Pulmonary Assessment

The condition of having too much carbon dioxide circulating in the blood

• 90 degrees or less
• the angle increases when the rib cage is chronically overinflated, as in emphysema

Because it could potentially hit the liver

Posterior

• A: anterior axillary line
• B: Mid clavicular line
• C: Mid sternal line

• A: Vertebral Line
• B: Scapular Line

• A: Mid axillary line
• B: Anterior Axillary line
• C: Posterior Axillary Line

7th and 8th

• C7
• T10
• T12

Mid clavicular, 5th intercostal space,

Eupnea

• Less than 12 Respirations per minute
• Anesthesia or pain meds

• Hyperventilation with periods of apnea
• Usually seen in pts who are dieing or have head injury

Seen in patients with unmanaged diabetes. deep labored breathing

• your sputum will be green/yellow
• your sputum will be rusty red
• your sputum will be frothy... full of fluid and air

• Ask about the cough. Do you have a cough? when did it start? How long? Any time of day?
• Do you have shortness of breath
• Do you have chest pain with breathing
• Do you have a past history of respiratory infection
• Do you have a past history of allergies
• Do you smoke
• Are there environmental factors we should be concerned about

2:1

• Pectus Excavatum (funnel chest)
• Pectus Caranatum (pigeon chest)
• Barrel Chest

The normal stimulus for humans to breath is an increase in CO2

A decrease of oxygen in the blood (hypoxemia) also increases respirations but is less effective than hypercapnia

• Posterior; T9 and T10
• Anterior; costal margins

if someone has had chest surgery, people may get air in subcutaneous tissue. If you touch chest around incision it will sound like rice crispies. Or in a pt with a chest tube and pt got air in subcutaneous tissue.

• If pt has a collapsed lung
• If pt has asthma

Fremitus normally decreases as you progress down because more and more tissue impedes sound transmission.

• occurs when anything obstructs transmission of vibrations
• (e.g., obstructed bronchus, COPD, tumor, very thick chest wall, or emphysema).
• Any barrier that comes between the sound and your palpating hand will decrease fremitus.

• occurs with compression or consolidation of lung tissue (e.g., lobar pneumonia).
• This is present only when the bronchus is patent and when the consolidation extends to the lung surface. Note that only gross (large) changes increase fremitus. Small areas of early pneumonia do not significantly affect fremitus.

• –Listen to lung areas from apices at C7 to bases at T10, and laterally from the axilla down to the
• 7th or 8th rib.
• ask pt to breath in and out of mouth

• short, high pitched, and loud. inspiration is less than expiration
• over the trachea and larynx on the anterior side

• moderate pitched and inspiration and expiration are =
• over major bronchi (just outside the sternum and just outside of the upper spine)

• Low pitched, soft, and inspiration is longer than expiration
• Found over peripheral lung fields where small bronchioles and alveoli are

• Inspiration
• Short
• Equal
• Long

added breath sounds

• caused by air passing through moisture in air passages
• usually inspiratory, not usually cleared by coughing
• fine rales=sm. airways;
• course rales=lg. airways
• found in the patient with pulmonary edema and Congestive Heart failure

• caused by passage of air through an airway obstructed by thick secretions, muscular spasm or new growth.
• rumbling or snoring sound
• heard on inspiration or expiration, but usually expiration
• originates in larger airways
• coughing may alter sound or clear it
• usually from bronchitis

• caused by air trying to squeeze through a passage narrowed by bronchospasm, tumor or a foreign body.
• high-pitched, musical sound
• usually expiratory, but can be expiratory or inspiratory
• occurs with asthma or pneumonia

caused by foreign body, tumor or severe bronchospasm

• musical sound of constant pitch that is predominantly inspiratory, sounds like a crowing sound
• often louder in the neck than over the chest wall
• *can be caused by child who swallows a penny etc

• caused by rubbing together of inflamed or roughened pleural spaces
• grating sound with the quality of old leather crackling; can also be a squeaky sound
• heard on inspiration and expiration

• Stop smoking
• Radon tests
• influenza vaccine
• pneumonia vaccine
• PPD test

• 65 years old +
• In a long term care facility
• on meds that decrease the immune system
• a smoker
• or a victim of chronic illness