1. Denise Coffey MSN, RN

2. Respiratory Assessment Structure and Function Subjective Data—Health History Questions Objective Data—The Physical Exam Abnormal Findings

3. Anterior Thoracic Cage Slide 18-3

4. Posterior

5. Reference Lines Midsternal line Midclavicular line Scapular line Vertebral line Anterior, posterior, midaxillary lines

6. Reference Lines Anterior

7. Reference Lines Posterior

8. Lateral

9. Structure and Function Thoracic cavity Mediastinum defined Lobes of the lungs Anterior Posterior Lateral Pleurae Trachea and bronchial tree Location of trachea and bronchi Dead space

10. Structures of the Respiratory System

11. Mechanics of Respiration Four functions of respiratory system Changing chest size during respiration Inspiration Expiration Control of respiration

12. Mechanics of Respiration

13. Subjective Data What would you want to know?

14. Subjective Data Cough Shortness of breath Chest pain with breathing History of respiratory infections Smoking history Environmental exposure Self-care behaviors

15. Objective Data- The Physical Exam Preparation Position Draping Timing during a complete examination Cleaning stethoscope endpiece Equipment needed Stethoscope Small ruler marked in centimeters Marking pen Alcohol swab

16. Objective Data- The Physical Exam Posterior Chest—Inspect Thoracic cage Shape and configuration of chest wall Anteroposterior/transverse diameter Position of person Skin color and condition

17. Objective Data- The Physical Exam Posterior Chest—Palpate Symmetric expansion Tactile (or vocal) fremitus Technique Factors that affect normal intensity of tactile fremitus Palpate the entire chest wall Posterior Chest—Percuss Predominant note over lung fields Diaphragmatic excursion

18. Objective Data- The Physical Exam Anterior Chest—Palpate Symmetric chest expansion Tactile fremitus Palpate the anterior chest wall Anterior Chest—Percuss Predominant note over lung fields Borders of cardiac dullness

19. Objective Data- The Physical Exam Anterior Chest—Auscultate Breath sounds Abnormal breath sounds

20. Objective Data- The Physical Exam Anterior Chest—Auscultate Breath sounds Abnormal breath sounds

21. Expected Breath Sounds Breath sounds Technique Bronchial breath sounds—characteristics Bronchovesicular breath sounds— characteristics Vesicular breath sounds—characteristics

22. Abnormal Breath Sounds Rhonchi Wheezes Crackles Stridor Croup Pleural friction rub

23. Listen http://www.youtube.com/watch?v=NnuaHGW1cwU

24. Measurement of Pulmonary Function Pulse ox ABGs Pulmonary Function Tests

25. Abnormal Findings Barrel chest Scoliosis Kyphosis

26. Barrel Chest

27. Scoliosis

28. Kyphosis Slide

29. Abnormal Findings Common Respiratory Conditions Atelectasis Lobar pneumonia Bronchitis Emphysema Asthma (reactive airway disease) Pleural effusion thickening Congestive heart failure Pneumothorax Pneumocystis carinii pneumonia Tuberculosis Pulmonary embolism Acute respiratory distress syndrome (ARDS)

30. Interventions Ambulation Incentive Spirometer ( IS) Repositioning Coughing and Deep Breathing Medications Education

31. Case scenario You are caring for Mrs. Brown, a 75-year-old retired school teacher who underwent repair of a right fractured femur. This is her first postoperative day on your clinical unit. Upon auscultation of her posterior lung field bases, you hear a crackling noise upon inspiration. What is this sound, and what does it indicate?