Ronald C. Gonzalez DNP, MSN, MHA, RN
2
6
7

Visceral pleura

Parietal pleura

Intrapleural space
Pneumothorax (air shouldn’t be here)
 Hemothorax (blood shouldn't be here)
 Empyema (puss shouldn’t be here)

Any History of coughing?
◦ Productive/Non-productive
 Sputum Characteristics
 Any Shortness of Breath?
◦ Orthopnea

Any Chest Pain?
Cardiac/Respiratory/Musculoskeletal
 Any History of Smoking?
 Is there Environmental exposure?

9

Shape & Configuration (AP diameter < transverse)

Level of Consciousness (check oxygen)

Position of the patient

Note use of accessory muscles

Location of trachea (deviation)

Skin color and condition (cyanosis)

Rate Normal = 12-20/ min (tachypnea)
10
11

Barrel Chest

Scoliosis

Kyphosis

Pectus Excavatum

Pectus Carinatum
12

Tachypnea: shallow

Bradypnea: slow

Hyperventilation: deep (CO2)

Cheyne-Stokes: apnea

Kussmaul respirations: deep (CO2)
17

Symmetric Expansion

Tactile Fremitus

Note areas of tenderness

Note lumps or masses
18
24
25
26

Crackles
◦
◦
◦
◦

Non-musical, popping sound
Fine: roll hair between fingers by ear
Coarse: opening Velcro
Due to fluid, mucus or pus
Wheezing
◦ High pitched
◦ Due to airway narrowing

Stridor

Ronchi
◦ High-pitched during inspiration
◦ Due to obstruction of upper airway
◦ Low-pitched, snore-like
◦ Due to airway narrowing and secretions




Atelectasis
COPD
◦ Chronic Bronchitis
◦ Emphysema
Asthma
Pleural Effusion
◦ Pneumonia
◦ Heart Failure
◦ Hemothorax
28



Pneumothorax
◦ Cyanosis, tachypnea, tracheal
deviation, ↓BS
Tuberculosis
◦ Rust colored sputum, fever, night
sweats
Acute Respiratory Distress Syndrome
(ARDS)
29
Patient denies any cough, shortness of breath, or
chest pain with breathing. No past history of
respiratory diseases. Denies smoking. Respirations
16/min, relaxed and even. Anterior and posterior
chest expansion symmetric. Tactile fremitus equal
bilaterally. No tenderness to palpation. No lumps
or lesions noted. Lung sounds clear bilaterally over
all lung fields.---------------- J. Nurse SN, CSN