NCM 120 - HEALTH ASSESSMENT

CARDIOVASCULAR SYSTEM
Assessing the Heart, Central Vessels, and
Peripheral Vascular System
BY: DAX E. SENDRIJAS

ANATOMY OF THE HEART PATH OF BLOOD FLOW THROUGH

THE HEART

4 CHAMBERS OF THE HEART

 CORONARY SINUS SINOATRIAL NODE(SA NODE) - generates an
electrical signal that causes the upper heart
chambers(Atria) to contract.
ATRIOVENRICULAR NODE(AV NODE) - connects
electrical systems of the atria and the ventricles,
providing electrical impedance from the atria and an
intrinsic pacemaker in its absence.
BUNDLE OF HIS - quickly transmits the impulse to
the left and right bundle branches and into the
ventricles, resulting in a synchronized contraction of
the ventricles.
LEFT AND RIGHT BUNDLE BRANCHES - conducts
impulses into the left and right ventricles.
PURKINJE FIBERS -plays an important role in
electrical conduction and propagation of impulse to
Coronary Sinus - is the largest vein of the the ventricular muscle.
heart; it drains over half of the deoxygenated BACHMANN'S BUNDLE - a band of bundles
blood from the heart muscle into the right traversing the left atrium, curving posteriorly within
atrium. the inter-atrial septum and reaching the crest of the
AV node.
FUNCTIONS OF THE HEART

Keeps the 02-poor blood separate from the 02

rich blood.
Keeps the blood flowing in one direction; blood
flows away and then back to the heart in each
circuit.
Creates blood pressure, which moves the
blood through the circuit.
Regulates the blood supply based on the
current needs of the body.

CONDUCTION SYSTEM OF THE HEART

CARDIAC OUTPUT

Is the amount of blood pumped by the

ventricles by a given period of time (usually 1
minute) and is determined by the stroke
volume (SV) multiplied by the heart rate (HR)
= CO.

