o Xiphoid Process

NCM 120: Health Assessment

Angle of Louis – Manubriosternal angle
RESPIRATORY SYSTEM: ASSESSING THE continuous with the 2nd rib
THORAX AND LUNGS Coastal angle – Usually 90 degrees or less.
(Increases when rib cage is chronically
OUTLINE overinflated).

Structure and Function

POSTERIOR THORACIC LANDMARKS
Health History
Physical Assessment
Abnormal Findings

THORACIC CAVITY

Mediastinum: Boundaries and Subdivisions

BONY FRAMEWORK OF THORAX

Vertebral Prominens
o Flex head, feel most prominent bony
projection at base of neck
o C7 next lower one is T1
Spinous Processes
o Spinal column
Scapula
o Symmetrical, lower tip at the 7-8th rib
th
12 rib
o Bleeding Time (b/t) spine and side

ANTERIOR CHEST

ANTERIOR THORACIC LANDMARKS

Suprasternal Notch – U shaped depression

Sternum – “breastbone” = 3 parts
o Manubrium
o Body
Nipples LUNG BORDERS
Suprasternal notch
Manubriosternal junction (Angle of Louis) Anterior Chest
o Useful rib identification o Thin
Midsternal Line o It is vertical on the right side and
o Imaginary vertical line through the shows cardiac notch on the left side
middle of the sternum below 4th costal cartilage
Coastal Angle o Apex 3-4 cm
Clavicles o Inner 1/3 of the clavicles
Midclavicular Line o Base – rests on the diaphragm
o 6th rib
POSTERIOR CHEST o MCL
Lateral Chest
o Extends from Axilla apex to the 7th to
8th rib
Posteriorly
o Apex of lung is at C7 – Base T10 (on
deep inspiration to T12)
o Thick and ill defined

LOBES OF THE LUNG

Right Lung
o 3 lobes, upper, middle, lower
o Shorter due to liver
Left Lung
o LUL = Left Upper and Lower (2 lobes)
o Narrower due to heart
Vertebra Prominens
o Spinous process of C7 ANTERIOR LUNG
Vertebral Spine
o Midspinal
Scapular Line

LATERAL CHEST

POSTERIOR LUNG

Anterior Axillary Line

Posterior Axillary Line
Mid-axillary Line
 LATERAL LUNGS Pleural Cavity
o The inside of the envelope – space
between the visceral and parietal
pleura, lubrication
o Normally has a vacuum or negative
pressure

TRACHEA AND BRONCHIAL TREE

TRACHE

LOBES
Diagonal sloping segments
Oblique fissures

3 IMPORTANT POINTS

1. Left Lung – o middle lobe

2. Anterior chest contains upper and middle
lobes with every little lower lobe.
3. Posterior chest has almost all lower lobe.
Related to middle lobe does not project into
the posterior chest.
PLEURAE
The Pleurae form an envelope between the
lungs and chest wall.
Visceral Pleura
o Lines outside of lungs
Parietal Pleura
o Lines inside of chest wall and
diaphragm
Anterior to esophagus
10-11 cm long, begins at cricoid cartilage
Bifurcates just below the sternal angle (AKA
angle of Louis, manubriosternal angle).
Right Main Stem Bronchus
o Shorter, wider, more vertical
o (Intubation – listen to breath sounds
bilaterally)
Left Main Stem Bronchus
BRONCHI
Secrete Mucus
o Captures particles
Cilia
 o Moves the trapped particles up to be
expelled or swallowed

ACINUS

Functional respiratory unit consisting of

o Bronchioles
o Alveolar Ducts
o Alveolar Sacs
o Alveoli
Gaseous exchange in alveolar duct and alveoli

MECHANISMS OF RESPIRATION

4 MAJOR FUNCTIONS OF THE

RESPIRATORY SYSTEM

1. Supply O2 for energy production

2. Remove CO2, waste product of energy
reactions
3. Homeostasis, acid-balance of arterial blood
4. Heat exchange

Respiration maintains pH (acid-base balance)

of the blood by supplying O2 and eliminating
CO2
Normal Range Values of Arterial Blood Gases
o pH = 7.35-7.45
o PaCO2 (partial pressure) = 35-45
mmHg
o PaO2 = 80-100 mmHg
o SaO2 (oxygen saturation) = 94-98% CONTROL OF RESPIRATION
Lungs help to maintain the pH balance by
adjusting the amount of CO2 through: Involuntary control by respiratory center in the
o Hypoventilation brain stem consisting of the pons and medulla.
o Hyperventilation Hypercapnia is an increased in CO2 in the
blood and provides the normal stimulus to
HYPERVENTILATION breath.
Hypoxemia
SIGNS AND SYMPTOMS

