LECTURE
ASSESSING THE THORAX AND LUNGS
Video Discussion - https://bit.ly/35yzKsg
THORAX
● Identifies the portion of the body that extends
from the base of the neck superiorly to the
level of diaphragm inferiorly
● In the human lungs the distal portion of the
trachea and the bronchi are located in the
thorax
● And this portion constitute to the lower
respiratory system and the outer structure
of the thorax is what we called the thoracic
cage
● Going back this is a vital organ must be
supported with a cage or thoracic cage
Thoracic Cavity
● Many contains your respiratory components
that would help the person to breath and
regulate the breathing
● And a thorough assessment to the lower
respiratory system would focus on the
chest as well as the components of the
thoracic cavity.
Assessing The General Appearance
Normal Findings
● No Nasal Flaring
● The diaphragm and muscles is relaxed
● Evenly Colored Skin
● Pink tones should be seen
● 160 degree angle between the base nails and
● The skin
● Nasal Flaring should never be observe in a
normal patient
● Because normally the diaphragm and the
external intercostal muscles do not do all of
the movements or the contraction.
● This is the evidence of what we call the
outward expansion or the “rise and fall of the
chest”. Inspiration and expiration which is a
normal breathing.
● The client when we observe in assessing the
skin, should have an even color without any
forms of promonents discoloration.
● In his/her nails should be at a normal angle,
which is a 160 degree angle, and the nails of
the bed are intact.
ABNORMAL FINDINGS ON THE ASSESSMENT
OF THE GENERAL APPEARANCE
Nasal Flaring
●
● Nasal Flaring normally there should be a
proper inhalation and exhalation.
● Nasal Flaring is what we call the labored
breathing (nostrils are being widened) due to
wanting to engulf oxygen. This process is
normal for a child/baby. As mentioned, they
are still on a developing stage.