CARDIAC OUTPUT
Normal cardiac output is 4 to 6 liters/minute
Cardiac output (CO)= (Heart rate (HR)
bpm)(Stroke Volume (SV) ml/beat)
ml/min
Normal range of HR and SV
CO = (70bpm)(70ml/beat) = 4900ml/min
HEALTH HISTORY
General Health History
PRESENT HEALTH STATUS
Do you have chronic diseases such as DM, -Diet? Alcoholic drinks? Cocaine or street drugs?
Renal failure, Chronic Hypoxemia or Caffeinated drinks? Smoke?
Hypertension? If yes, describe.
Are you taking any medications? If yes, what PROBLEM-BASED HISTORY
are you taking? Have you had any adverse
effects?
(Anti depressants, Phenothiazine, Lithium and
Ophylline- Tachycardia and Dysrhythmias;
contraceptives- Thrombophlebitis;
Corticosteroids- Na and water retention)
What OTC do you take? Herbs? How
often?
(Aspirin- Blood thinner; Decongestants-
aggravate hypertension; Ayurvic Herbs- Cardiac
Stimulant; other cardiac-depressants)
PAST HEALTH HISTORY
As a child did you have congenital heart
disease or heart defect?
During childhood, did you experience any
"growing pains" (unexplained joint pains)?
Rheumatic fever? Heart Murmur?
Have you been told that you have high levels
of cholesterol or elevated triglycerides?
Have you ever had surgery on your heart?
Blood vessels? If so, which procedure was
done? How successfu was the surgery?
Have you ever had any test on your heart ?
What was the result? Any treatment did you
receive?
FAMILY HISTORY
Does any in your family have history of DM,
CVD, Hyperlipedemia or Hypertension?
Personal and Physiological History
-Do you exercise? What kind? How often?
-How do you describe your personality type? How
do you deal with stress?
-How often do you take time to relax? Hobbies?
Sports? Meditation? Yoga? Music?
Subjective Data:
1. Assessment of chief complaints:
Chest pain: location, quality, duration, and
associated symptoms.
Irregular heart beat: too fast, jump, etc.
Shortness of breath
Cough
Urinating during the night
Fatigue
 Subjective Data:
1. Assessment of chief complaints:
Fainting
Swelling of extremities
Leg cramps or pain - Arterial insufficiency -
Intermittent claudication or rest pain; Venous Palpation (supine position)
insufficiency
2. Assessment of risk factors:
Ask about history of hypertension, diabetes, and
rheumatic fever.
Ask about family history of heart attack,
hypertension, stroke, and diabetes.
Describe your nutritional intake: High cholesterol, relation to mid-sternal, mid-clavicular, or axillary
triglyceride level.
Do you smoke? How much? And for how long?
How do you view yourself? What do you do to
relax?
How many hours a day do you work? How do
you cope with stress?
Exercise: What do you do for exercise? How
often?
Pain in calves, feet, buttocks or legs? What
aggravates the pain? (walking, sitting for long
periods, standing for long periods, sleep) What
relieves the pain? "Elevating legs, rest, lying Percussion: "not used in cardiac assessment"
down".
In what type of chair do you usually sit on?
Does he/she cross legs frequently?
INSPECTION
Observe the patient for general appearance, skin
color and breathing effort.
-Client must be in supine or sitting position
according to his health.
By inspection and palpation you may detect
ventricular hypertrophy.
Use source of light to inspect subtle movements
in chest e.g.: pulsation, retraction, etc. (jugular
vein distentions) if so, may indicate right sided
heart failure.
Apical pulse in left fifth intercostal space,
if deviation in site observed may indicate
cardiac enlargement 6th intercostal space.
Retractions may be seen around the site of
apical pulse, marked retraction may indicate per
PALPATION
Palpate from apex, moving to external border to
base.
Detect abnormalities in site of palpation and
abnormal sounds especially for the thrill
"abnormal flow of blood"
Describe in terms: locations of pulsation in
lines.
Palpation of apical pulse, strength differs from
thin person to obese.
Conditions such as anxiety, anemia, fever, and
hyperthyroidism may increase in force and
duration of apical pulse (you feel lifting sensation
under your fingers).
Palpation of pulse at base of the heart
(putting your hand at the second left
intercostal space at sternal borders).
AUSCULTATION
All heart sounds are generally low pitched "low
frequency" and difficult for the human ear to hear.
Auscultation can be started from base of apex to the
base.
Assess:
Rate and rhythm of the heart beat.
Concentrates initially on sound "1", noting its intensity
and variations, possible duplication and effects of
respiration.
Sound 1 caused by the closing of the tricuspid and
mitral valves.
Systole begins with sound "1" and extends to sound
"2".
Then listen to sound "2" for same characteristics.
Sound "2" results from closing of the aortic and
pulmonary valves
Diastole begins with sound "2" and extends to the next
sound "1".
Sound "2" louder than sound "1" at the base of the
heart, and is lighter than sound "1" at the apex.
Finally listen for extra sounds and NECK VESSELS
murmurs
Sound "3" : During diastole, a rapid filing
and distention of ventricles occur causes
vibrations of ventricular walls and this is
known as sound "3". Sound "3" best heardat
the apex of the apex with the bell of the
stethoscope. It indicates Pathological
alterations in vantricular filling in early
diastole. It represents a normal finding in
children.
Sound "4" : Occurs after sound "3" (late
diastolic filling), occur from vibrations of
ventricular wall or vibrations of the valves. It
is usually associated with cardiac disease,
often with altered ventricular compliance.
Gallop Sound : A gallop characterized by
INSPECTION
the superimposition of abnormal third and
fourth heart sounds, usually indicative of The jugular venous pulse is not normally visible
myocardial disease. with the client sitting upright.
Heart Murmurs : (abnormal sounds The jugular vein should not be distended, bulging,
produced by vibrations within the heart or in or protruding at 45 degrees or greater.
the walls of large vessels during "systole or
diastole"). Murmurs occurrence result from ABNORMAL FINDING:
valve defects, changes in the blood vessels Fully distended jugular veins with the client's torso
or an increased flow of blood through normal elevated more than 45 degrees indicate increased
structure (eg, with fever, pregnancy, central venous pressure.
hyperthyroidism). RIGHT VENTRICULAR FAILURE, PULMONARY
HYPERTENSION, PULMONARY EMBOLI, OR
CARDIAC TAMPONADE.

