Pulmonary examination 1

Surface landmarks

-sternal angle (in line with 2nd rib)

-4th rib

-5th rib (mid axillary)

-T2/T3

-6th rib

-T10 (where tissue stops)

***landmarks help find fissures which helps find lobes

Normal and adventitious breath sounds

-normal--> soft and low

-adventitious-->abnormal sounds

Typical breath sounds

-tracheobronchial: deep, loud

-bronchial: loud and high

-bronchovesicular: transition point-->softer version of bronchial

-vesicular: light, airy sound

Auscultation procedure

-know your stethoscope

-clean with alcohol wipe

-seat pt comfortably in quiet environment

-make sure earpieces are facing fwd

-place diaphragm of stethoscope evenly on pts bare skin

-instruct pt to open mouth slightly and "breathe in and out"

-listen to at least one breath in ea. bronchopulmonary segment

-perform exam cranial to caudal, bilaterally

-perform ant. and post. in systematic manner

-listen for intensity, pitch, and quality

Precautions to consider during auscultation

-prevent pt from falling if weak or if poor balance is noted

-prevent pt from becoming dizzy secondary to hyperventilation by auscultating slowly btwn pulmonary segments

-maintain appropriate draping pt, particularly females

-if auscultation reveals very faint or distant sounds, remind the pt to take deep breaths and breathe in and out

Egophony

-pt say "E" while therapist auscultates

Normal egophany

-PT hears muffled or faint "E"

Abnormal egophony

-PT will hear A

Bronchophony

-patient say "99" while PT auscultates

Normal bronchophony

-muffled or indistinguishable sound in area other than main bronchi

Abnormal bronchophony

-Clearly hear "99" in area other than main bronchi

Whispering pectoriloquy

-patient whispers "99" while PT auscultates

Normal pectoriloquy

-little to no sound

Abnormal pectoriloquy

-loud and clear 99 sounds

Fremitus procedure

-use ulnar surface against back

-have pt repeat "99"

-assess all of chest wall contralaterally

***can also use open palms

Normal fremitus

-palpation reveals uniform vibration throughout chest wall

Increased fremitus

-presence of secretions or consolidation in particular area of lung

Decreased fremitus

-indicates increased air in particular area of lung

Mediate percussion

-The act of tapping the surface of the body to identify areas of altered density

Mediate percussion sounds

-dull over dense tissue

-resonant over lung

-tympanic/hollow over empty stomach or hyperinflated chest