● But in Assessing an Adult this means that it is
an indication of a patient having hypoxia, or it
is an inadequate oxygen delivery in the
tissue.
Pursed Lip Breathing
● Purpose of this is for patients who have
Asthma, Emphysema and patients who are
also experiencing congestive heart failure.
● They are performing a pursed lip breathing is
because it mainly works into the lungs by
excreting the carbon dioxide, and this
breathing technique would help the airway
open longer
● Pucker or “Purse” the lips as if they are going
to whistle
● Pursed lip breathing is also used when the
patient is experiencing any pain, this could be
instructed to the patient.
● It would slowly progress the intensity of the
pain.
● With patients having this condition it helps
them elevate their breathing by moving the
oxygen into the lungs.
Ruddy to Purple Complexion
Due to (COPD)
● It is seen in patients with your (COPD) or
mainly the Chronic Obstructive Pulmonary
Disorder.
● Normally the color should never be a Ruddy
to Purple complex,
● The cause of this disorder is a poor airflow of
breathing and main symptoms include the
shortness of breathing and cough, typically
this is the reason why their skin turns to
purple color.
● Purple skin results from bleeding and
bruising, broken blood vessels (hemorrhage),
and this is the reason for low levels of blood
oxygen (hypoxemia) and reason why airflow
won’t properly circulate into the system.
● It would create a decrease in the level of
hemoglobin and the circulation.
● Eventually, the distal part of the body of a
patient who has COPD, will eventually start to
have a (necrosis)/cell death, death of body
tissue, due to a lack of oxygen air flows of the
entire body because of the destruction.
Maybe the patient is a long time smoker or
has a bronchitis disease.
● Grasp of air
● It has different stages, not all patients with
COPD are then having a ruddy complex
TYPE STAGES
1. Mild Stage
- When it is mild somewhat the breathing of the
patient is inped (shortness of breath)
2. Moderate Stage
- In This stage of observing, the patient would
grasp air
3. Severy to very severe
- In this observation, the patient is already
having the ruddy complex. And with this the
patients have COPD, when the patient is
palpated and by touching them they are
somewhat cold and have clammy skin. It is
already a sign of hypoxia.
Cyanosis
Due to Hypoxia
● Patients with these findings make the skin
appear blue or bluish, especially in the very
orbital nail bed and the conjunctiva area; it is
the note of bluish discoloration.
● If a client has dark skin, it would appear as a
blue dull or lifeless in the areas in the nails,
palm and toes
● These three assessments in the nails, palms,
toe nails would indicate that the patient is
 having a decreased oxygenation, it would
lead to the patient appear to be cyanotic.
NAILS
Clubbing of Fingers
Due to Hypoxia
● Nails - the normal degree of your nails should
160 degrees and should be intact. No signs
of crooked and freckles.
● Nail beds should be pinkish in color.
● Pale, Cyanotic nails, greater than 180 degree
angle, the tips of the fingers enlarge and the
nails become extremely curved from front to
back.
A. because of hypoxia there is pale and
cyanotic nails, greater than 180
degree where the tip becomes
enlarged, which would indicate
clubbing
B. Another test that you would perform to
determine, If the angle of your nail
beds are within 160 degree
Schamroth window test.
Schamroth Window Test
● If 2 opposing fingers are held back to back
against each other, a diamond-shaped space
should normally appear.
● That means you have a good perfusion and
your nail angle is 160 degrees,
● This could be done by either your index finger
or your thumb
● If the patient is a smoker it could be the
thumb, index, middle and pinky fingers
● Once that it won’t create a diamond shape,
that is what can be called a positive clubbing
finger
● level. They can be given calcium
Inspecting The Posterior Thorax
● One thing in doing an inspection of the
posterior thorax is that you would first assess
to perform the inspection of the
posterior thorax’s configuration.
● While the client would sit, The arms should
be at side or stand behind and observe the
position of the scapula
● Note the configuration of the chest wall.
● So with this you would know the indicator
where you should inspect the configuration of
the scapula. Symmetrical alignment and
symmetry of the posterior thorax.
NORMAL FINDINGS ON THE INSPECTION OF
THE POSTERIOR THORAX
● Scapula which is the base of the
configuration are symmetrical and non
protruding.
● A normal person his/her shoulder are equally
horizontal in position and the ratio of the
anterior and posterior transverse diameter is
1 is to 2.
“The Dominant 80 which is your anterior, posterior
ratio to letter T and it should 1 is to 2.”
● Spinous Process appears straight and thorax
appears symmetric with a 45 degree angle
relation to spine.
- With this the ribs of a normal person are
sloping downward and should never be
upward because that is an abnormal finding.
● There should be no curvature in the spine for
it signifies that there is lordosis, kyphosis or
scoliosis or unsymmetric illness in the spine.
Because it would depend on the S and I
shape or any degrees of curvature .
● When we age some of our patients, elders
their height would decrease because it is a
normal process of the development and
decreased functionality of the body, the
calcium levels are also decreased in this
state.
● When Patient goes old they are much prone
to hypoglycemia or decreased calcium
supplement together with vitamin D to
prevent it from occurence.
● Kyphosis is a normal thing for a normal adult
(older adults). Because of the result of lung
elasticity,
● Ketosis is a decreased of bone density and
is also normal for an adult (older adults)
● No accessory muscle is used in breathing.