Tingling and numbness in the hands and

around the mouth.
Deep, rapid respiration with rapid pulse
Marked anxiety, escalating to panic
Dizziness, syncope
Fingers and hands drawn into a claw like
spasm

TREATMENT

Try to calm and reassure

Explain to the causality what is happening
Slow the breathing by mimicking breathing
Administer oxygen
DEVELOPMENTAL COMPETENCE Had been diagnosed with respiratory disease
such as asthma, chronic fibrosis, emphysema,
INFANTS AND CHILDREN lung cancer or pneumonia.
Had injury to the chest or surgery
When cord is cut, blood is cut off from
placenta and rushes into pulmonary FAMILY HISTORY
circulation.
Due to less resistance in pulmonary arteries, Family History of ling disease
the foramen ovale closes, along with ductus Personal and Psychosocial History
arteriosus. o Smoking History
Newborn chest is round and consistent with Home Environment
head size until approximately 2 years. o Air pollution, pets, type of heating or
Newborns noticeably use the diaphragm and air conditioning, hobbies, second and
abdominal muscles for respiratory effort. third hand smoke exposure, radon
Lungs grow until about 300 million alveoli in (gas from rocks and dirt)
adolescence. Occupational Environment
While infant is sleeping, can inspect and o Asbestos, paint fumes, vapors, etc.
auscultate the lungs. Travel
Infants normally have a rounded thorax,
reaching a 1:2 (anteroposterior to transverse) PROBLEM-BASED HISTORY
diameter by age 6.
If a barrel shape persists after age 6, possible COUGH
chronic asthma or cystic fibrosis. Onset? Gradual or Sudden? Frequency?
If baby begins to cry, it actually enhances the Continuous throughout day
palpation of tactile fremitus. o Acute illness (respiratory infection)
Afternoon / Evening
PREGNANCY o May reflect exposure to irritants at
The enlarging uterus elevates the diaphragm work
4cm during pregnancy, but the increased Night
estrogen relaxes thoracic ligaments allowing o Postnasal drip, sinusitis
compensation by increasing the transverse Early Morning
diameter. o Chronic Bronchial inflammation of
Mother’s tidal volume increases to meet smokers
demands of fetus.
Physiologic dyspnea SPUTUM
Wider thoracic age How much?
o Chronic Bronchitis – Productive cough
AGING for 3 months of the year for 2 years in
Kyphosis a row.
o Outward curvature of thoracic spine Characteristics
Calcification of costal cartilages leading to less o White of clear mucoid – Colds, viral
mobility infection, bronchitis
Decreased vital capacity o Yellow or Green – Bacterial infection
Decreased number of alveoli o Red - Hemoptysis
Decreased mucous production o Rust colored – Tuberculosis,
pneumococcal pneumonia
GENERAL HEALTH HISTORY o Pink, frothy – Pulmonary edema,
medications
Present health status
Chronic illness
Allergies
DOB with activities, at rest or lying flat Cough up blood?
Taking meds for respiratory disorder Description of cough – dry, hacking
Using oxygen at home Aggravating and Alleviating factors
Painful? Severity
PAST HEALTH HISTORY

Had problems with lungs or breathing

SHORTNESS OF BREATH (SOB) GENERAL INSPECTION

Onset, associated factors

o Determine how much activity NORMAL
precipitates SOB Inhalation
Affected by position? o Diaphragm pulls downward, helping
o Orthopnea – Difficulty breathing when lungs expand with oxygen.
supine (heart failure)
Time of day / night
o Paroxysmal Nocturnal Dyspnea –
Awakening from sleep with SOB and
needing to be upright to achieve
comfort.
Allergies?
o Asthma attacks
Alleviating Factors
Chest pain with breathing?
o Location, onset, duration, frequency,
intensity, associative and alleviate
factors Exhalation
Past history of respiratory infections? o Diaphragm returns upward, forcing
o Bronchitis lungs to expel carbon dioxide.
o Emphysema
POSTERIOR THORAX
o Asthma
o Pneumonia Anterior-Posterior transverse diameter is 1:2
Smoking History
Environmental Exposure
ABNORMAL
Self-Care Behaviors
o Immunizations Nasal Flaring
o Tuberculosis skin test Cyanosis
o Chest X-rays Cyanotic Nails
Tripod Position – COPD
ASSESSMENT – INSPECTION

