Health and

Physical Assessment
in Nursing
ANALYN GARINGANAO
Instructor
 respiratorysystem

health assessment
ANALYN GARINGANAO
Instructor
2
I: interviewassessment
Cough

Sputum Production

Shortness of Breath

3
I: interviewassessment
Chest Pain with
Breathing

Past History of
Respiratory Infection

Smoking History

Environmental
Exposure

Self Care Behaviors

4
Sputum Production
-reaction of the lungs to any constantly recurring irritant, its
nature is often indicative of its cause
Bacterial: purulent sputum (thick yellow, green or rust colored)
Viral: whitish, mucoid, watery
Bronchitis, bronchiectasis: gradual increase of sputum over time
Lung tumor- pink-tinged, mucoid
Pulmonary edema- profuse, frothy, pinkish
The lungs are a pair of spongy, air-filled organs lo
Visceral Pleura- covers the surface of the lungs,

Parietal Pleura- covers the inside of the thorax,

mediastinum, and diaphragm.

The very thin space between the layers is called the pleural
cavity. A liquid, called pleural fluid, lubricates the pleural
cavity so that the two layers of pleural tissue can slide
against each other.
musclesofrespiration

muscles of the
thoracic cage

diaphragm

accessorymuscles
scalene

sternocleidomastoid

trapezius

pectoralis

9
rectus abdominis
• Pulmonary Consolidation is a region of normally
compressible lung tissue that has filled with liquid instead
of air.

• Pneumothorax is a collapsed lung

• Chronic Obstructive Pulmonary Disease (COPD) is a

chronic inflammatory lung disease that causes obstructed
airflow from the lungs. ( Emphysema)

• Pleural Effusion, also called water on the lung, is an

excessive buildup of fluid in the space between your lungs
and chest cavity.

A pneumothorax is a collapsed lung

• Pneumonia is an infection that inflames the air sacs in one or
both lungs. The air sacs may fill with fluid or pus, causing cough
with phlegm or pus, fever, chills, and difficulty breathing.

• Asthma is a chronic, or long-term, condition that intermittently

inflames and narrows the airways in the lungs.

• Bronchitis is an inflammation of the bronchial tubes, the

airways that carry air to your lungs. It causes a cough that often
brings up mucus.

• Heart failure is a condition in which the heart can't pump

enough blood to meet the body's needs.
• Pulmonary fibrosis is a lung disease that occurs when
lung tissue becomes damaged and scarred. This
thickened, stiff tissue makes it more difficult for your lungs
to work properly.

• Congestive Heart Failure- fluid builds up around the heart

and causes it to pump inefficiently.
• Eupnea- Normal respiration

• Apnea- absence of breathing.

• Tachypnea- refers to rapid breathing; especially rapid and

shallow breathing.

• Bradypnea- abnormally slow respiration

 respiratorysystem

health assessment
14
 General Conduct

• 1. Doctors and medical professionals are in a

position of trust. It is generally assumed that you will
act with professionalism, integrity, honesty and with
respect for the dignity and privacy of your patient.

• 2. People who you may have only just met will take
off their clothes and allow you to look at and touch
their bodies, something that would be completely
unacceptable to many people in any other situation.
 General Conduct

• 3. People maybe more comfortable with undressing

themselves if you have established an appropriate
rapport during history taking.

• 4. The manner in which you conduct yourself during

the examination can make the difference between an
effective examination and a formal complaint. Be
alert also to cultural and religious differences when in
comes to disrobing in front of others.
 General Conduct

• 5. Projected confidence will be picked up by the

patient, making them more at ease and constant
verbal and non verbal communication should ensure
that no misunderstandings may occur.

• 6. Ensure that you have chaperone present another

student, doctor, nurse or other healthcare
professional.
 General Conduct

• 7. Whenever you perform any intimate examination

and that chaperone should ideally be the same
gender as the patient.
 Objective

• 1. To provide baseline data for the respiratory system

• 2. To determine the presence of any abnormalities in

the respiratory system.
• PREPARATION PHASE:

• 1. Introduce yourself and explain the procedure to the

client.

• 2. Prepare the equipment and wash your hands.

 Equipment

• Stethoscope

• Centimeter
ruler

• Marking pen
II: physicalassessment
POSTERIOR AND LATERAL CHEST
II: physicalassessment
POSTERIOR AND
LATERAL CHEST

A. Inspection

• 1. Inspect for the symmetry of

the back and scapulae.

• 2. Inspect spine for mobility,

structural deformity,
symmetry and posture.

• 3. Inspect for skin color,

lesions, and hair distribution.
23
II: physicalassessment

B. Palpation

• 1. Gently palpate posterior chest,

ribs, spine and note for tenderness
and deformities.

