A Comprehensive Chest Assessment
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A Comprehensive Chest Assessment Lisa Pezik RN BScN Clinical Educator Objectives ∗ Discuss the normal physiology ∗ Learn how to obtain a history ∗ Review the assessment techniques of inspection, auscultation, percussion, and palpation ∗ Discuss signs, symptoms, and treatment for pneumonia, sleep apnea, and a tracheostomy Normal Physiology ∗ Like gas and exhaust on a car ∗ Brings oxygen into the system ∗ Removes carbon dioxide waste ∗ Main parts ∗ Trachea ∗ Passage of air ∗ Esophagus ∗ Passage of food ∗ Bronchi and Bronchioles ∗ Air into the lungs ∗ No gas exchange ∗ Alveoli ∗ Gas exchange Lobes ∗ Cone shaped organs ∗ Right Lung ∗ 3 lobes ∗ Left Lung ∗ 2 lobes Digging Deeper ∗ Obtain baseline data through ∗ History ∗ Physical Assessment ∗ ∗ ∗ ∗ Inspection Palpation Percussion Auscultation Family/ Personal History ∗ ∗ ∗ ∗ ∗ ∗ ∗ ∗ Smoking and exposure to second-hand smoke Frequency of colds and asthma Occupational and Environmental exposure Allergies Specific diagnoses of respiratory diseases Medications Admissions to hospital Vaccination history and Mantoux history History of Symptoms ∗ ∗ ∗ ∗ ∗ O.P.Q.R.S.T.U.V Asthma, embolism, COPD Heart failure, pulmonary edema TB, AAA, pancreatitis, pneumothorax Bronchitis, pneumonia, obstruction ∗ ∗ ∗ ∗ ∗ ∗ ∗ ∗ ∗ Cough SOB Chest Pain Hemoptysis Sputum Wheeze Fatigue Anorexia Diaphoresis Inspection ∗ General appearance ∗ ∗ ∗ ∗ ∗ ∗ Posture Degree of comfort Sweating Ability to speak and breathlessness Colour Nutrition and hydration status ∗ Chest ∗ Shape and movement ∗ Respirations ∗ Evidence of trauma of scars Palpation ∗ Above the chest ∗ Tracheal position ∗ Lymph nodes ∗ Chest ∗ Chest wall tenderness ∗ Normal rise and fall ∗ Tactile fremitus ∗ Vibration with “Ninety nine” ∗ Use ball of your hand ∗ Pleural friction rub sound ∗ Above and below the chest ∗ Spinal alignment ∗ Ascites Percussion ∗ Places ∗ Of the chest wall ∗ Over the diaphragm ∗ Sounds ∗ Listening for air, fluid, or solid material ∗ Dull is solid ∗ Over liver and bones ∗ PE or pneumonia ∗ Resonant is hollow ∗ Over lung tissue ∗ Pneumothorax Auscultation ∗ Bronchophony ∗ “Ninety- nine” spoken with a normal voice ∗ Should be heard equally in all lung fields ∗ Whispered Pectoriloquy ∗ “Ninety-nine” whispered ∗ Should hear faint sounds or nothing at all ∗ Eqophony ∗ “E.E.” spoken with a normal voice ∗ Should be heard equally in all lung fields Auscultation ∗ Bronchial ∗ Wind blowing through a tube ∗ Tubular ∗ Vesicular ∗ Leaves blowing ∗ Soft ∗ Equal air entry in all lobes ∗ Quality of breath sounds Auscultation ∗ Abnormal Breath Sounds ∗ Wheeze ∗ Airways is blocked ∗ Treated with bronchodilators ∗ Asthma and COPD ∗ Crackles ∗ Popping sound of aveoli ∗ Fluid with pulmonary edema, pneumonia, CHF ∗ Pleural Friction Rub ∗ Pleural space gets sticky and inflamed ∗ Pneumonia Pneumonia ∗ Causes ∗ Decreased muscle mass and chest wall expansion ∗ Weak cough and clearing airway ∗ Aspiration ∗ Signs and Symptoms ∗ Cough, SOB, wheeze, CP, crackles, rub, fever, confusion, sputum ∗ Treatment ∗ Vitals, labs, X-ray, repositioning, swallowing assessment ∗ Oxygen and Inhalers ∗ Antibiotics ∗ Amoxicillin, Levofloxacin, Clindamycin Sleep Apnea ∗ Causes ∗ Apnea from partial or total collapse of upper airway ∗ Loss of signal to the brain’s respiratory center ∗ Signs and Symptoms ∗ Excessive sleepiness, snoring, depression, weight gain ∗ Short-term memory loss and headaches ∗ Treatment ∗ Sleep Study ∗ Positive Airway Pressure ∗ Blows airs with inspiration and expiration ∗ Keeps airway open Sleep Apnea Tracheostomy Tracheostomy ∗ Indications ∗ By-pass upper airway obstruction ∗ Keeps airway patent ∗ Improves mobility, hygiene, and secretion removal ∗ Risk of infection, impairs speech and swallowing ∗ Trach Care ∗ ∗ ∗ ∗ ∗ ∗ Change inner cannula 2x/day and PRN Change outer cannula every 3 months Cue cough and deep breathing Suction as per breath sounds and assessment Cleanse outer stoma with normal saline Always have suction equipment ready at bedside Questions