AUSCULTATION AND PALPATION

NORMAL:
No blowing or swishing or other sounds
heard.
Pulses are equally strong; A 2+ or normal with
no variation in strength from beat to beat.
Contour is normally smooth and rapid on the
upstroke and slower and less abrupt on the
downstroke.
Arteries are elastic and no thrills are noted.
 AUSCULTATION AND PALPATION NORMAL FINDINGS

NORMAL: Heart rate should be 60-100 beats/min, with

regular rhythm
PULSE AMPLITUTED SCALE: Radial and Apical pulse rates should be identical.
0 = ABSENT S1corresponds with each carotid pulsation and is
1 = WEAK loudest at the apex of the heart. S2 immediately
2 = NORMAL follows after S1 and is loudest at the base of the
3 = INCREASED heart.
4= BOUNDING

ABNORMAL :
A bruit, blowing or swishing sound through a
narrowed vessel (Indicative of Occlusive Arterial
Disease)
Pulse inequality (Arterial Constriction or Occlusion
in one carotid)
A bounding, firm pulse (Hypovolemia, Shock,
Decreased Cardiac Output)
A delayed upstroke (Aortic Stenosis)
Loss of elasticity, thrills (Arteriosclerosis)

HEART (PRECORDIUM)
The region or the thorax immediately in front of the
heart.

INSPECTION

The apical impulse (PMI) may or may not be visible

PALPATION

The apical impulse is palpated in the mitral area

and may be the size of a nickel (1-2 cm). 2cm -
25 centavo coin.
No pulsations or vibrations in the areas of the
apex, left sternal border or base.

ABNORMAL FINDINGS
Enlarged ventricle from overload of work.
A thrill which feels similar to a purring car.
Grade IV or higher murmur.
Bradycardia (less than 60 beats/min) or
Tachycardia (more than 60 beats/min) may result
in decreased cardiac output.
A pulse deficit may indicate atrial fibrillation, atrial
flutter, premature ventricular contractions and
varying degrees of heart block.
Accentuated, Diminished, Varying, or Split S1.
 NCM 120 - HEALTH ASSESSMENT
PERIPHERAL SYSTEM
Assessing the Peripheral Vascular System
BY: DAX E. SENDRIJAS

ARMS ABNORMAL FINDINGS:

INSPECTION
Brachial pulses are increased, diminished
NORMAL FINDINGS: or absent.
Enlarged Epitrochlear lymph nodes.
Arms are bilaterally symmetric with minimal Pallor persists with Allen's test.
variation in size and shape.
LEGS
No Edema, no prominent venous patterning.
Color should be the same bilaterally. INSPECTION
NORMAL FINDINGS:
ABNORMAL FINDINGS:
Pink color for lighter skinned clients and pink or
Lymphedema results from blocked lymphatic red tones visible under darker skinned clients.
circulation. No changes in pigmentation.
Prominent venous patterning with edema. Hair covers the skin on the legs and dorsal
(Venous obstruction) surface of the toes.
PALPATION Free from lesions or ulcerations.
Identical size and shape bilaterally; no swelling
NORMAL FINDINGS: or atrophy.

Radial pulses are bilaterally strong 3+, artery ABNORMAL FINDINGS:

walls have a resilient quality.
ULNAR PULSES MAY NOT BE DETECTABLE. Pallor, especially when elevated.
BRACHIAL PULSE HAVE EQUAL STRENGTH Rubor, when depended, cyanosis, rusty or
BILATERALLY. brownish pigmentation around ankles.
EPITROCHLEAR LYMPH NODES ARE NOT
PALPATION
PALPABLE.
PINK COLORATION RETURNS TO THE PALMS
NORMAL FINDINGS:
WITHIN 3-5 SECONDS IF THE ULNAR ARTERY
No edema present.
AND RADIAL ARTERY IS PATENT.
Toes, feet, and legs are equally warm
bilaterally.
ABNORMAL FINDINGS:
Contender, movable lymph nodes up to 1 or
even 2 cm are commonly palpated.
Increased radial pulse volume, diminished or
Femoral pulses strong and equal bilaterally.
absent.
No sounds auscultated over the femoral
Obliteration of pulses.
arteries.
Lack of resilience or elasticity.
Not unusual for popliteal pulse to be difficult to
detect, and yet for circulation to be normal.
 LEGS
PALPATION
ABNORMAL FINDINGS:
PITTING EDEMA
DORSALIS PEDIS AND
POSTERIOR TIBIAL PULSE

