keywords:
Bookmark and Share



Front Back
Assessment of the Thorax and Lungs: Subjective data
  • Cough? How long?
  • Productive or non-productive?
  • What color your sputum? (Rust: blood/possible TB, Green: infection, Pink and frothy: pulmonary empolism/pulmonary edema)
  • Does it wake you at night? (often asthma)
  • Is it more common at a specific time?
  • Does activity make it better or worse?
Assessment of Thorax and lungs: subjective data cont.
  • Do you have shortness breath? In what way?
  • What brings it on?
  • How long does it last?
  • Any PNP (paroxysmal noturnal dyspnea) or orthopnea?
  • What positions help?
  • Do you have night sweats? (possible TB/cancer)
  • Do you make any sounds when short of breath? (Grunting in children=PEEP)
Assessment of Thorax and lungs: subjective data cont.
  • Do you have chest pain when breathing? Point to location.
  • When did it start? Describe the pain.
  • Anything help to decrease the pain?
  • Pleuritic pain is often stabbing
  • costochondritis?
Assessment of Thorax and lungs: subjective data cont.
  • Any past history of respiratory infections?
  • Any family history of allergens?
  • Smoking history in packs per day
  • Enviromental history? pollution, smoke, etc.
  • Chronic bronchitis? (associated with COPD)
  • What self care behaviors are present? (TB test, flu shot, CXR)
Assessment of Thorax and Lungs cont.
  • Inspect anterior and posterior chest
  • shape and configuration: barrel chest, etc.
  • Look at pt position: sitting upright, hunched, tripod
What are abnormalities that should be noticed upon inspection?
  • scoliosis: S curve to spine
  • barrel chest:increased anteroposterior chest diameter
  • pectus excavatum: caved in, sunken appearance of the anterior chest
What should be noticed when palpating the anterior and posterior chest?
  • assess for thoracic excursion
  • look for equal expansion
  • assess fremitus: incresed with consolidation (fluid, pneumonia, tumors), decreased with air trapping
  • crepitus: coarse crackling sensation palpable over the skin surface (SQ emphysema)
What should be noticed when percussing the posterior chest?
  • resonance: air filled vs dull/flat with density in the cavity
  • normal lungs sound resonant
  • Hyperresonance is due to the presence of too much air
  • dull or flat sounds might suggest consolidation or pneumonia
What are bronchial lung sounds?
  • Auscultated over the trachea and larynx
  • high, loud, and harsh, and blowing
  • sounds are not muffled by lung tissue
  • Duration: inspiration < expiration
What are bronchovesicular lung sounds?
  • Auscultated over the major bronchi, between the scapula, and near the sternum
  • Have the qualities of bor bronchial and vesicular sounds
  • moderate/medium pitch
  • Duration: inspiration=expiration
What are vesicular lung sounds?
  • auscultated over the peripheral lung fields smaller
  • from the smaller bronchioles and alveoli
  • low and soft "breezy" sound like witd rustling through trees
  • Duration: inspiration > expiration
What are abnormal lung sounds?
Normal lung sounds ascultated in the wrong place or abnormally soft lung sounds
What are adventitous lung sounds?
crackles (rales), coarse crackles (rhonchi), pleural friction rub, wheezing, stridor
What are the characteristics of crackles (rales)?
  • Fine, high pitched, short, crackling popping sound heard during inspiration not cleared by cough.
  • Inhaled air collides with deflated airways that suddenly "pop" open.
  • Causes: CHF, pulmonary fibrosis, asthma, maybe COPD
What are the characteristics of coarse crackles (rhonchi)?
  • Loud, low pitched, moist bubbling and gurgling that start in early inspiration and can be present in expiration
  • Inhaled air collides with secretions in the trachea and large bronchi
  • Causes: pulmonary edema, pulmonary fibrosis, pneumonia, depressed cough reflex
What are the characteristics of a pleural friction rub?
  • Coarse and hollow pitch which has a grating quality.
  • sounds like two pieces of leather rubing together
  • Causes: inflammed pleura and loss of their normal lubricating fluid
  • pleuritis accompanied by pain from the rub disappears after fluid accumulates
What are the characteristics of wheezing?
  • Can be high or low in pitch. A musical squeak of snoring. Mainly through expiration, but can happen on inspiration.
  • Due to airflow obstruction or squeezing of air through narrowed passage ways.
  • Obstructive lung disease, asthma, emphysema, bronchitis
What are the characteristics of stridor?
  • A high pitched monophonic inspratory crowing sound which is louder in the neck than over the chest.
  • Originates in the larynx or upper airway obstruction can be from swollen, inflamed tissue, or foreign body.
  • can be caused by croup, epiglottits (pt will have trouble swallowing), for a foreign body
x of y cards