Health Assessment - respiratory, thorax, lungs

ventilation

mechanical movement of air

respiration

exchange of O2 and CO2

external respiration

at alveoli

internal respiration

cellular level

components of respiratory assessment

vital signs, skin hair nails, head neck, CNS, lungs

angle of louis

sternal angle at 2nd rib

costal margin

inferior rib border

thymus

gland of immune system, shrinks post puberty, T cell production

visceral pleura

lines lungs

parietal pleura

lines tharcic wall, mediastinum, diaphragm

pleural space

trauma can cause lung collapse

trachea bifurcates

sternal angle anteriorly, T4 posteriorly

right main bronchus

shorter, wider, more vertical than left, risk for foreign body aspiration

inspiration

triggered by rise in blood CO2. external intercostals and diaphragm contract, lung fields descend by two rib spaces

expiration

longer than inspiration and passive

inspiration nerves

phrenic nerve C3-C5 and CNX

lung fields

supraclavicular - 6th rib mid clavicular line, 8th rib midaxillary line.

RUL and LUL

RUL is 2.5cm higher than LUL apex

RML

4th-6th rib, gives way to RLL at anterior axillary line

size of LUL

= RUL +RML

RLL and LLL

same size and position

posterior lung fields

C7-T10. LUL and RUL = C7 - T3. LLL and RLL = T3 -T10. During inspiration they descend by 2 rib spaces

process of assessment

general survey, history, physical examination

Health history for respiratory

PAMFROSSTI: R - review of systems particularly important to assess throat, CV, head abdominal etc

tachypnea

abnormally rapid breathing

dyspnea

shortness of breath

sleep apnea

breathing stops and restarts many times while you sleep

pleuritic pain

a sharp, stabbing chest pain caused by inflammation of the pleura, the lining around the lungs

hemoptysis

coughing up blood or blood-stained mucus from the lower respiratory tract

stridor

a high-pitched, harsh, or whistling sound caused by turbulent airflow through a narrowed or obstructed upper airway (trachea or larynx)

order of physical exam

inspection, palpation, percussion, auscultation

inspection of respiratory

LOC, skin and mucus membranes, expression, posture, shape of thorax, movement and effort, rate, rhythm, depth, quality of breathing

thorax shape

diameter should be less than transverse. unexpected = barrel chest where transverse is equal to anteroposterior diameter. generally caused by COPD

COPD

a progressive, incurable lung disease characterized by chronic inflammation and damaged air sacs (emphysema) or airways (chronic bronchitis)

palpation of respiratory

superior to inferior, left to right consecutively, anterior and posterior assessment. note tenderness, masses, lesions and crepitus.

crepitus

bubble wrap sensation (air trapping)

tactile fremitus

used when there are concerns about lung disease. ulnar surface of hand on chest wall to feel vibrations. patient repeats 99. sounds are usually reduced at bases and more intense between scapulae.

Unexpected findings = denser or inflamed lung tissue, air or fluid in pleural space, decrease in lung tissue density

pneumothorax

air or fluid in pleural space

causes of decreased lung tissue density

COPD and asthma

chest expansion (also part of palpation)

assessed when there are concerns about lung volume. posterior- place hands at T9 and T10, slide thumbs medially to raise a skin fold and ask patient to inhale deeply. skin fold should expand or disappear, note symmetry. Anterior- hands at costal margin.

Unexpected = low or asymmetrical

percussion of respiratory

percuss from lung apex to base (avoid clavicle and ribs). compare side to side. anterior and posterior assessment. should be resonant throughout.

Unexpected: hyperresonance (air trapping, COPD) or dullness (fluid)

diaphragmatic excursion (also percussion)

tested when there are concerns with chest expansion. instruct to exhale and hold, percussion down mid scapular line intercostal spaces. mark change to dullness. let them have a break then percuss from first line down, should be at least 1-2 rib spaces. Repeat on other side.

auscultation of respiratory

assess intensity and pitch, quality, duration, adventitious sounds. not over clothing, with diaphragm of stethoscope, ask to breath THROUGH MOUTH, one full breath per location. compare symmetry

tracheal breath sound

equal inspiration and expiration. loud, high pitched. over the trachea

bronchial breath sound

inspiratory sound shorter than expiratory. loud and relatively highpitched. over the manubrium, above the clavicles

bronchovesicular breath sound

equal inspiration and expiration. medium loudness and pitch. first and second intercostal spaces next to sternum and scapula

vesicular breath sound

inspiratory longer than expiratory sound. soft, low pitch. heard over most of the lung field.

wheeze

continuous sounds. high or low. usually more pronounced on expiration

crackles

discontinuous brief popping sounds. more common during inspiration.

spirometry

test used to diagnose and monitor lung conditions like asthma and COPD. It measures how much air you can breathe in and out, and how fast you can exhale. The test lasts less than 10 minutes, involving a deep breath and a forced, rapid exhalation into a mouthpiece connected to a machine

red flags

short sentences, few words. irritable, unable to focus, LOC alterations.

positioning: leaning forward, standing, tripod position (sitting leaning forward)

mouth breathing, pursed lips, nasal flaring, accessory muscle use (neck and intercostal)