Explain the examination of the thorax (Inspection, Palpation, Percussion, Auscultation), to include the significance of specific alterations.
- a. Inspection: The patient should be sitting upright to allow the examiner to adequately observe the anterior, lateral, and posterior aspects of the thorax. The chest should be inspected for scars, radiation marks, or trauma.
- i. Barrel chest refers to the dramatic increase in AP diameter of the chest in some COPD patients
- b. Palpation: Involves touching the chest wall of a patient in order to determine chest expansion and the degree of tactile fremitus. Although palpation is not a routine part of every patient assessment, it can be helpful in quantifying the degree of impairment involved in certain disease processes.
- c. Percussion: Also used to assess the ratio of air to lung tissue via the transmission quality of sound waves created by striking the patients chest wall with ones fingertip.
- d. Auscultation: Performed to identify normal and abnormal heart and lung (breath) sounds using a conventional stethoscope. Chest auscultation can provide the examiner eith essential information regarding the status of the airways and the lung parenchyma.
Explain the term tactile fremitus and conditions that increase the ratio of air to lung tissue.
- a. Tactile fremitus is a technique where the examiner paces their fingertips or ulnar surface of the hand or fist on the anterior and posterior surfaces of the chest wall in a systematic order as the patient repeats a number. The tactile sensataion felt by the examiner form the vibrations caused by the patients phonation is referred to as fremitus.
- i. Air is a poor transmitter of sound waves and resultant vibrations, whereas solid substances tend to enhance transmission.
- 1. Conditions that increase the ratio of air to lung tissue:
- a. Pneumothorax
- b. Emphysema
List the 3 components of the Glasgow coma scale (Table 5-6).
- a. Eye opening
- b. Verbal response
- c. Motor response
List the body systems inspected during the physical examination.
- a. Vital signs
- b. Head
- c. Ears
- d. Eyes
- e. Nose
- f. Neck
Explain E-a egophony and whispered pectoriloquy and the breath sounds they are associated with.
- a. E-a egophony: An audible “A” sound when the patient says “E”.
- i. Associated with consolidation
- b. Whispered pectoriloquy: Refers to a distinct increase in transmission of vocal sounds associated with early pneumonia, pulmonary infarction, or atelectasis.
Explain digital clubbing and what it is associated with.
- a. Digital clubbing is often associated with chronic pulmonary disease abd on occasion lung cancer,
- b. If can be characterized by a bulbous swelling of the distal phalanges of the fingers and toes caused by proliferation of the connective tissue between the nail matrix and the distal phalanx.
Compare and contrast peripheral and central
- a. Cyanosis is defined as a bluish discoloration of the skin, nail beds, and mucus membranes caused by an elevated level of desaturated (deoxygenated) hemoglobin in the arterial blood.
- i. Central cyanosis: Refers to cyanosis of the oral mucosa or trunk
- ii. Peripheral cyanosis: Observed in the hands, fingertips, and nail beds of the hands and feet
Explain the breath sounds and the related clinical implications (Table 5-15).
- a. Vesicular: Normal over most of the chest except over major airways
- b. Tracheal or bronchial: Harsh, loud sounds. Normal if found over a large airway. Indicative of consolidation if heard elsewhere.
- c. Bronchovesicular: Normal over or near large airways. Associated with consolidation if heard elsewhere.
- d. Diminished or absent: Associated with hypoventilation of that portion of the lung, severe COPD, pneumothorax, pleural effusion, atelectasis, bronchial intubation.
- e. Wheezing: Wheezes are associated with partial obstruction of small airways, such as occurs with bronchospasms as in asthma. Sometimes heard wit tumor, foreign body, aspiration, or other irritations.
- f. Rhonchi: Rhonchi are low pitched gurgling sounds associated with secretions in a bronchus or larger airway that may clear following cough.
- g. Crackles: Discontinuous “popping” sounds associated with the opening and closing of alveoli during breathing. Inspiratory crackles are sometimes heard in the bases in patients with pulomonary edema, atelectasis, pneumonia, bronchiectasis, and interstitial lung disease.
- h. E-a egophony: An audible “A” sound when the patient says “E”. Associated with consolidation.
- i. Pleural friction rub: Loud, dry, coarse, leathery sound associated with pleural irritation and inflammation.
List the normal ranges for pulse rate, respiratory rate, blood pressure, SpO2 and explain alterations in vital signs.
- a. Respiratory rate:
- i. Adults: 12-20
- ii. Infants: 30-40
- iii. Children: 18-30, varies with age
- b. Blood pressure:
- i. 120/80
- c. Pulse rate:
- i. 80 bpm
- d. SpO2:
List all traditional vital signs (4).
- a. Pulse
- b. Respiration
- c. Blood pressure
- d. Temperature