thorax and lungs

Subjective questions: past medical history

• Any pulmonary dieases (asthma, COPD, cystic fibrosis)?

• Ever had any history of bronchitis or pneumonia?

  • Could be chronic or damaged lungs

• What medications are you taking to improve breathing

  • May need med change or using med improperly

Subjective questions: psychosocial

• What is you occupation? Are you exposed to envirnmental pollutants?

  • Increase risk for pulmonary dieases, cancer, and effect breathing

• Do you smoke?

  • Strips lungs of normal defenses and paralyzes cleansing process

  • Normally have early morning cough

Subjective questions: breathing

• Do you ever feel short of breath?

  • Cardiac diease

  • At night = paroxysmal nocturnal dyspnea (left HF)

• How many pillows do you sleep on at night?

  • CHF patients breath easier with more pillows

• Do you have shortness of breath specifically on inhale?

  • Indicates pulmonary embolism due to inflammed pleural membrane

Subjective questions: cough

• Do you have a cough? Wehen did it start and how long?

• Do you cough up any mucus? Any blood?

  • Nonproductive dry cough has no mucus

  • Hacking cough is persistent dry cough in many respiratory infections

  • Chronic 8 weeks

Subjective questions: chest pain

Do you have any chest pain?

Physical exam: outline

1. Inspection

2. Palpation

3. percussion

4. ausculation

Physical exam: inspection

1. Inspection

   1. Thoracic cage (conical)

   2. Respirations (unlabored)

   3. Skin color and condition

   4. Person’s position

   5. Facial expression

   6. Level of consciousness

Physical exam: palpation

1. Palpation

   1. Symmetric expansion

   2. Tactile fremitus

      1. Increased fremitus may indicate increased density of the lung tissue; may be related to fluid or pathology in the lung that is changing the density or compressing the lung tissue, such as pneumonia. 

      2. Decreased fremitus may indicate the vibrations are obstructed with fluid (pleural eff usion), decreased air movement (emphysema), obesity, or increased musculature.

   3. Lumps, masses, tenderness

Physical exam: percussion

1. Percuss over lung fields (resonance, low-pitched, hollow)

Physical exam: ausculation

1. Normal breath sounds (vesicular)

2. Any abnormal breath sounds (bronchial, bronchovesicular)

   1. If present, perform bronchophony, whispered pectoriloquy, egophony

3. Adventitious sounds (wheezes, crackles, rhonchi, stridor, and pleural rubs)