NORMAL FINDINGS:
Dorsalis pedis pulses are bilaterally strong
Posterior tibial pulses should be strong SPECIAL MANEUVERS FOR VASCULAR
bilaterally. ASSESSMENT
Veins are flat and barely seen under the
Check for deep phlebitis by quickly squeezing calf
surface of the skin.
muscles against tibia (normally no pain).
Check Homan's sign by extending leg and dorsiflexing
foot (normally no pain).

HOMAN'S SIGN
NORMAL FINDINGS:
No pain or tenderness (negative sign).

ABNORMAL FINDINGS:
Calf pain and tenderness(positive sign).

ABNORMAL FINDINGS:
Absent or weak femoral pulses.
Bruits.
A weak or absent dorsalis pedis pulse may
indicate impaired arterial circulation.
A weak or absent posterior tibial pulse
indicates partial or complete arterial occlusion.
Varicose veins may appear as distended,
nodular, bulging, and tortuous, depending on
severity.
 NCM 120 - HEALTH ASSESSMENT
RESPIRATORY SYSTEM
Assessing the Thorax and Lungs
BY: DAX E. SENDRIJAS
 THORACIC CAVITY

Mediastinum middle of the thoracic cavity and

contains Esophagus, Trachea, Heart, and Great
Vessels.
Pleural Cavities on either side of the mediastinum
contain the lungs.

POSTERIOR THORACIC LANDMARKS

Vertebral Prominens - Flex head, feel most
prominent bony projection at the base of the
neck = C7 next lower one is T1
Spinous Processes - Spinal Column
Scapula - Symmetrical, lower tip at the 7-8th rib.
12th rib = midway b/t spine and side

THORACIC REFERENCE LINES

ANTERIOR CHEST

ANTERIOR THORACIC LANDMARKS

Suprasternal Notch - U shaped depression.
Sternum - "breast bone" = 3 parts
1. Manubrium
2. Body
3. Xiphoid Process
Angle of Louis - manubriosternal angle
continuous with the second rib.
Costal Angle - usually 90 degrees or less.
(increases when the rib cage is chronically
overinflated).
POSTERIOR CHEST LUNG BORDERS

ANTERIOR CHEST
Apex 3-4cm. ^ inner 1/3 of the clavicles.
Base - rests on the diaphragm, 6th rib, MCL.
LATERAL CHEST
Extends from Axilla apex to 7th-8th rib.
POSTERIORLY
Apex of lung is at C7 - Base T10 (on deep
inspiration of T12)

Vertebra Prominens - Spinous process of C7.

Vertebral line mid spinal.
Scapular line.
LOBES OF THE LUNG
LATERAL CHEST
Diagonal sloping segments.
Oblique fissures.

RIGHT LUNG
3 Lobes, Upper, Middle, Lower.
Shorter due to liver.
LEFT LUNG
LUL = Left Upper Lung
LLL = Left Lower Lung
Narrower due to the Heart.

