Assessments of common respiratory conditions

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Expected findings

Inspection: AP:T diameter 1:2, relaxed posture,

RR 10-20, regular even respirations, no cyanosis

or pallor, SpO2 >95% on RA

• Palpation: symmetric chest expansion, tactile

fremitus present and equal bilaterally, no

lumps, masses, or tenderness

• Percussion: resonance throughout lung fields

• Auscultation: clear lung sounds throughout

Atelectasis

Collapsed alveoli

• Inspection: cough, may note slightly elevated

RR, mild cyanosis, AP:T diameter WNL, SpO2

may be slightly decreased requiring

supplemental O2

• Palpation: chest expansion may be decreased

on affected side, tactile fremitus decreased or

absent over area

• Percussion: dull over area, remainder of lung

fields resonant or may be hyper-resonant

• Auscultation: lung sounds decreased over area,

may note fine crackles

Pleural effusion

Fluid in interpleural space – can be fluid,

exudate, purulent, blood

• Inspection: tachypnea, dyspnea, dry cough,

decreased SpO2, cyanosis

• Palpation: decreased or absent tactile

fremitus, decreased chest expansion on

affected side

• Percussion: dull over affected area

• Auscultation: crackles over affected area

Heart failure

Pump failure leading to backup of pulmonary

circulation

• Subjective: dyspnea on exertion (DOE), edema, cough

• Inspection: tachypnea, increased WOB, orthopnea,

PND, nocturia, dependent edema, pallor; severe may

have pink, frothy sputum

• Palpation: skin moist, clammy; tactile fremitus WNL

• Percussion: resonance throughout

• Auscultation: crackles especially at bases, may note

extra heart sound

Pneumothorax

Free air in pleural space with fully or

partially collapsed lung

• Inspection: unequal chest expansion, if

severe may have tachypnea, cyanosis,

decreased SpO2, anxiety, tracheal deviation

to unaffected side, tachycardia, hypotension

• Palpation: decreased or absent tactile

fremitus, chest expansion decreased on

affected side

• Percussion: hyper-resonance on affected

side

• Auscultation: lung sounds decreased or

absent on affected side

Asthma

Bronchospasm and inflammation in

airways causing resistance

• Inspection: tachypnea, SOB,

decreased SpO2, prolonged expiration

• Palpation: decreased tactile fremitus

• Percussion: resonant

• Auscultation: bilateral wheezing,

usually on expiration

Tuberculosis

Prolonged infectious process secondary

to tubercle bacilli

• Subjective: Initially asymptomatic but may be

noted on CXR, progresses with weight loss,

fatigue, weakness, low grade fever, night

sweats

• Inspection: cough nonproductive progresses

to purulent yellow-green blood-tinged,

dyspnea, orthopnea

• Palpation: chest expansion equal

• Percussion: resonant, dull over areas of

effusion

• Auscultation: crackles that persist even after

coughing

Lobar pneumonia (PNA)

Infection causes alveoli to be edematous

and porous

• Subjective: fever, cough, pleuritic chest pain,

chills, SOB, fatigue, malaise

• Inspection: tachypnea, increased WOB, my

note cyanosis and hypotension with severe

illness

• Palpation: chest expansion decreased on

affected side, tactile fremitus may be increased

• Percussion: dull over area of infection

• Auscultation: fine to medium crackles

Acute bronchitis

• Infection of trachea and larger bronchi,

usually viral

• Subjective: cough lasting up to 3 weeks, may have

fever, sore throat, fatigue

• Inspection: productive or nonproductive cough,

AP:T diameter WNL, no increased WOB

• Palpation: no pain, tactile fremitus WNL, equal

chest expansion

• Percussion: resonant

• Auscultation: clear and equal bilaterally

Chronic bronchitis

Type of COPD – proliferation of mucus in

airways

• Subjective: SOB, recurrent productive cough

• Inspection: hacking rasping cough with thick

mucoid sputum, dyspnea, fatigue, decreased

SpO2, finger clubbing

• Palpation: tactile fremitus normal

• Percussion: may be hyper-resonant

• Auscultation: may note crackles, prolonged

expiration, wheeze especially during exacerbation

Emphysema

Type of COPD – destruction of pulmonary

connective tissues

• Subjective: SOB worse with activity, chest tightness,

cough, history of cigarette smoking

• Inspection: increased AP:T diameter approaching 1:1,

may note accessory muscle usage, increased WOB,

tripoding, decreased SpO2

• Palpation: decreased tactile fremitus and chest

expansion

• Percussion: hyper-resonant

• Auscultation: decreased breath sounds with prolonged

expiration

Lung cancer

Different types

• Subjective: fatigue, nausea/vomiting,

persistent cough, SOB, poorly localized chest

pain; may be asymptomatic

• Inspection: weight loss, clubbing, hoarseness,

anemia, hemoptysis

• Palpation: WNL

• Percussion: resonant, may note dullness if large

tumor

• Auscultation: may note wheezing, decreased

lung sounds

Pulmonary embolism (DONT FOCUS TM)

Blood clot in pulmonary artery

• Subjective: chest pain worse on deep

breath, SOB, anxious

• Inspection: restlessness, mental status

changes, decreased SpO2, tachycardia,

diaphoresis, hypotension

• Palpation: AP:T diameter 1:2, tactile

fremitus WNL

• Auscultation: crackles, wheezes

Acute respiratory distress syndrome

(ARDS) (DONT FOCUS TM)

Damage to alveolar capillaries causes

permeability and pulmonary edema

• Subjective: acute onset SOB, anxiety

• Inspection: restlessness, disorientation,

hypoventilation, productive cough,

decreased SpO2, tachycardia, hypotension

• Palpation: equal chest expansion

• Auscultation: crackles/rhonchi throughout

lung fields