ABNORMAL FINDINGS ON THE INSPECTION
OF THE POSTERIOR THORAX
Scoliosis
● sideways curvature of the spine that occurs
most often. Uneven shoulders and/or hips.
Bump in the lower back. Numbness,
weakness, or pain in the legs. Trouble
walking Trouble standing up straight
Shortness of breath. Loss of height.
● Kyphosis is a spinous process making
deviation or forming an S-shape. There is an
equal alignment of the spine that makes it an
S-shape.
- With this there is an even shoulder
and an even hips that can be
observed.
- Patients would also feel numbness
due to the channel of electrical
impulses going to the brain and going
to the peripheral central system. If
there is a misalignment that would
cause an impede
- There are weaknesses and pain in the
legs because of an even distribution
of weight, including in the pelvis,
should be straight so that the weight
of the shoulders would be equalized.
This is for scoliosis.
Kyphosis
● Which is normal for the Adults or elderly
which is 60 and above, and is identified
abnormal if is found young patients this is the
kyphosis the abnormal excessive curvature
● abnormally excessive convex curvature of the
spine as it occurs in the thoracic and sacral
regions
➢ Mild to severe back pain
➢ Back pain with movement
➢ Tenderness and stiffness in the spine
➢ Forward posture of the head
➢ Chest pain or difficulty breathing
➢ Difference in shoulder height
➢ Tight hamstrings (muscles in the back
of the thighs) - most common
symptom
● The curvature of the spine is forming like a
C-Shape is a kyphosis and Scoliosis is
S-Shape.
● Once there is an abnormal curvature into the
spine it would affect the heart and also affect
the breathing and muscles that are nearby.
Atelectasis
● It is mainly collapsed on the lungs, or
permanent collapse or only one of the lungs
is (atelectasis) it is closure of a lung resulting
in reduced or absent gas exchange.
● It is only half of the lungs and the other half is
still functioning.
● Decreased chest expansion, mediastinal
displacement towards the affected side and
elevation of the diaphragm. Patients develop
dullness to percussion over the involved area,
wheezing and diminished or absent breath
sounds on auscultation.
What causes Atelectasis?
● It can be caused by an injury of a patient that
have experience in an accident
● Determine the type of work and the activities
that the patient did
● There is a pleural effusion and is also
pneumonia and if a patient is at an elderly
age and is bedridden the patient needs to
turn it side to side, to prevent progress into
pneumonia.
● There is scarring of tissue, it could illusion or
a viral infection or a cancer that would
eventually metastasized,
● but most common is the pleural effusion,
where our lungs is filled with water, between
the layers of the pleura outside the lungs
● The spaces (plura outside the lungs) should
not be filled with water because of a
boundary called allowance (pleural sac)
allowance of the body to prevent friction from
rubbing.
● So once that allowance will be filled with
water, it could also be filled with air, and it
becomes a positive pressure, it should
 never go inside the body and just maintain a
negative pressure. With this, it would lead to
atelectasis.
● Absence of breath sounds.
24:24 mins/sec
Tripod Position
Due to COPD
● It is found more commonly in patients who
have COPD. Chronic Obstructive
Pulmonary Disorder.
● It is when the patient sits or stands leaning
forward on the edge of the bed or chair and
supporting the upper body with hands on the
knees or on another surface.
● This is done so that the patients would have a
more comfortable position and can help the
patient to breathe accordingly.
● These patients cannot sit properly in chair
leaning their backs on the chair and making a
supine position because it would suffocate
them and had a hard time breathing
● Patients with tripod position are sleeping with
2 to 3 pillows or more, the more pillows can
help support the breathing of the patient.
● Cannot lay down properly in the bed to sleep,
some of the patients who have the COPD will
sleep while standing for this would help them
to breath.
Palpation of the Posterior Thorax
● It can be done Using one or Both Hands
● Use the fingers to Palpate for the tenderness,
warmth, pain and sensation
● In the areas there are sensation
● In palpating the thorax always start at the
midline and at the levels of the left scapula.
● Once it starts palpating, move the hand from