2 IMPORTANT POINTS
Anterior chest contains upper and middle lobes
very little lower lobe.
Posterior chest has almost all lower lobe. Rt
middle lobe does not project into the posterior
chest.
Anterior Axillary Line.
Posterior Axillary Line.
Mid-Axillary Line.
 PLEURAE
The pleurae forms an envelope between the
lungs and chest wall
Visceral Pleura - Lines outside of lungs.
Parietal Pleura - Lines inside of chest wall and
diaphragm.
Pleural Cavity - The inside of the envelope -
space b/t visceral and parietal pleura, lubrication. NORMAL RANGE VALUES OF ARTERIAL BLOOD
Normally has a vacuum or negative pressure.
TRACHEA AND BRONCHIAL TREE
Trachea - Anterior to the Esophagus .
10-11cm long, begins at cricoid cartilage.
Bifurcates just below the sternal angle (AKA
the angle of Louis, manubriosternal angle) into
the...
Right Main Stem Bronchus - Shorter, wider,
more vertical (Intubation - Listen to breathe
sounds bilaterally)
Left Main Stem Bronchus
Bronchi
Secretes Mucus - Captures Particles
Cilia - Moves the trapped particles up to be
expelled or swallowed.
Acinus
Functional respiratory unit
Bronchioles, Alveolar ducts, Alveolar sacs, and
Alveoli.
Gaseous exchange in Alveolar duct and Alveoli.
MECHANISMS OF RESPIRATION
4 MAJOR FUNCTIONS OF THE RESPIRATORY
SYSTEM
Supply O2 for energy production .
Remove CO2, waste product of energy reactions.
Homeostasis, acid-base balance of arterial blood.
Heat exchange
Respiration maintains pH (Acid-base balance) of
blood by supplying 02 and eliminating CO2.
GASES
pH = 7.35-7.45
Pa CO2(partial pressure) = 35-45 mmHg
PaO2 = 80-100 mmHg
SaO2 (oxygen saturation) = 94-98%
Lungs help to maintain the pH balance by
adjusting the amount of CO2 through:
HYPERVENTILATION
HYPOVENTILATION
HYPERVENTILATION
SIGNS AND SYMPTOMS
Tingling and numbness in the hands and around
mouth
Deep, rapid respiration with rapid pulse.
Marked anxiety, escalating to panic.
Dizziness, syncope.
Fingers and Hands drawn to a claw like spasm.
TREATMENT
Try to calm and reassure.
Explain to the casualty what is happening.
Slow the breathing by mimicking the breathing.
Administer oxygen.
 While infant is sleeping, can inspect and
auscultate the lungs.
Infants have a normally rounded thorax, reaching
1-2 (anteroposterior to transverse) diameter by
the age of 6.
If barrel shape persists after age 6, possible
chronic asthma or cystic fibrosis.
If baby begins to cry, it actually enhances the
palpation of tactile fremitus.

PREGNANCY
The enlarging uterus elevates the diaphragm 4
cm during pregnancy, but the increased estrogen
relaxes thoracic ligaments allowing
compensation by increasing the transverse
diameter.
Mother's tidal volume increases to meet
demands of the fetus.
Physiologic Dyspnea.
Wider Thoracic cage.

AGING
Kyphosis
Calcification of costal cartilage.
Decreased vital capacity.
CONTROL OF RESPIRATION Decreased number of alveoli.
Involuntary control by respiratory center in the Decreased mucous production.
brain stem consisting of the Pons and Medulla.
Hypercapnia is an increase in CO2 in the blood
and provides the normal stimulus to breathe.
Hypoxemia

DEVELOPMENTAL COMPETENCE

INFANTS AND CHILDREN

When cord is cut, blood is cut off from the
placenta and rushes into pulmonary circulation.
Due to less resistance in pulmonary arteries, the
foramen ovale closes, along with ductus
arteriosus.
Newborn chest is round and consistent with
head size until approx. 2 years of age.
Newborns use the diaphragm and abdominal
muscles for respiratory effort.
Lungs grow until about 300 million alveoli in
adolescence.
 Characteristics:
GENERAL HEALTH HISTORY
Yellow or Green - bacterial infection
Present health status Rust colored - TB, Pneumonal
Chronic Illness Pneumonia.
Allergies Pink, Frothy - Pulmonary Edema,
DOB with activities, at rest or lying flat Medications?
Taking meds for respiratory disorder
Using oxygen at home Cough up blood?
Description of cough - Dry, Hacking
PAST HEALTH HISTORY Aggravating and Alleviating Factors
Painful? Severity
Had problems with lungs or breathing.
Had been diagnosed with respiratory
Shortness of breath (SOB)
disease such as asthma, chronic
bronchitis, cystic fibrosis, emphysema,
Onset, Associative factors
lung cancer or pneumonia
Determine how much activity
Had injury to the chest or surgery.
percipitates SOB
FAMILY HISTORY Affected by position?
Orthopnea - difficulty in breathing
Family history of lung disease. when supine (heart failure?)
Personal and Psychosocial history - Time of the day/night
smoking history. Paroxysmal Nocturnal Dyspnea -
Home Environment - Air pollution, pets, Awakening from sleep with SOB and
type of heating or air conditioning, needing to be upright to achieve
hobbies, second and third hand smoke comfort.
exposure, radon (gas from rocks or Allergies?
dirt). Asthma attacks
Occupational Environment - Asbestos, Alleviating Factors
Paint fumes, Vapors, etc.
Travel ASSESSMENT - INSPECTION