• Normal result in palpation: muscle

should be firm and underlying tissue
smooth. The chest should be free of
lesions or masses. The area should
be nontender to palpation.
24
 II: physicalassessment
ASSESS SYMMETRIC CHEST EXPANSION.

• A. Placed warmed hands on the

posterolateral chest wall with the
thumb sat the level of T9 or T10

• B. Slide hands medially to pinch

up a small fold of skin between
thumbs.

• C. Ask the patient to take a deep

breath.

• D. Note any lag in expansion.

25
 II: physicalassessment
ASSESS TACTILE FREMITUS ( palpable vibration when the client
speaks)

• A. Use either the palmar

base of fingers or ulnar
edge of one hand and
touch the patient’s chest
while he or she repeats the
phrase “ninety nine” or
“blue moon”

• B. Start over lung Apices Normal lung transmits a

and palpate from one side palpable vibratory sensation
to another. to the chest wall.
26
 II: physicalassessment
C. PERCUSSION- is an assessment technique which
produces sounds by the examiner tapping on the patient's
chest wall.

1. ASSESS LUNG FIELDS

a. Start at the apices and percussion the band of normally

resonant tissue across the tops of both shoulders.

27
II: physicalassessment

C.PERCUSSION

1. ASSESS LUNG FIELDS

b. Percussion in the interspaces, make a side to

side comparison all the way down the lung region.

c. Percuss at 5 cm intervals.

28
II: physicalassessment
Tone Description

soft intensity, high pitch, short

Flat duration
*bones, large pleural effusion

medium intensity, medium

pitch and duration
Dull *liver, pneumonia, tumor,
pleural effusion

loud intensity, low pitch, long

Resonance duration
*normal lung

very loud, low pitch, longer

Hyperresonance duration
*emphysema, pneumothorax
29
II: physicalassessment
• 2. ASSESS DIAPHRAGMATIC EXCURSION
(is the movement of the thoracic diaphragm
during breathing.)

• a. Ask the patient to exhale and hold it briefly

while you percuss down the scapular line until
the sound changes from resonant to dull on
each side; mark the spot.

• b. Ask the patient to take a deep breath and

hold it; continue percussion down from your
first mark and mark the level where the sound
changes from resonant to dull on this deep
inspiration; measure the difference.
30
II: physicalassessment
• Normal diaphragmatic Excursion: 3-6 cm

• Abnormal: asymmetrical diaphragm may

indicate diaphragmatic paralysis or pleural
effusion of the elevated side

• shortened excursion indicates that the

lungs are not fully expanding; pain or
abdominal pressure can inhibit full
expansion; the diaphragmatic excursion is
shortened in emphysema, atelectasis and
respiratory depression
31
 AUSCULTATION

• NORMAL BREATH sound is vesicular breath sound, it is low

pitch, inspiration is longer than expiration, no gap between two
phases.

• ABNORMAL BREATH SOUNDS

• RHONCHI ( Rhonchi are continuous low pitched, rattling lung

sounds that often resemble snoring), occur when air tries to pass
through bronchial tubes that contain fluid or mucus. ( (COPD),
bronchiectasis, pneumonia, chronic bronchitis)

• CRACKLES ( discontinuous clicking or rattling sounds), occur if

the small air sacs in the lungs fill with fluid. ( pneumonia,
atelectasis, acute bronchitis, bronchiectasis, acute respiratory
distress syndrome (ARDS)
• WHEEZING ( high-pitched whistling noise) occurs when the
bronchial tubes become inflamed and narrowed. ( cold, asthma,
allergies, chronic obstructive pulmonary disease (COPD))

• STRIDOR ( high-pitched, wheezing sound ), occurs when the

upper airway narrows. ( bronchitis, tonsillitis, epiglottis, vocal cord
paralysis)

• PLEURAL RUB FRICTION is heard on inspiration and expiration

and sounds like a low-pitch harsh/grating noise. (Pleuritis)

• FINE CRACKLES are brief, discontinuous, popping lung sounds

that are high-pitched. ( pulmonary fibrosis, congestive heart
failure.)
• Bronchial- auscultated over anterior
chest and heard over tracheal area.
Characteristics: sound will have a high
pitch and be loud, inspiration will be
slightly SHORTER than expiration

• Bronchovesicular- auscultated
anteriorly and posteriorly and heard
over the bronchi. anteriorly: 1st and
2nd intercostal space near the
sternum, posteriorly: between the
scapulae. Characteristics: sound will
have a medium pitch, inspiration and
expiration will be EQUAL

• Vesicular- auscultated anteriorly and

posteriorly and heard over peripheral
lung fields. Characteristics- sound will
be soft with a low pitch, inspiration will
be slightly GREATER than expiration
posteriorly: between the scapulae
II: physicalassessment

D. AUSCULTATION

1. ASSESS BREATH SOUNDS

a. Evaluate the presence and quality of normal breath

sound.

b. The patient is sitting, leaning forward slightly, with

arms resting comfortably across the lap.

