Chest and Lungs: NURS330

ASSESSMENT OF THE CHEST AND LUNGS – QUIZLET IMPORT SET

Function of Breathing ⇢ Brings oxygen in (21% in room air) and removes CO₂.

Main function of the ribs ⇢ Protect the lungs and heart; lower ribs protect liver and stomach.

Major muscle of breathing ⇢ Diaphragm.

Intercostal muscles ⇢ Muscles between ribs; assist in breathing; active during respiratory distress.

Intercostal space ⇢ The space between ribs.

Trachea ⇢ Flexible tube anterior to esophagus; made of C-shaped hyaline cartilage rings; 10–12 cm long in adults.

Right mainstem bronchus ⇢ Shorter, more vertical, three lobes; more likely site for aspirated objects.

Left mainstem bronchus ⇢ Longer, more horizontal, two lobes.

Terminal bronchioles ⇢ Lead to alveolar ducts and sacs; channel air into alveoli.

Alveoli ⇢ Increase surface area for gas exchange.

Medulla and pons ⇢ Control respiratory drive; respond to CO₂ levels.

Ventilation ⇢ Process of breathing air in and out.

Right lung accessibility ⇢ Right lateral lobe easiest to access.

Age & Condition Variations

Lung maturity in infants ⇢ 38 weeks gestation.

Delayed cord clamping ⇢ ~1 minute after birth.

Normal infant RR ⇢ 30–60 breaths/min.

Acrocyanosis ⇢ Bluish discoloration in newborns’ extremities.

Effect of cold stress in infants ⇢ Hypothermia → respiratory compromise.

Pregnancy respiratory changes ⇢ Increased RR, shallow breaths, increased O₂ use, dyspnea, congestion.

Kyphosis ⇢ Outward curvature of the spine.

Gibbus ⇢ Sharp spinal curve deformity.

Common elderly lung conditions ⇢ COPD, emphysema.

History Collection

Chief complaints for chest/lung assessment ⇢ Dyspnea, cough, chest pain, trauma.

HPI includes ⇢ Onset, location, duration, character, aggravating/relieving factors, timing, severity.

Respiratory illnesses in PMH ⇢ TB, pneumonia, asthma, COPD, cystic fibrosis, emphysema.

Family history concerns ⇢ Asthma, allergies, cystic fibrosis.

Pack-year formula ⇢ (Packs per day) × (Years smoked).

Orthopnea clue ⇢ Number of pillows used when sleeping.

ROS highlights ⇢ Chest pain, snoring, sleep apnea, night sweats, sputum, wheezing, allergies.

Physical Examination

IPPA order ⇢ Inspection, Palpation, Percussion, Auscultation.

Normal chest shape ⇢ A/P diameter < transverse diameter.

Barrel chest ⇢ A/P diameter ≈ transverse diameter; seen in COPD.

Pectus carinatum ⇢ Pigeon chest (chest out).

Pectus excavatum ⇢ Funnel chest (chest in).

Clubbing ⇢ Rounded nailbeds; sign of chronic hypoxia.

Normal skin/nail color ⇢ Pink; indicates good oxygenation.

Crepitus ⇢ Air trapped under skin; trauma-related.

Tracheal deviation ⇢ Sign of pneumothorax or lung collapse.

Thoracic expansion check ⇢ Hands at T10 level; should be symmetrical.

Tactile fremitus ⇢ Vibration felt when patient speaks; decreased in obstruction.

Percussion tone: Resonance ⇢ Normal, healthy lung.

Percussion tone: Hyperresonance ⇢ COPD or excess air.

Percussion tone: Dullness ⇢ Over organs like the liver.

Percussion tone: Flatness ⇢ Over bone.

Percussion tone: Tympany ⇢ Pneumothorax (air-filled).

Auscultation

Vesicular breath sounds ⇢ Soft, low-pitched; over peripheral lungs.

Bronchovesicular sounds ⇢ Medium pitch; over main bronchi.

Bronchial sounds ⇢ Loud, high-pitched; over trachea.

Crackles ⇢ Bubbling, discontinuous; may indicate fluid or atelectasis.

Rhonchi ⇢ Snoring, coarse, continuous; may clear with cough.

Wheezes ⇢ Musical, high-pitched; continuous; seen in bronchitis or asthma.

Pleural rub ⇢ Grating, low-pitched; seen in pleurisy.

Bronchophony ⇢ Increased clarity of spoken words.

Whispered pectoriloquy ⇢ Whispered words heard distinctly through stethoscope.

Egophony ⇢ “E” sounds like “A” during auscultation.

Respiratory Patterns

Eupnea ⇢ Normal breathing.
Tachypnea ⇢ Rapid breathing.
Bradypnea ⇢ Slow breathing.
Dyspnea ⇢ Shortness of breath.
Apnea ⇢ Absence of breathing.
Hyperpnea ⇢ Deep, rapid breathing.
Cheyne-Stokes ⇢ Alternating fast/slow/apneic; end-of-life pattern.
Kussmaul ⇢ Deep, rapid breathing (metabolic acidosis).
Stridor ⇢ High-pitched sound from upper airway obstruction.

Disorders & Key Findings

Pneumonia ⇢ Dull percussion; bronchial breath sounds.

Pleurisy ⇢ Grating “pleural rub” sound.

Bronchitis ⇢ Wheezing and productive cough.

Pneumothorax ⇢ Tracheal shift, unequal expansion, absent sounds, tympany.

Hemothorax ⇢ Blood in pleural space.

Emphysema ⇢ Barrel chest, wheezing, hyperresonance, clubbing.

Respiratory distress signs ⇢ RR > 20, difficulty speaking, accessory muscle use, cyanosis, panic.

Respiratory distress treatments ⇢ Nebulizer, oxygen therapy, steroids.

Summary Points

Respiratory exam sequence ⇢ Inspection → Palpation → Percussion → Auscultation.

Be systematic ⇢ Always follow the same pattern for both anterior and posterior chest.

Know landmarks ⇢ Helps locate lobes and interpret findings.

Goal of assessment ⇢ Identify normal vs. abnormal respiratory patterns and sounds.