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Health Assessment Respiratory System - Coggle Diagram
Health Assessment Respiratory System
Anatomy of lung
Both lung divided in half by
Oblique ( majour) fissure
Left oblique fissure
Right oblique fissure
At 6th midclavicular line
Right lung further divided by
Horizontal (minor) fissure
4th rib to joining right oblique fissure at 5th rib at midaxillary line
Right lung
Upper
Middle
Better ausculated in anterior & posterior chest wall
Lower
Left lung
Upper
Lower
Apex of lung
Above clavicles
Posterior C7 on vertebral line
Base of lung
8th rib on midaxlliary line
Chest landmarks
Clavicle
Sternum
Suprasternal notch
Manubrium
Sternal angle (angle of Louis) [at 2nd rib]
Xiphoid process [at 6-7th rib]
Costal angle
Reference lines
Anterior axillary, Mid-axillary, Posterior axillary
Midsternal
Midclavicular
Scapular
Vertebral
History taking
Current respiratory problem
Shortness of breath
Difficulty breathing
Need to stay upright position to breathe
Rapid & shallow breathing
Cough
Past health history of respiratory disease
Asthma
Bronchitis
Pneumonia
Lifestyle
Smoking
Alcohol
Exercise
Environment exposeure
Pollutants
Self care behaviours
Chest X-ray
TB skin test
Influenza vaccine
Cough +/- sputum
Color
Consistency
Amount
Chest pain
Family history
allergies
asthma
tuberculous
Lung cancer
Physical examination
Compare one side of thorax & lung to another side
Inspection->Palpate->Percuss->Auscultate
[ IPPA ]
Inspection
Facial expression & position in breathing
Relaxed posture / Tripod position [leaning foward]
Signs of respiratory difficulty
Color [ skin, lips, nail beds]
Neck & fingers [clubbing]
Clubbing
Enlarged fingertips and loss of the normal angle at the nail bed
Normal angle
160
Clubbing
180 [180 -> early clubbing]
Early clubing
1 more item...
Normal: nail adheres to the nail bed, nail base is firm to palpate
Use of accessory muscles
listen to breathing
Rate, rhythm, depth, regularity & effort of breathing
Respiration rate
Chest size and shape
Normal
Posterior & anterior chest with symmetric thorax, elliptical shape with downward sloping ribs
Anteroposterior diameter : Transverse diameter ratio = 1:2
Abnormal
Barrel chest
Increased anteroposterior diameter : transverse diameter to 1:1
Pigeon chest
Narrowed transverse diameter, increased anteroposterior diameter with protuding sterum
Funnel chest
Sternum decompressed, narrowing the anteroposterior diameter
Spine
Normal
Spine vertically aligned
Abnormal
Kyphosis
Excessive curvature of the thoracic spine
Lordosis
Excessive curvature of the lumbar spine, common in children < 5
Scoliosis
Lateral deviation of the spine
Palpation
Chest wall
Tenderness
Skin temperature
Superficial lumps & masses
Skin lesions
Principle
Systematic palpation
entrie chest wall
Anterior, posterior, lateral chest wall
Warm & clean hands
Keep warm
Provide privacy & safe
Trachea
Position
At midline directly above the suprasternal notch
Spacr above to the inner borders of the sternomstoid muscle should be equal on both sides
Chest expansion
Confirm symmetric chest expension
At anterior 5-6 th ribs, posterior 10th ribs
Unequal chest expansion
Pnumonia, Thoracic trauma [fractured ribs/ peumothorax]
Tactile Fremitus [ninety-nine/ 55]
Palpate vibration of the chest wall that result from speech
Symmetric
Various fremitus in healthy people
Relative location of bronchi to the chest wall
Thickness of chest wall
Pitch and intensity of the voice
Best felt posteriorly at 2nd/ 3rd ICS
Increased fremitus
Compression/ consolidation of lung tissue
Lobar pneumonia, pulmonary fluid,
copious bronchial secrections, mass, tumour
Decreased fremitus
Obstructs transmission
Obstructed bronchus, pleural effusion/ thickening, pneumothorax, emphysema, infection, edema
Percussion
Principle
Provide privacy & warm
Anterior, Posterior, Lateral chest wall
Systematic
Side-to-side comparison
Sound
Resonance
Normal lung tissue in adult
Hyperresonance
Normal in children
Abnormal in adult, too much air filled in lung
Emphysema, pneumothorax
Dull
Abnormal density in lung
Pneumonis, pleural effusion, tumor
Diaphragmaic Excursion
Equal bilaterally, 3-5cm
High level of dullness/ absence of excersion
Pleural effusion
Auscultation
Breath sound
Bronchovesicular breath sound
Morderate pitch, morderate amplitude, Inspiration=Expiration, Mixed
Normally located at majour bronchi, posterior-> between scapular, anterior->around upper sternum in the 1st & 2nd ICS
Vesicular breath sound
Low pitch, Soft, Inspiration>Expiration, Rustling like the sound of the wind in the trees
Normally located at peripheral lung fields, air flow through small bronchioles & alveoli
Bronchial breath sound
Normally located at Trachea & Larynx
High pitch, Loud, Inspiration>Expiration, Harsh, hollow tubular
Decresed/ absent
Obstructive bronchial tree
Secretion, foreign body
Loss of elasticity in lung fibers, decreased force of inspired air
Emphysema
things obstructing transmission of sound between the lung and stethoscope
Pneumthorax, pleural effusion
Increased
Consolidation
Pneumonia with consolidation
Adventitous Breath Sound
Crackles (Rales, crepitation)
Non-musical noises
Occur in inspiration, small airways
Cause by fuild filled in alveoli
Pulmonary edema/ pneumonia
Rhonchi
Low pitched musical and continous noises
Normally in expiration, large airway [bronchioles & bronchi]
Cause by air passing through large airway with constriction, narrowing, spasm [due to secretion, swelling, tumors]
Secretions in large bronchi, asthma, bronchitis, bronchospasm
Wheezes
Stridor
Pleural friction rubs
Thorax
Assess air flow through the tracheobranchial tree
With precussion, helps to assess the condition of the surrounding lungs and pleural space
Use diaphragm, ask client to breathe deeply through an open mouth
Compare symmetric, avoid scapula
Listen at least one full breath in each location
Voice sound
Bronchophony
Egophony
Whispered Pectoriloquy
Examine in
sitting position