Chest_auscultation.ppt

Respiratory assessment

1. Chest Auscultation

2. FOUR COMPONENTS OF A
RESPIRATORY ASSESSMENT
INSPECTION
PALPATION
PERCUSSION
AUSCULTATION

4. Anterior Chest Landmarks.

7. ACCORDING TO UNDERLYING
LUNGS AND LOBES
RIGHT LUNG
UPPER
MIDDLE
LOWER
LEFT LUNG
UPPER
LOWER

9. INSPECTION
Shape
Scars
Prominent veins
Resp rate and
rhythm
Chest wall
movement
Intercostal
recession
Added sounds
Cyanosis
Sputum

10. PALPATION
Tenderness
Position of apex beat
Chest wall expansion

11. Apex beat

12. Chest Wall Expansion

13. TRACHEAL POSITION
Central?
Above the sternal notch?
?shift ?direction

14. Tracheal Deviation
Towards
•Atelectasis
•Pleural fibrosis
•Pneumonectomy
•Lung
agenesis/aplasia
Away
•Pneumothorax
•Pleural effusion
•Tumors

15. Left lung
border
Trachea
deviated to
Right

16. PERCUSSION
compare both sides
start over the clavicles move down anterior
chest, ensure to percuss over lateral chest

17. Percussion Sounds
Sound Description Significance
Resonant Long, loud, low
pitched, hollow
Normal Lung sounds
Dullness Medium in intensity
and pitch, moderate
length
areas of increased
density/decreased air
(consolidation,
collapse, fibrosis,
abscess, neoplasm)
Stony dull Thudlike unique for pleural
effusion
Hyper resonant Very loud, low
pitched
areas of decreased
density-increased air
(pneumothorax)

18. TACTILE FREMITUS
VOCAL FREMITUS –say 99
INCREASED FREMITUS
DECREASED FREMITUS

19. Auscultation
BREATH SOUNDS
•Normal
•Absent
•Reduced
•Bronchial

20. Added sounds
Wheeze
Crackles
Rub
Stridor

21. Vocal resonance
•Bronchophony
•Whispering pectoriloquy
•Egophony

22. Common Conditions
Percussion Breath
Sounds
Added
Sounds
Vocal
Resonance
Consolidation dull Bronchial
breathing
Crackles
(course)
Increased
Pleural
Effusion
dull BS Rub? Decreased
Pneumothorax Hyperresonant BS
Fibrosis Normal Normal Crackles
(fine)
Pulmonary
Oedema
Normal Normal Crackles
(fine)

23. Chest sounds
https://www.youtube.com/watch?v
=O8OC7EiqBKQ

24. References
Breath Sounds Made Incredibly Easy (2005)–
Lippincott Williams and Wilkins
Gleadle J(2012)History and Clinical Examination at a
GlanceWiley Blackwell
Hogan-Quigley, Palm, Bickley (2012) Bates Nursing
Guide to Physical Examination and History Taking
Lippincott Williams and Wilkins