PROBLEM BASED HISTORY

Inspect Thorax
Cough
Onset, Gradual or sudden, Frequency?
Continuous throughout the day - acute
illness (respiratory infection)
Afternoon/Evening - May reflect
exposure or irritants at work.
Night - Postnasal drip, sinusitis
Early Morning - Chronic Bronchial
inflammation of smokers.
Sputum? How much? Characteristics?
Chronic Bronchitis - Productive cough
for 3 months of the year for 2 years in a
row.
Characteristics:
White clear mucoid - colds, viral
infection, bronchitis
Symmetry and configuration.
AP diameter
Normal 1:2 to 5:7
Note position of person to breathe.
Orthopnea COPD - Tripod position;
Sitting position.
Skin color and Condition, Nail color
AP diameter - Transverse diameter,
"barrel chest", chronic emphysema,
and asthma.
Symmetry and normal development of
trapezius muscle.
Hypertrophied in COPD
 GENERAL - INSPECTION

ABNORMAL FINDINGS

NASAL FLARING, CYANOSIS, NAILS

GENERAL - INSPECTION

NORMAL FINDINGS
 PALPATION

Symmetric Chest Expansion

Place warmed hands on posterolateral chest
wall with thumbs at level of T9 or T10.
Slide hands medially to pinch up a small fold of
skin between thumbs.
Ask person to take a deep breath.
As person inhales, the thumbs should move
apart symmetrically.
Unequal chest expansion occurs with
atelectasis, pneumonia, thoracic trauma.
Pain accompanies deep breathing when
pleurae are inflamed.

Entire Chest Wall - Note to gently palpate.

Tenderness, skin temp., moisture, lumps,
lesions.

Client reports no tenderness, pain, or unusual

sensations.
Temperature should be equal bilaterally.
No palpable crepitus.
No lesions and masses.
Normal chest expansion (should move 5-10 cm
apart symmetrically). ABNORMALITIES IN FREMITUS
Fremitus is symmetric and easy to identify.
DECREASES FREMITUS - Occurs when anything
TACTILE FREMITUS obstructs transmission of vibrations.
Fremitus is palpable vibration transmitted Obstructed bronchus
through patent bronchi and lung parenchyma to Pleural effusion or thickening
the chest wall where they can be felt as Pneumothorax
vibrations. Emphysema
Place either palmar base of ulnar edge of one of
the hands on the person's back and ask to INCREASED FREMITUS - Occurs with compression
repeat "ninety-nine" or "blue moon" Start at lung or consolidation of lung tissue.
apices and palpate from one side to another. Lobar Pneumonia
Symmetry is most important.
Normally, fremitus most prominent between RONCHAL FREMITUS - Palpable with thick
scapulae and decreases as you progress down. secretions