the left going to the right and comparing the
both. And this is called bilateral.
● Whatever is compared from the left, should
also be noted on the right and this is what
you call a bilateral comparison.
● Hands would move systematically
downwards to the portion of the base of the
lungs.
- It's because we could still palpitate
the boney prominents.
- Once we cannot palpate it is already
basing your kidneys.
- You would know the limit in palpation
into base of the lungs
Palpation for Crepitus
Subcutaneous Emphysema
● crackling - feel to the touch , a sensation that
has been described as similar to touching
Rice Krispies ; This sensation of air under the
skin is known as subcutaneous crepitation.
- It is like the sound of a Rubbing of hair
against each other or a crepitus
sound.
Palpation for Surface Characteristics
Assessing the Fremitus
● Palpate for Fremitus : Vocal fremitus is a
vibration transmitted through the body It
refers to the assessment of the lungs by
either the vibration intensity felt on the chest
wall (tactile fremitus) and/or heard by a
stethoscope on the chest wall with certain
spoken words (vocal resonance)
 - Once you palpate it and you note the
patient has lesions, in assessing you
need to use gloves.
- This is also an assessment in the
expansion of the chest,
- it should be bilateral symmetrical;
whatever is on the left should also be
on the right. It's because you will be
palpating also for the expansion that
is part of the surface characteristics.
● First is palpating for Fremitus, A fremitus is
a vibration of air in the bronchial that is
transmitted into the chest wall, This is the
Fremitus sound
- Once you palpate it the normal
findings should be symmetric and
easily identified in the upper region
- As you go along in the lower, it would
diminish the reason is the higher the
position of your hands the closer to
vibrations, because it is closer to
the lungs.
- But if it is farther from the lungs it
would diminish, because of distant the
region from the lungs and these are
your fremitus
30:18 mins/sec
NORMAL FINDINGS ON THE ASSESSMENT OF
THE FREMITUS
● Symmetric and easily identified in the upper
region which is the bronchi.
● If the fremitus is not palpated on either side
the patient may need to speak louder.
● A decrease in intensities of intensities from
Fremitus is Normal, because as you go along
the lower and farther you are from the lungs.
● This should remain symmetric for bilateral
position.
ABNORMAL FINDINGS ON THE ASSESSMENT
OF THE FREMITUS
● Upon palpation it has Unequal Fremitus result
in consolation.
- The consolidation in the lungs means
that the lungs are accumulated by air.
- The small airways are replaced by air
or water, it is filled with anything or
something else, that is the
consolidation.
● Usually when there is consolidation it would
increase the fremitus sound, which should
not be.
● Bronchial Obstruction or air trapping or if
there is emphysema, or pneumothorax
which causes decrease in the fremitus sound.
● Diminished Fremitus even with aload spoken
word or speaking in a loud voice, would
indicate that there is an obstruction on the
tracheobronchial tree.
● Unequal chest expansion can occur with
decreased chest excursion - COPD,
● There should also be a proper understanding
when the client is speaking, so a proper
assessment can be done.
- Because it may create false results and it
would lead into false intervention that would
be formulated on the patients.
● Those are the abnormal findings.
Percussion For Tone
● chest wall and underlying tissues into motion,
producing audible sounds and palpable
vibrations. Percussion helps to determine
whether the underlying tissues are filled with
air, fluid, or solid material.
● Percussion for tone always starts in the apis
or the apices of the scapula or the
“acromion” in the same manner as for the
other side.
- It should be an outward manner
● In percussion use the index finger and middle
finger. Percuss both shoulders on the
intercostal spaces across down and start
 comparing the sides, and the reason why it
should start from left to right as to compare
the other parts.
● It would determine abnormal findings in any
lateral aspect of the posterior thorax.
Assessing The Tone
NORMAL FINDINGS
● Resonance - Normal lung tone
➢ resonance is when we do your
percussion it is a normal lung tissue
● Excursion - Equally bilateral
ABNORMAL FINDINGS ON THE ASSESSMENT
OF THE TONE
