RESPIRATORY ASSESSMENT

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RESPIRATORY ASSESSMENT

• BARBARA B. REES, RN DSN

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FOUR COMPONENTS OF ASSESSMENT

• INSPECTION
• PALPATION
• PERCUSSION
• AUSCULTATION

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GENERAL APPROACH

• PATIENT UNDRESSED TO THE WAIST
• GOOD LIGHTING
• COMPARE ONE SIDE WITH THE OTHER
• WORK FROM ABOVE DOWN
• VISUALIZE THE UNDERLYING STRUCTURE IN YOUR MINDS
  EYE

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ANTERIOR LANDMARKS

• SUPRASTERNAL NOTCH
• MANUBRIUM
• STERNAL ANGLE
• COSTAL ANGLE
• COSTOCHONDRAL JUNCTIONS

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POSTERIOR LANDMARKS

• INFERIOR ANGLE OF SCAPULA
• VERTEBRA PROMINENCE - C7

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IMAGINARY LINES

• ANTERIOR
• a. MIDSTERNAL LINE
• b. MIDCLAVICULAR LINES
• c. ANTERIOR AXILLARY LINES
• LATERAL
• a. MID AXILLARY LINE
• b. POSTERIOR AXILLARY LINE

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• POSTERIOR
• a. SCAPULAR LINE
• b. VERTEBRAL LINE

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ACCORDING TO UNDERLYING LUNGS AND LOBES

• RIGHT LUNG
• a. UPPER
• b. MIDDLE
• c. LOWER
• LEFT LUNG
• a. UPPER
• b. LOWER

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INSPECTION

• NUTRITION
• A-P DIAMETER 12 NORMAL
• SLOPE OF RIBS 45 DEGREES

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ALTERED SHAPE

• KYPHOSIS - CONVEXITY OF THORACIC SPINE
• SCOLIOSIS - S CURVATURE OF SPINE
• KYPHOSCOLIOSIS
• LORDOSIS - ANTERIOR CURVATURE OF LUMBAR SPINE

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STERNUM

• PECTUS CARINATUM- PIGEON BREAST
• PECTUS EXCAVATUM - COBBLERS CHEST

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HYPERTROPHIED NECK MUSCLES

• AS IN A PATIENT WITH COPD

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RATE PATTERN OF RESPIRATIONS

• RATE ADULT 12-20, NEWBORN 30-50, 6 MONTHS
  20-30, 2 YEARS 20-30, ADOLESCENT 12-20
• TACHYPNEA gt24
• BRADYPNEA lt10
• DYSPNEA
• APNEA

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PATTERN

• NORMALLY INSPIRATION EXPIRATION
• CHEYNE-STOKES
• BIOTS
• KUSSMAULS

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MOVEMENT OF THORAX

• SHOULD BE SYMMETRICAL
• ABDOMINAL OR DIAPHRAGMATIC
• UPPER THORACIC

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LABORED RESPIRATIONS

• USE OF ACCESSORY MUSCLES
• RETRACTIONS - ON INSPIRATION , INDICATES
  OBSTRUCTION
• BULGING

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NON-RESPIRATORY MOVEMENT

• PMI - POINT OF MAXIMAL IMPULSE
• PULSATIONS
• CYANOSIS
• a. PERIPHERAL
• b. CENTRAL

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CLUBBING

• MILD - ANGLE STRAIGHTENS OUT
• MODERATE - 180 DEGREE ANGLE
• SEVERE - BASE OF NAIL SWOLLEN

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POSTURE

• ORTHOPNEA
• CHRONIC LUNGER- LEANING ON BEDSIDE TABLE

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COUGH

• CHRONIC
• PRODUCTIVE
• IF PRODUCTIVE - AMOUNT

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PALPATION

• TRAPEZIUS
• POINT
• FIST

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TACTILE FREMITUS

• VOCAL FREMITUS - SAY 99
• INCREASED FREMITUS - LIQUID OR SOLID INSIDE LUNGS
  TRANSMIT VIBRATIONS BETTER THAN AIR
• DECREASED FREMITUS

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OTHER

• PLEURAL RUB FREMITUS
• RHONCAL FREMITUS
• SUB-Q CREPITUS

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TRACHEAL POSITION

• CHECK TO SEE IF STRAIGHT AND ABOVE SUPRASTERNAL
  NOTCH
• NOTE DIRECTION OF SHIFT

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PERCUSSION

• RESONANT- LUNG
• HYPERRESONANCE - EMPHYSEMA, CHILD
• TYMPANIC- STOMACH
• DULL- ORGAN, BONE
• FLAT- MUSCLE

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AUSCULTATION

• DIAPHRAGM AND BELL
• VESICULAR - BREZY, 31 RATIO
• BRONCHOVESICULAR - UPPER BODY OF STERNUM, 11
  RATIO
• BRONCHIAL - INSPIRATION SHORTER, 23 RATIO
• TRACHEAL - IE, 11 RATIO

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ADVENTITIOUS

• RALES AND RHONCHI
• EARLY INSPIRATORY CRACKLES
• LATE INSPIRATORY CRACKLES
• BOTH INSPIRATORY AND EXPIRATORY CRACKLES
• WHEEZES

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VOICE SOUNDS

• BRONCHOPHONY - SAY 99
• EGOPHONY - E TO A
• WHISPERED PECTORILOQUY - WHISPER 99