INSPECT THORAX

Symmetry and Configuration

AP diameter
Normal 1:2 to 5:7
Note position of person to breathe
Barrel Chest – Emphysema
o Orthopnea COPD – Tripod position,
sitting position
Skin Color and Condition, Nail Color
AP diameter = Transverse diameter, “barrel
chest”. Occurs with:
o Normal Aging
o Chronic Emphysema
o Asthma
Symmetry and Normal Development of Pectus Excavatum (Funnel Chest)
Trapezius Muscle Pectus Carinatum (Pigeon Chest)
o Hypertrophied in COPD
 Kyphosis TACTILE FREMITUS
Scoliosis
SEQUENCE OF PALPATION
PALPATION

SYMMETRIC CHEST EXPANSION

Fremitus is a palpable vibration transmitted

through patent bronchi and lung parenchyma
to the chest wall where they can be felt as
vibrations.
Place either the palmar base of ulnar edge of
one of the hands on the person’s back and ask
NORMAL FINDINGS to repeat “ninety-nine” or “blue moon”. Start at
Place warmed hands on posterolateral chest lung apices and palpate from one side to
wall with thumbs at level of T9 or T10. another.
Slide hands medially to pinch up a small fold Symmetry is most important
of skin between thumbs. Normally, fremitus most prominent between
Ask person to take a deep breath scapulae and decreases as you progress
As person inhales, the thumbs should move down.
symmetrically.
ABNORMAL FINDINGS
ABNORMAL FINDINGS Decreased fremitus occurs when anything
Unequal chest expansion occurs with obstructs transmission of vibrations
atelectasis, pneumonia, thoracic trauma o Obstructed bronchus
Pain accompanies deep breathing when o Pleural effusion or thickening
pleurae are inflamed o Pneumothorax
o Emphysema
Increased fremitus occurs with compression or
consolidation of lung tissue
Entire Chest Wall o Lobar pneumonia
o Gently palpate Rhonchal Fremitus
o Note tenderness, skin temperature, o Palpable with thick secretions
moisture, lumps, and lesions
Client reports no tenderness, pain, or unusual PALPATION
sensations
Unequal Fremitus
Temperature should be equal bilaterally
Diminished Fremitus
No palpable crepitus
Unequal Chest Expansion
No lesions and masses
Consolidation
Normal chest expansion (should move 5-10
Bronchial Obstruction
cm part symmetrically)
Emphysema
Fremitus is symmetric and easy to identify
Crepitus
o A coarse crackling sensation (like
bones or hairs rubbing against each
other)
 PERCUSSION
Start at the apices and percuss across tops of
both shoulders and down the lung region at
approximately 5cm intervals.
Make a side to side comparison
Avoid damping effect of scapulae and ribs
NORMAL FINDING
Resonance percussion tone elicited over
normal lung tissue
EXPECTED PERCUSSION NOTES
PERCUSSION NOTES
ABNORMAL FINDING
Hyperresonance
o Is elicited in cases of trapped air
o Emphysema or Pneumothorax
Dullness
o Is present when fluid or solid tissue
replaces air in the lungs or occupies
the pleural space.
o Lobar Pneumonia, Pleural Effusion or
Tumor
DIAPHRAGMATIC EXPANSION
Now take deep breath and hold
Percuss from mark to dull sound and mark
Measure the difference. Should be + bilaterally
3-5cm in adult may be 7-8cm in well-
conditioned person
Note: Hold your own breath when conducting
this test
AUSCULTATING POSTERIOR CHEST
BREATH SOUNDS
Instruct the person to breathe through the
mouth a little deeper than usual, but to stop if
they feel dizzy.
Hyperventilation may lead to fainting
Use the flat diaphragm endpiece of the
stethoscope and listen for at least one full
respiration in each location.
Continue to think:
o What I am hearing?
o What should I expect to be hearing?
 Do not confuse background noise with lung POSTERIOR
sounds
o Stethoscope tubing bumping together
o Shivering
o Hairy Chest
o Rustling of Gown

AUSCULTATION

BREATH SOUNDS

Bronchial
o Anterior Chest only
o Over Trachea and Larynx
o Quality = Harsh, hollow, tubular
o Inspiration < Expiration
o Amplitude = Loud
Bronchovesicular
o Over major bronchi, posterior between
the scapulae, anterior upper sternum,
1st and 2nd ICS CHARACTERISTICS OF NORMAL BREATH
o Pitch = High SOUNDS
o Inspiration = Expiration
o Moderate amplitude
Vesicular
o Anterior and Posterior
o Quality = Rustling, wind in trees
o Inspiration > Expiration
o Soft amplitude