● Hyper Resonance - trapped air
➢ It means that the patient may have
emphysema.
● Dullness - fluid or solid tissues that replaces
the lungs so it could be the patient is having a
pleural effusion.
● Tympany - a hollow drum-like sound that is
produced when a gas-containing activity is
tapped sharply.
➢ It should be normally hear into the
stomach
➢ If there is tympany it could be the
patient is having pneumothorax or
there is an air inside the thorax.
Auscultating The Breath Sounds
● Assesses the airflow through the
trachea-bronchial tree. It is important to
distinguish normal respiratory sounds from
abnormal ones
● To best assess the breath sound is to use a
stethoscope with it so the breath sounds can
be directly heard.
● Never attempt to listen or auscultate if the
patients has clothings because sounds can
never be heard directly,
➢ ask the patient to remove its clothing
to expose the posterior or anterior
aspects of the patient's thorax.
➢ And by this you would begin to place
the diaphragm in the stethoscope.
➢ If it is on inspecting the thyroid we use
the bell since it is a large organ, use
the diaphragm, and directly put the
diaphragm on the posterior chest wall
of the apex.
40:32 mins/sec
● You should know that you are in the apex on
the posterior chest wall or go to cervical 7 or
C7 on the spinal cord to clarify.
● Once you locate the C7, it is about the
anacosta chest wall.
● When we do the auscultation for the breath
sounds we should make the patients
comfortable, and alert for any signs of
distress
● Take Note if the patient has any problems
with the procedure because we need to
expose the posterior and back of the patient.
➢ There are three types of normal
(41:38)
1. When you do the palpation you will hear
sounds louder if you're on the upper portion
and in the lower portion would make the
sounds lower or soften in vibrations or “The
transmit of the ver bations.”
2. In auscultation of the abbreviation (B,B,V)
first B stands Bronchial and second B stands
for bronchovesicular and the V is vesicular
- It means that there is a much clearer
and larger quantity of sound in the
upper portion then going to vesicular
the sound becomes lower and a
medium sound on the
Bronchovesicular.
Assessing the Breath Sound
Three Normal Breath Sounds
● Bronchial Breath Sound - The pitch of this
is high and the quality is harsh and hollow
because it is closer to the respiratory region.
- The amplitude is loud
- The nearer the louder
- The duration is short during inspiration
- And long when it is during expiration
 - The location is in the upper windpipe
located in your trachea and your
thorax
- It is loud because it is closer to the
upper portion or windpipe
-
● Bronchovesicular Breath Sound - it is in
the middle, combination of both bronchial and
vesicular.
- The pitch is moderate and the quality
is mixed with harsh and breezy sound
- The amplitude is moderate during
inspiration and expiration
- There is short inspiration and long
expiration
- The location of this is at the middle of
the posterior scapula and anterior
sternum. In your first and second
intercostal space.
● Vesicular Breath Sound - The quality of the
pitch is low and it's breezy.
- The amplitude is low
- It has long inspiration and short expiration,
opposite to the bronchial
- This is usually in the peripheral field or base
of the pulse.
❖ These are the normal findings, sounds
and areas where to locate them
❖ If there is diminished or absent breath
sound that would indicate that there is
no air moving in or out of the lungs
that is being auscultated by the
examiner.
➢ This indicate that there could be an
obstruction
➢ Some lungs as result of sucration, mucus
plugging or forgin objects that would clog in
hearing the breath.
➢ It could also be an indicator for pleural space
effusion or there is pneumothorax or fluid in
the thorax.
➢ Hyperinflation or there is a nature of the
lungs that would basically lose its elasticity of
the lungs tissue or decrease in function.
ABNORMAL FINDINGS
Diminished or Absent Hyperinflated Nature
of the Lungs Adventitious Sound
● Mainly the musical sounds that are the
abnormal sounds that should not be heard.
● These sounds are the musical sounds that
would be heard upon auscultation.These are
superimposed or over the normal breath
sounds during auscultation
Types of Adventitious Sound
● Fine Crackles - are high pitch, short
popping, short heard during inspiration and
not cleared with coughing.
➢ Characteristics