35
II: physicalassessment

c. Instruct the patient to breathe

through the mouth a little bit deeper
than the usual but to stop if he/ she
feels dizzy.

d. Be careful to monitor the breathing

throughout the examination and offer
times for the person to rest and breath
normally.

36
II: physicalassessment

e. Use the flat diaphragm end

piece of the stethoscope and
hold it firmly on the patient’s
chest wall.

f. Listen to at least one full

respiration on each location;
make a side to side
comparison.

37
 II: physicalassessment

g. While standing behind the

patient, listen to the following
areas- posterior from the
apices at C7 down to the
bases at around T10, and
laterally from the axilla down
to the 7th or 8th rib.

38
 Start at the Apex of the lungs ( right above the Clavicle)

Then move to the 2nd intercostal space to assess the right and left
upper lobes.

At the 4th intercostal space you will be assessing the right middle
lobe and the left
upper lobe.

Then midaxillary at the 6th intercostal space you will be assessing

 Start at above the scapulae to listen to the apex of the lungs.

Then find C7 (which is the vertebral prominence) and go to T3…in

between the shoulder blades and spine. This will assess the right
and left upper lobes.

Then from T3 to T10 you will be able to assess the right and left
lower lobes.
II: physicalassessment
2. ASSESS VOICE SOUNDS

-Voiced sounds can provide important information

about the presence of a lung abnormality and its
location.

a. Determine the quality of voice sounds or vocal

resonance.

b. Ask the person to repeat a phrase while you listen

over the chest wall.

41
 II: physicalassessment

Bronchophony is the abnormal transmission of sounds from the

lungs or bronchi. Let patient say “99” while we auscultate.

Normally, the sound of the patient's voice becomes less distinct

II: physicalassessment
Egophony- let patient phonate the long “ee’ sound while we
auscultation.

Over normal lung areas, you will here the same 'e' tones. Over consolidated
tissue, the 'e' sound changes to a nasal quality 'a' (aaaaay), like a goat's
43
II: physicalassessment
whispered pectoriloquy- let patient whisper
“99”, “1,2,3” or “A,B,C” while you auscultation.

Normally the whispered voice will be distant and very muffled through
the stethoscope 44
II: physicalassessment
Anterior Thorax and
Lungs

A. Inspection

• 1. Inspect for symmetry of the

thorax, ribs and clavicles

• 2. Inspect skin color, lesions,

hair distribution and note
width of costal angle

• 3. Note manner of breathing

and any signs of respiratory
difficulty
45
II: physicalassessment

Anterior Thorax and Lungs

B. Palpation

• 1. Gently palpate anterior

chest to note any tenderness
and to detect any superficial
lumps or masses; note skin
mobility, turgor, skin
temperature and moisture

46
II: physicalassessment
2. ASSESS SYMMETRIC CHEST EXPANSION

a. Place warmed hands on the anterolateral

wall with thumbs along the costal margins
pointing towards the xiphoid process.

b. Ask the patient to take a deep breath.

c. Watch your thumb move apart symmetrically

and note smooth chest expansion with your
fingers.

47
II: physicalassessment
3. ASSESS TACTILE (VOCAL) FREMITUS ( palpable
vibration when the client speaks)

a. Begin palpating over the lung apices at the

supclavicular areas.

b. Compare vibration from one side to the other as

the patient repeats “99”.

c. Avoid palpating female breast tissue.

Normal lung transmits a

palpable vibratory sensation to
48 the chest wall.
II: physicalassessment
C. PERCUSSION

1. Begin percussion at the apices.

2. Percuss the interspaces and compare one

side to the other, move down to the anterior
chest.

3. Note the border for Cardiac and liver

dullness.

49
II: physicalassessment
D. AUSCULTATION

1. ASSESS BREATH SOUNDS

a. Auscultation the lung fields over the anterior

chest from the apices in the supraclavicular areas
down to the 6th rib.

b. Progress from side to side as you move

downward; listen to one full respiration on each
location.

C. Evaluate normal breath sound, noting any

abnormal or adventitious sounds.
50
Tachypnea is fast, shallow breathing.
II: physicalassessment
2. ASSESS VOICE SOUNDS

a. Determine the quality of voice sounds or vocal

resonance.

b. Ask the patient to repeat phrase while you listen

over the chest wall.

b.1. Bronchophony- let patient say “99” while you

auscultate.

b.2. Whispered pectoriloquy- let patient whisper

“1,2,3” or “A,B,C” while you auscultate.

b.3. Egophony- let patient phonate the long “ee”

sound while you auscultate.
52
End of Respiratory
Assessment