Learning objectives of teaching resource
- review anatomy of pulmonary system
- provide visual reference
- identify necessary assessment skills
- review necessary skills needed to perform a competent assessment
- identify adventitious breath sounds
- identify abnormal findings
5 lobes of lung
Assessment Skills
History taking- the source could be from the patient or the chart
- to identify risk factors (asthma, obesity, recent respiratory illness-bronchitis, pneumonia, smoker)
- chief complaint
- common concerning symptoms
- medications
- medical history
- trauma
- allergies
Inspection – visual observation to identify what is normal and detect abnormalities
- facial expression
- level of consciousness
- respiratory rate, rhythm
- chest movement should be equal and bilateral
- effort/ work of breathing – use of accessory muscles, retraction
- skin color and color of nailbeds to detect any cyanosis
- ability to speak in complete sentences
- clubbing of finger digits due to chronic condition
- detect any audible noises associated with breathing (wheezing, stridor)
- note quality, timing and strength of cough, presence or absence of pain with coughing, any secretions (Moore, 2007, p.53)
- sputum- different types could give a clue to underlying condition.
- Types of sputum: white and frothy could indicate pulmonary edema; hemoptysis could indicate pulmonary embolism; green and purulent is often indicative lung infection or pneumonia ; blood stained could indicate pneumonia, lung abscess; yellow/green and copius amount may indicate advanced chronic bronchitis (Moore, 2007, p. 53)
Palpation - uses sense of touch to gather information
- to determine symmetrical chest expansion, palpate bilateral movements of chest and diaphragm
- tactile fremitus – feel vibrations and symmetry with the palm of your hand as you ask the patient to say ninety-nine
- decreased fremitus could be due to obstructed bronchus, pleural effusion, pneumothorax or emphsyema
- increased fremitus could be due to lobar pneumonia (Jarvis, 2004, p.451)
- use fingers to detect any lumps or masses, or any areas of tenderness or other abnormalities such as crepitus
- crepitus- coarse crackling sensation palpated can be due to subcutaneous emphysema
Percussion - tapping the patient's skin with the examiners fingers to identify the different sounds associated with different density of the area being examined
- resonance is heard in healthy lung tissue
- compare left to right side
- hyperresonance is heard when there's too much air as in cases of emphysema or pneumothorax
- dull note could indicate abnormal density such as with pneumonia, pleural effusion, atelectasis
Auscultation - uses diaphragm of stethoscope to listen to breath sounds
- normal breath sounds are either bronchial, bronchovesicular or vesicular depending on the location
- compare one side to the other
- identify adventitious breath sounds such as crackles and wheezes
Normal Breath Sounds
Adventitious Breath Sounds