- Sounds are discontinued and can be
simulated by rolling or strand of hair between
the fingers and near the ears.
➢ Source
- Inhaled air suddenly opens in a small deflate
passage that coated a sticky with exudates
➢ Associated Condition
- Late in inspiration with respective diseases
like pneumonia.
● Coarse Crackles - are low pitch, there's a
bubbling moist sound that may be persistent
from early inspiration and early expiration.
➢ Characteristics
- It is also described as your velcro, these are
all musical sounds.
➢ Source
- Usually accumulation of mucus
➢ Associated Condition
- The indicator of this is the patient has
pulmonary edema or it could be your
pulmonary fibrosis.
● Pleural Friction Rub - it is a low pitch so
but there is a grunting.
➢ Characteristics
- It's more like crackles but the friction rubs are
more superficial. Crackles are very much
deep unlike the friction rub.
➢ Source
- Factor is result in rubbing and there is an
inflammation of the pleural space because of
a Pleuritis
- Pleuritis is you would observe that the patient
is having a friction because of the
inflammation
- The purpose why lungs has spaces (plura) in
between the ribs so that it doesn’t touch the
ribs and cause grunting
- It is very painful and causes discomfort for
the patient.
● Wheezing - something like a narrowing
sound because of vasoconstriction. Like a
“Takure” or teapot sound.
➢ Characteristics
- It is the high pitch musical sound primarily
heard during expiration, and can also be
heard during the inspiration stage.
- Because of the constriction, the tumor,
swelling or there is secretion there is less air
that could pass.
➢ Source
- It is most like seen on asthmatic patients, and
when there's a vasoconstriction
● Stridor - are harsh hoonking wheezes
sounds. Most likely associated with
laryngospasm, one of the reasons that
causes stridor.
➢ Characteristics
- Low pitch, snoring and moaning
- Primarily during expiration
- This type of condition is life threatening
because it would impede the clearance of
airway clearance of the patient
➢ Source
- It could be an inflammation of the bronchial,
which is dangerous.
- It's like air hunger or like the patient is
breathless from running a marathon.
➢ Associated Condition
- Eq. allergy attack, which causes inflammation
and swelling. likely associated with
laryngospasm
Auscultate the Voice Sound
1. Bronchophony - “kung Broncho only of
course anything that starts with bronx naa
siya sa taas” you would ask the client to
repeat the word and say 99
- Abnormal Findings of bronchophony
is the word 99 can easily be easily
understood and it is very loud
- The normal should be cannot be
distinguished
- If you determine that there is a very
loud transmission of voice this means
that the patient may be having a lung
consolidation
2. Egophony - if you want the client to listen for
the “E sound” in the chest wall.
- Normal Findings The voice
transmission will be soft and muffled
and Letter E should not be
distinguishable upon auscultation.
- The voice transmission will be soft
and muffled
- If the letter A is the one determine
rather than Letter E upon auscultation
it is already an abnormal findings
because it indicates there is lung
consolidation
- Whispered Pectoriloquy - if you ask
a client to whisper the phrase 1, 2 or 3
while you auscultate the chest wall.
- These are your voice transmission
that is soft, muffled and indistinct
when auscultate. The sound may be
heard but the actual phrase cannot be
distinguished, so this is when you are
going to use a stethoscope.
- Normal Findings is Transmission of
the sound is really faint and muffled
and it may be inaudible at times.
- This is a consolidation, or there is
compression that the sound is
transmitter clearly and distinctly in
areas of the client it also signifies that
there is a lung consolidation
THIS ENDS THE DISCUSSION OF THE
POSTERIOR ASPECT
Assessing on The Anterior Thorax
● Observe the condition of the skin and inspect
the chest for deformities, asymmetry, and
respiratory movement. Next, palpate the
chest to locate any areas of tenderness or to
assess any lesions or abnormalities . Then,
assess chest expansion.
● Always start the inspection at the shape and
configuration, in the posterior and anterior it's
just the same manner and principle on
distinguishing normal from abnormal findings.
 ● Lung condition that causes shortness of
NORMAL FINDINGS ON THE ASSESSMENT OF
THE ANTERIOR THORAX breath.

