Professional Documents
Culture Documents
Anatomical
mapping
Midsternal line
Midclavicular line
Anterior axillary
line
Midaxillary line
Posterior axillary
line
Vertebral line
Scapular line
Anatomy of the Lungs
Lungs
Right has 3 lobes
Left has 2 lobes
Oblique fissure divides
upper & lower lobes
Trachea
Anterior to esophagus
Branches into right & left
bronchi
Right wider, shorter,
more vertical (
aspiration)
Bronchioles
Alveoli
Anatomy of the Lungs
Mapping of the lungs
Anterior chest
primarily upper lobes
Posterior chest
primarily lower lobes
RML best heard right
anterior axillary line
History
Chief complaint / present illness
Cough
Shortness of breath / difficulty breathing
Chest pain
Congestion
Sudden onset breathing problem (aspiration)
Apnea
Snoring
History
Past medical history
Hospitalizations for respiratory
condition
Chronic pulmonary conditions, i.e.,
asthma, TB, emphysema, cystic fibrosis
Other chronic conditions, i.e., heart
disease
Allergies
Trauma or surgery to thoracic, nose,
mouth
Medications used
History
Family history
TB
Cystic fibrosis
Emphysema
Allergies, asthma, atopic dermatitis
Bronchitis
Clotting disorders (risk of pulmonary
emboli)
Smoking
History
Personal and social
Tobacco use / exposure
Environmental toxin exposure, i.e., air
pollution, pesticides, smoke, mold,
animals
Exposure to respiratory infections
Occupation
Travel
Exercise tolerance
Assessment of the Chest and
Lungs
Inspection
Palpation
Percussion
Auscultation
Assessment of the Chest and Lungs
Inspection
Sitting or lying with chest fully exposed
Note shape and symmetry of chest
Lateral chest > anterior/posterior diameter
Barrel chest indicates chronic breathing problem
Kyphosis and scoliosis abnormalities of spine
Shape and position of sterum
Assessment of the Chest and
Lungs
Inspection
Respirations
Rate
Per minute
Rhythm
Regular
Irregular
Regularly irregular
Effort
Assessment of the Chest and
Lungs
Inspection
Respirations
Effort
Abdominal breathing normal in children
Nasal flaring
Substernal or intercostal retractions
Ratio of inspiration to expiration
Normal 2:1
Expiration prolonged with air trapping i.e.,
asthma, emphysema
Grunting is attempt to increase thoracic
pressure
Never normal
Assessment of the Chest and
Lungs
Inspection
Color
Cyanosis is a late sign of respiratory
distress
Clubbing of fingers is a sign of prolonged
oxygen deficit
Assessment of the Chest and
Lungs
Palpation
Areas of tenderness, bulges, masses,
crepitus
Fremitus (increased airflow turbulence due to
blockage or fluid)
Compare lung fields for fremitus at rest and while
person speaks
Thoracic expansion
Compare symmetry of lung expansion
Palpating for Fremitus Comparing Lung Fields
Palpating for Thoracic Expansion
Assessment of the Chest and
Lungs
Percussion
Tap sharply and consistently with wrist
Compare side to side
Percuss between ribs
Resonant tone over unobstructed lung
fields
Hyperresonance found with hyperinflation
Dullness with atelectasis, pneumothorax,
effusion
Flat tone over scapula and spine
Dull tone over heart, liver, diaphragm
Percussion Technique
Percussion Areas for Chest and Lungs
Assessment of the Chest and
Lungs
Auscultation
Place diaphragm of stethoscope firmly on
skin
Listen to all lung fields, front, back, right
axillary
Listen for sounds of inspiration &
expiration
Clarity
Duration of sound, ratio of inspiration to
expiration
Auscultation
Diaphragm Bell
Auscultation
Auscultation
Pectus Carinatum
(pigeon chest)
Pectus Excavatum
(funnel chest)
Abnormalities of Chest and
Lungs
Kyphosis
Abnormalities of Chest and
Lungs
Abnormalities of Chest and
Lungs
Abnormal lung sounds
Fine crackles (rales)
End inspiration, high-pitched, not cleared by cough
Pneumonia
Medium crackles (rales)
Midstage inspiration, lower pitch, moist, not cleared
by cough
Bronchiolitis (can also have wheeze)
Coarse crackles (rales)
Loud bubbly noise during inspiration
Bronchitis
Abnormalities of Chest and
Lungs
Abnormal lung sounds
Rhonchi (bronchial)
Loud, coarse, heard during inspiration & expiration
May clear with cough
URI, bronchitis
Wheeze
Musical noise or squeak
Heard both on inspiration & expiration, louder
expiration
Asthma
Pleural friction rub
Dry, rubbing, grating sound
Heard both on inspiration & expiration lower lateral
chest
Abnormalities of Chest and
Lungs
Abnormalities of Chest and
Lungs
Abnormalities of Chest and
Lungs
Breast Cancer