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Health Assessment (Respiratory System overview)

Clinical Instructor: Sir Beven

Mary Knoll Espejo

on 26 April 2013

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Transcript of Health Assessment (Respiratory System overview)

Abnormal breath sounds Team 0 + - = 9 8 7 1 2 3 4 5 6 c Health History Ask the patient about shortness of breath
Determine if the patient has Orthopnea; ask the number of pillows he/she uses when sleeping.
Ask the patient if he/she has cough. If he does, ask him whether it is Productive or Non-productive, and to describe the sputum.
Have the patient describe any chest pain including its location, how it feels, if it radiates, causes.
Ask about the patients' medical history (including smoking, pneumonia and exposure to irritants). Respiratory System Qualities of normal breath sounds Members Castro, Aimee
Corpuz, Katrina
Cimeni, Zennia
Dableo, Mara
Espejo, Mk Grading dyspnea To assess dyspnea (SOB) as objectively as possible, ask your patient to briefly describe how various activities affect his breathing. Then document his response using this grading system: Inspection
Watch for chest-wall symmetry as the patient breathes. Note any paradoxical, or uneven, chest-wall movement.
Count the patient's RR for a full minute (longer if you note abnormalities); normal RR (adult): 12 to 20 bpm; up to 40 bpm for infants
Observe the patient's respiratory pattern; it should be even, coordinated, and regular with occasional sighs.
Inspect the skin, tongue, mouth, fingers, and nail beds, which can provide more information about the patient's respiratory status. Health Assessment Abnormal respiratory patterns ANATOMY Upper Airways The upper airways include the nasopharynx (nose), oropharynx (mouth), laryngopharynx, and larynx. These structures warm, filter, and humidify inhaled air. Lower Airways The lower airways begin with the trachea (windpipe), which exptends from the carotid cartilage to the carina. The trachea then divides into the right and left mainstem bronchi, which ocntinue to divide all the way down to the alveoli, the gas exchange units of the lungs. Bronchial Tracheal Vesicular Quality: Harsh, high-pitched
Inspiration-expiration (I:E) ratio: I=E
Location: Above supraclavicular notch, over the trachea Quality: Loud, high-pitched
Inspiration-expiration (I:E) ratio: I<E
Location: Just above clavicles on each side of the sternum, over the manubrium Quality: Medium in loudness and pitch
Inspiration-expiration (I:E) ratio: I=E
Location: Next to sternum, between scapulae Bronchovesicular Quality: Soft, low-pitched
Inspiration-expiration (I:E) ratio: I>E
Location: Remainder of lungs Palpation
Gently use your palms to palpate the chest for crepitus, tenderness, alignment, bulging, or retractions. Palpate the front and back of the chest.
Use the pads of your fingers to palpate the chest, including over the ribs. Note skin temperature, turgor and moisture as well as the presence of scars, lumps, lesions, or ulcerations.
Palpate for tactile fremitus.
Assess chest-wall symmetry and expansion by placing your hands on the front of your chest with thumbs touching each other, and ask the patient to inhale deeply. Percussion
Hyperextend the middle finger of your left hand if you're right-handed or the middle finger of your right hand on the patient's chest.
Place your hand firmly on the patient's chest.
Use the tip of the middle finger of your dominant hand to tap on the middle finger of your other hand just below the distal joint.
The movement should come from the wrist of your dominant hand, not your elbow or upper arm.
Follow the standard percussion sequence over the front and back chest walls. Auscultation (The sequence used in percussion is also used for auscultation.)

To distinguish between normal and adventitious breath sounds in the patient's lungs, press the diaphragm of the stethoscope firmly against the skin. Listen to a full inspiration and a full expiration of each site of sequence, Remember to compare sound variations from one side to the other. Document adventitious sounds that you hear and include their locations. Assessment Abnormal findings Chest deformities Increased anteroposterior diameter Anteriorly displaced sternum Raised shoulder and scapula, thoracic convexity, and flared interspaces Depressed lower sternum Shallow breathing with increased respiratory rate Decreased rate but regular breathing Absence of breathing, may be periodic Deep, fast breathing Rapid, deep breathing without pauses, in adults, more than 20 bpm; breathing usually sounds labored with deep breaths that resemble sighs Breaths that gradually become faster and deeper than normal, then slower, and alternate with periods of apnea Rapid, deep breathing with abrupt pauses between each breath; equal depth to each depth 1.25 0 Not troubled by breathlessness except with strenuous exercise Troubled by SOB when hurrying on a level path or walking up a slight hill Walks more slowly on a level path than people of the same age because of breathlessness or has to stop to breathe when walking on a level path at his own pace 3 4 Stops to breathe after walking approximately 100 yards (91 m) on a level path Too breathless to leave the house or breathless when dressing or undressing 1 2 Fine crackles Coarse crackles Wheezes Rhonchi Intermittent
Short, cracking, popping sounds
Heard during inspiration Intermittent
Bubbling, gurgling sounds
Heard during early inspiration and possibly during expiration
Squeaky, whistling sounds
Predominantly heard during expiration but may also occur in inspiration Musical
Snoring, moaning sounds
Heard during both inspiration and expiration but are more prominent during expiration
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