● increase in the anterior posterior diameter of

● Anteroposterior Dm Less Than
the chest wall resembling the shape of a
● The Transverse Dm (1 : 2) Anterior Posterior barrel
to Transverse should be 1 is to 2 that is the
normal ABNORMAL FINDINGS ON THE
ASSESSMENT OF THE BREATH
● Retraction Not Observed SOUNDS

● Rib Slope Downward, rib should not be Pectus Excavatum

sloping in a 90 Degrees Costal Angle

● Patient should be Relaxed, Effortless

● No Accessory Muscles Is Used

Lung Consolidation

● There should be no Air, Fluid or Blood

● There should be no pus in the lungs for it

because lung consolidation is the ● sunken sternum or funnel chest, it is inherited
accumulation of fluid and that is your pleural or could start to form the birth.
effusion
● It doesn’t cause any harm to the patient but it
● If there is air that is your pneumothorax causes self-consciousness
● When there is blood that is your hemothorax ● It is a congenital chest wall deformity in which
several ribs and the sternum grow
● And if there is pus or “nana” this is your pyro
abnormally, producing a concave, or caved-in
thorax and that would cause a long
appearance in the anterior chest wall.
consolidation

Abnormal Findings on
ABNORMAL FINDINGS
Assessing the Breath Sounds
Emphysema
Pectus Carinatum

● Breast bone protrudes in an outward position

● An abnormal size in the anterior, posterior
which should 1 is to 2 is what we call ● This is your forward protrusion of the sternum
hyperinflation or hyper inflamed that is what causing an adjacent rib to slow backward
we call your barrel chest
● Often this is also referred to as your pigeon’s
● Ribs appear to be horizontal that angle chest.
greater than 45 degrees, that is the cause of
emphysema and commonly seen with a
barrel chest
 ● One of the complications of one of the
Abnormal Findings on
Assessing the Breath Sounds categories of C or COPD is your emphysema
aside from the bronchitis this is the cause of
Barrel Chest barrel chest

● Configuration results in a more horizontal

position and coastal angle or more than 90
degree, or there is a hyperinflation.

● Commonly if a patient is a smoker and

develops COPD (Chronic Obstructive
Pulmonary Disorder)

Breathing Patterns

Abnormal Findings on Assessing the Breath Sounds

Pattern Condition Description

Eupnoea ● Normal Breathing Rate And

Pattern

● Normal respiratory rate of an

adult is 12 to 20 breath per
minute

● The patient is relaxed and not

using any accessories muscles

Tachypnoea ● Increase Respiratory Rate

● Above the normal rate of 12 to

20 breath per minute ex. 22 bpr
and Above

● A 21 bpr is the borderline so it is

not included

Bradypnoea ● Decreased Respiratory Rate

● Anything that is below 10 bpr

● Breathing is deep and shallow

Apnoea ● Absence of breathing

● Rapid and shallow breathing

Hyperpnoea ● Increased Depth And Rate Of

Breathing

Cheyne - ● Gradual Increases And

Stokes Decreases In Respirations With
Periods Of Apnoea

Biot’s ● Abnormal Breathing Pattern

With Groups/Clusters Of Rapid
Respiration Of Equal Depth And
Regular Apnoea Periods

● For three seconds or two


Kussmaul’s
Apneustic
Percussing for Tone
● It would determine abnormal findings
in any lateral aspect of the posterior
thorax.
● In the apices, which is above the
clavicle, in a downward motion
- Same manner in the
posterior thorax, start from
the left to right and going to
the opposite direction
- So that you would determine
the resonance and tone that
seconds the breathing is Within
the same rate the same depth
and the same manner and
pattern
● usually these are individuals
who are having your infections
● Tachypnoea And Hyperpnoea
● Most likely seen in a patient who
are having respiratory disorder
and a patient having a
deficiency in iron
● Prolonged Inspiratory Phase
With A Prolonged Expiratory
Phase
● here is also a period of the
sensation of breathing within a
second
is elicit over the normal
tissues.
- And determine for hyper
resources, which is elicit in
case of air trapping, dullness,
pleural effusion or tumor.
● Auscultate for Breath sounds,
Adventitious Sounds and Voice
Sound.