ABC, airway, breathing and circulation is the basis for any resuscitation and assessment of a patients condition. Having a patent airway and effective air exchange is a priority because without this the rest does not matter. It is important for a nurse, regardless of the unit she's currently working on, to be able to do a complete pulmonary assessment in a competent manner because at any point in time, one could be called upon to use this skill to determine the stability of the patient's condition and status and to act swiftly in order to maintain or improve a patient's condition.

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

Anatomy

http://www.instantanatomy.net/thorax.html

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

source: http://freemedicalmovie.blogspot.com/