Unequal Fremitus
Diminished Fremitus
Consolidation, Bronchial Obstruction,
Emphysema
Unequal Chest Expansion
Crepitus - Is a coarse crackling sensation (like
bones or hairs rubbing against each other).
 PERCUSSION
Start at the apices and percuss across
tops of both shoulders and down the
lung region at approximately 5 cm
intervals.
Make a side to side comparison.
Avoid damping effect of scapulae and
ribs.
Resonance percussion tone elicited
over normal lung tissue.
ABNORMALITIES
HYPERRESONANCE - Is elicited in
cases of trapped air. Emphysema or
Pneumothorax.
DULLNESS - is present when fluid or
solid tissue replaces air in the lungs or
occupies the pleural space. Lobar
Pneumonia, Pleural Effusion or Tumor.
DIAPHRAGMATIC EXPANSION
Lower lung borders in expiration and
inspiration.
1st Exhale and hold - percuss down the
scapulae line until sound changes from
resonant to dull. Mark with marker.
Estimates the level of diaphragm separating
the abd cavity. May be higher on Rt. Due to
liver.
Now take a deep breath and hold.
Percuss from mark to dull sound and mark.
Measure the difference. Should be +
bilaterally 3-5 cm in adult; may be 7-8 cm in
well conditioned person.
Note, hold your own breath when
conducting the test.
AUSCULTATING POSTERIOR CHEST
BREATH SOUNDS
Instruct the person to breathe through
the mouth a little deeper than usual, but
to stop if they feel nauseous.
Use the flat diaphragm end piece of the
stethoscope and listen for at least one
full respiration in each location.
Continue to think of:
What am I hearing?
What should I expect to be hearing?
Do not confuse background noise with lung
sounds
Stethoscope tubing bumping together.
Shivering
Hairy Chest
Rustling of gown
NORMAL FINDINGS:
BRONCHIAL - Anterior Chest only = over
trachea and larynx
Quality = harsh, hollow, tubular
Inspiration<Expiration
Amplitude = Loud
BRONCHOVESICULAR - Over major
bronchi, posterior b/t scapulae, anterior
upper sternum, 1st and 2nd ICS
Pitch = High
Inspiration = Expiration
Moderate amplitude
VESICULAR - Anterior and posterior
Quality = rustling, wind in trees
Inspiration>Expiration
Soft amplitude
 ABNORMALITIES:

ABNORMALITIES:
Discontinuous Lung Sounds:
Extra sounds heard less than 0.2 seconds during
Decreased or Absent Breath Sounds
a full respiration cycle.
Obstruction of the bronchial tree by secretions,
Voice Sounds normal voice transmission is soft,
mucous plug, F.B
muffled and indistinct.
Decreased lung elasticity, Emphysema =
Pathology that increase lung density makes words
Lungs hyper inflated.
clearer
Pleurisy, Pleural thickening, Pneumothorax (air),
Bronchophony - "99" sounds as if the patient is
Pleural effusion (fld.) in the pleural spaces.
directly talking into the stehoscope.
Increased Breath sounds
Egophony - ee-ee-ee if disease sounds like loud
Dense lung tissue enhances sound
aa-aa-aa Record as "E>A changes"
transmission as in consolidation ie. pneumonia.
Whisper pectoriloquy 1-2-3 sounds loud and
Silent Chest
clear as if patient is directly talking into the
Ominous
stethoscope.
ANTERIOR CHEST

INSPECT

Shape and Configuration

Expression - relaxed
LOC - alert and cooperative
Skin color and condition
Quality of Respirations - reg and even, no
retraction or use of accesory muscles.
 NORMAL Pattern = breathing rhythm. Normal
respirations are regular and even.
Cheyne - stokes = resp wax and wane in reg
pattern with periods of apnea(20 seconds).
Biot's or ataxisic - similar to Cheyenne - stokes
but pattern irreg.

Depth - on inspiration the normal depth is non-

exaggerated and effortless.
Shallow
Sighing - purposeful to expand the alveoli

RESPIRATORY PATTERNS Symmetry - bilateral rise and fall of the chest with
respiration.

NORMAL
Audibility - normally be heard by the unaided ear
several centimeters from the patient's nose/mouth
Relaxed, Effortless, and Quiet
Patient position - healthy person breathes
Regular rhythm and normal depth
comfortably in supine, prone, or upright position
Normal rate of 16-20 breaths/minute
Orthopnea
No retractions or bulging of intercostal
spaces are noted.
Mode of breathing - normally inhale/exhale through
nose
ABNORMAL

Sputum
Labored and noisy breathing
Sample
Tachypnea
Color
Bradypnea
Mucoid, clear, yellow/green, rust/blood tinged,
Hyperventilation
black, pink
Hypoventilation
Odor
Cheyne's Stokes Respiration
Amount
Consistency