Lungs and Thorax

Bates Video Viewing Guide: Lungs & Thorax PRINT for note taking during viewing Keep textbook handy to compare diagrams or pictures Each video clip last ~1-2 minutes. Every clip has SOUND,

Video clip #1 Initial Assessment Posterior Thorax INSPECTION: A. Brief survey- observations: 5 12345(answers) rate, rhythm, depth, effort, audible sounds B. Normal findings123( answer- easily quietly and regularly 14 20 times per minute) C. Inspect- neck for: _______________________________ (answer) supraclavicular or sternomastoid muscles contractions which if present demonstrates effort and difficulty in respiration. NORMAL - absent D. Examine posterior thorax Inspection for: 1.shape 2.symmetry 3.deformities 4. overlying skin

Video clip # 2: Assess Posterior Thorax (continued) A. PALPATE - to locate pain or tenderness, lesions or abnormalities B. Assess respiratory (chest) expansion- How is this performed? (1) Place thumbs close to spine at level of 10th rib (T9-T10). (2) Spread hands lightly over posterior thorax. (3) Ask the patient to: ____________________ (take a deep breath, inhale deeply and exhale fully ) (4) Look for your thumbs to move and feel for: range and symmetry of movement (5) Normal: thumbs move apart smooth, symmetrical expansion ABNORMAL: Lag in expansion on one side, unequal,

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Why is one side moving more that the other? Possible atelectasis, pneumonia or fractured ribs, pneumothorax Pain if pleurae inflamed.

C. PALPATE: Technique: Using the pattern, systematically palpate for tactile fremitus What is Tactile Fremitus? __________________________________(tactile means Vocal and Fermitus is a palpable vibration) Use what part of hand __________ (palmar base or ball of fingers). Ask pt to: _____________________________________(repeat the word, 99 since this generates strong vibrations) Assess systematically side to side down the thorax Palpate and compare - look for increase, decrease or absence of fremitus. Normal: KEY is symmetry of the vibrations. Abnormal: ________________________________( lack of symmetry side to sidedecrease fremitus obstruction of transmission of vibrations and increased fremitus with increased density or consolidation of lung tissue) ________________________________________________________ Video clip # 3 Assess Anterior Thorax Pt position ______________ ( lie supine )) Tell pt and instructions ___________( breath normally Inspection for: 1.shape 2.symmetry 3.deformities 4. overlying skin 5. respiratory movement PALPATE - what are you looking for? o normal o abnormal- (tenderness, lesions ) Assess respiratory (chest) expansion- How is this performed? (1) Place thumbs along the costal margins (2) Spread hands lightly pointing upward (3) Ask the patient to: ____________________ (take a deep breath) (4) Look for your thumbs to move and feel for: range and symmetry of movement (5) Normal: thumbs move apart smooth, symmetrical expansion ABNORMAL: Lag in expansion on one side, Unequal, why is one side moving more that the other? Possible atelectasis, pneumonia or fractured ribs, pneumothorax or postoperative guarding. ____________ Palpate for tactile fremitus: compare sides in 3 locations- look for increase, decrease or absence of fremitus. Normal: KEY is symmetry of the vibrations.

Video Clip # 4 : Normal and Adventitious Sounds -- LISTEN

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What are the NORMAL or expected sounds? What are the locations for each sound? . Which is longer? Inspiration or expiration? Carefully look at these charts. Can you hear the differences? Bronchial sounds (loud, high pitch, short inspiration & long expiration) Location: Trachea and larynx- anterior neck and tape of neck posterior Bronchovesicular sounds (moderate pitch, inspiration and expiration equal.) Location: over Bronchi tree- anterior 1-2 interspaces and posterior between scapula Vesicular ( soft, low pitch, long inspiration & short expiration) Location: Over peripheral lung fields

Video Clip # 5: Auscultation Technique- Anterior Thorax Sites for placement of stethoscope Watch her technique- symmetrical, comparison of side to side Start : _____ Remember: lateral sides Listen for duration, intensity, .pitch Ignore heart sounds and concentrate on lung sounds If hear bronchial or bronchovesicular voice sounds where should not be located, listen for transmitted voice sounds. Video Clip # 6: Auscultation Technique- Posterior Thorax NOTE THE TECHNIQUE and placement of stethoscope. Auscultation- assesses air flow throughout upper airways and lungs. Stand behind the person. Begin at _______ (apices or top) and go downwards ( to bases - ~ T-10) and move stethoscope systematically side to side- compare side to side.. NOTE location of sites to listen (remember: laterally from axilla down to 7-8 rib) USE: diaphragm Listen to one entire cycle at each location Listen to duration, pitch and intensity Listen to inspiratory and expiratory Note type and location Tell pt to: ___________________________ (breath deep thur mouth.

LISTEN and WATCH the technique demonstrated- note sites, sounds and pace. Refer to text for location confirmation as seen in this video. IMPORTANT Transmitted voice sounds- also called vocal resonance. Key Points: Normal: Transmission of vocal sounds thru healthy lung tissue is normally muffled.

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Abnormal: Consolidation or compression of lung tissue will enhance voice sounds making the words more distinct or clear. Suggest- air filled lung is airless!

If bronchial or bronchovesicular sounds are heard in the wrong place, this is ABNORMAL. So you need to listen for transmitted voice sounds. . While you listen with stethoscope- instruct the pt: Say 99- bronchophony = louder or clearer than normal Say EEE I if sounds like AAA with nasal component = egophany WHISPER 1,2,3 if louder and clearer than normal = whisper pectoriloquy

Video Clip # 7 : Adventitious Sounds (added breath sounds on top of the normal breath sounds) LISTEN & Note: Quality, pitch, location and timing as important characteristics. DisContinuous- result from air bubbling thru moisture in the alveoli or collapsed alveoli popping open. Crackles (intermittent, non musical, brief, like dots in time) fine- soft, high pitch, very brief coarse- louder, lower pitch, longer Continuous- caused by narrowing of airways by spasm, inflammation, mucus secretions or a solid tumor. These sounds last longer and sound musical wheezes - high pitch, hissing or shrill quality, rhonchi lower pitch, snoring quality Can you tell the differences when you listen??

Video Clip # 7 -8 : Percussion - Posterior and Anterior VIEW for awareness of techniques but percussion is not an expected skill