary assessment?

1.) review chart: check POC, labs, precautions

2.) check with the nurse for changes in patient status

3.) assess patient for changes

What are the 2nd steps of performing a pulmonary assessment?

Entering the Room:
1.) Wash your hands or don gloves

2.) introduce yourself/credentials

3.) check ID wrist band to verify patient

4.) Assess vital signs on monitor or manually

5.) Get a subjective

What are the 3rd steps of performing a pulmonary assessment?

Visual Assessment (general observations):

• level of mental awareness

• A & O x3

• speech: slurred?

• Body type, color, skin

• use of supplemental O2?

• patient posture and bed positioning

• using a pulse oximeter

What is step 4 of performing a pulmonary assessment?

inspect skin for signs of dehydration

What is step 5 of performing a pulmonary assessment?

assessing skin color

• cyanosis = blue

• check lips, nail beds and skin

What is step 6 of performing a pulmonary assessment?

Assess skin temperature

Is your patient:

• feverish?

• clammy?

• cold?

• warm?

What is step 7 of performing a pulmonary assessment?

Body inspection, assess for tubes

• check for: surgical scars, chest tubes, and other tubes

• Does your patient have clubbing?

What is clubbing?

referring to the bulbous uniform swelling of the soft tissue of the terminal phalanx of a digit with subsequent loss of the normal angle between the nail and the nail bed

What is step 8 of performing a pulmonary assessment?

Assess for peripheral edema

• pitting edema scale: depth of indentation determines the severity of edema

What is step 9 of performing a pulmonary assessment?

Assess the neck and face when breathing

• using accessory muscles at rest?

• shoulder elevated at rest?

• mouth or nose breathing?

What is step 10 in performing a pulmonary assessment?

Assess the chest wall appearance and movement

1.) symmetry of chest and trunk: check for bilateral rib cage expansion on a deep breath

2.) mobility of the trunk/thorax: observe active rib cage movements- anteriorly, posteriorly and laterally

What is step 11 of performing a pulmonary assessment?

assess posture in sitting and standing

What is a key feature of barrel chest posture?

increased anterior-posterior (AP) diameter of the chest

How does the upper chest compare to the lower chest in barrel chest?

the upper chest appears larger than the lower chest due to lung hyperinflation

What condition is commonly associated with barrel chest?

emphysema

What is one method to assess for barrel chest?

measure chest circumference and observe for increased AP diameter

What is Pectus Excavatum commonly called?

funnel chest

What is the defining characteristic of Pectus Excavatum?

the sternum is depressed into the chest, giving a caved-in or sunken appearance

What is Pectus Carinatum commonly called?

pigeon chest

What are the characteristic of Pectus Carinatum?

the sternum protrudes outward from the chest so it gives the chest a bowed-out or bird like appearance

What is step 12 of performing a pulmonary assessment?

assess patient position

What is tripod positioning?

patient leans forward on hands or forearms to stabilize and elevates the shoulder girdle to assist during inspiration

What is step 13 of performing a pulmonary assessment?

Assess breathing patterns: is your patient SOB at rest?

What is the normal inspiration-to-expiration (I:E) ratio at rest?

1:2

What is the inspiration-to-expiration ratio with increased physical activity?

1:1

What is an abnormal inspiration-to-expiration ration often seen in patients with respiratory dysfunction or disease?

1:4

In respiratory dysfunction, which phase of breathing is typically more difficult?

expiration - most patients can’t get the air out of their lungs

What is dyspnea?

labored breathing

What is tachypnea?

abnormally rapid RR

What is bradypnea?

abnormally slow RR

What is hyperventilation?

increased RR

What is orthopnea?

shortness of breathe (SOB) when supine

What is apnea?

temporary cessation of breathing, especially during sleep

What is step 14 of performing a pulomonary assessment?

listening to lung sounds

How should the patient breathe during anterior and posterior auscultation?

take deep breaths through the mouth

Which side of the stethoscope should be used for anterior and posterior lung auscultation?

diaphragm side

What is the correct pattern to follow when auscultating the anterior chest?

a backward “S” pattern starting from the superior portion of the chest

What is the correct pattern to follow when auscultating the posterior chest?

a forward “s” pattern starting from superior portion of the chest

What are normal breath sounds?

tracheal, bronchial, bronchovesicular, vesicular

What are abnormal breath sounds?

crackles and wheezes