LOCATION OF NORMAL BREATH SOUNDS

ANTERIOR

ABNORMAL FINDING
Decreased or Absent Breath Sounds
o Obstruction of the bronchial tree by
secretions, mucous plug, F.B
o Decreased lung elasticity, emphysema
= Lungs Hyperinflated
o Pleurisy, pleural thickening,
pneumothorax (air), pleural effusion
(fluid) in the pleural space
Increased Breath Sounds
o Dense lung tissue enhances sound
transmission as in consolidation
o Pneumonia
Silent Chest
o Ominous
 ADVENTITIOUS BREATH SOUND S
LOW PITCHED, MONOPHONIC WHEEZE
ABNORMAL FINDING
DISCONTINUOUS LUNG SOUNDS
These are extra sounds heard LESS than 0.2
seconds during a full respiration cycle.
COARSE CRACKLES
Crackles are also known as: RALES
Auscultates during inspiration and can extend
into expiration as well
Low-pitched, wet bubbling sound
May be heard in patient with fluid overload,
pneumonia etc.
FINE CRACKLES
Crackles are also known as: RALES
Auscultated during inspiration (DON’T CLEAR
with COUGHING)
High-pitched, crackling sound that is similar to
a fire crackling
May be heard in patients with edema in the
lungs or ARDS (Acute Respiratory Distress
Syndrome)
PLEURAL FRICTION RUB
Auscultated during inspiration and expiration
Low-pitched / Harsh grating sound
Patients may have pain when breathing in and
out due to inflammation of pleural layers
May be heard in patients with pleuritis
CONTINUOUS LUNG SOUNDS
These are extra sounds heard MORE than 0.2
second during a full respiration cycle
ABNORMAL FINDING
HIGH PITCHED, POLYPHONIC WHEEZE
Also known as: SIBILANT WHEEZE
Auscultated mainly in expiration but may
present during inspiration
Sounds like a high-pitched musical instrument
with MORE than one type of sound quality
May be heard in patients with asthma
Also known as: Sonorous Wheeze or Rhonchi
Auscultated mainly in expiration but may b
present at anytime
Sounds like a low-pitched whistling tune or
whine with ONE type of sound quality
May be heard in patients with COPD or
pneumonia etc.
STRIDOR
High pitched, inspiratory, crowing sound,
louder in neck than over chest wall.
Originates in larynx or trachea. Upper airway
obstruction from inflamed tissue or obstruction
Auscultated during inspiration
Croup and acute epiglottitis. Obstructed airway
INCREASED CONSOLIDATION OR
COMPRESSION
Voice sounds normal voice transmission is
soft, muffled and indistinct.
Pathology – “99” sounds as if patient is directly
talking into the stethoscope.
Egophony – “ee-ee-ee” if disease sounds like
loud “aa-aa-aa”, record as “E → A changes”
Whisper pectoriloquy 1-2-3 sounds loud and
clear as if patient is directly talking into the
stethoscope.
These tests are only done if lung pathology is
suspected.
ANTERIOR CHEST
INSPECT
Shape and Configuration
Expression – Relaxed
LOC – Alert and Cooperative
Skin Color and Condition
Quality of Respirations – Regular and even, no
retraction or use of accessory muscles.
SYMMETRIC EXPANSION
ASSESSMENT OF COMMON RESPIRATORY BRONCHITIS
CONDITIONS

NORMAL LUNG (FOR COMPARISON)

CONDITION
Proliferation of mucous glands in the
passageways, resulting in excessive mucus
secretion.
INSPECTION Inflammation of bronchi with partial obstruction
of bronchi by secretions or constrictions.
Anteroposterior < Transverse Diameter, Sections of lung distal to obstruction may be
relaxed posture normal musculature, rate 10 to deflated.
18 breaths per minute, regular, no Cyanosis or Bronchitis may be acute or chronic with
Pallor recurrent productive cough.
Chronic bronchitis is usually caused by
PALPATION cigarette smoking.
Symmetric chest expansion
Tactile Fremitus present and equal bilaterally, INSPECTION
diminishing toward periphery Hacking
No lumps, masses or tenderness Rasping cough productive of thick mucoid
sputum
PERCUSSION Chronic – Dyspnea, Fatigue, Cyanosis
Possible clubbing of fingers
Resonant
Diaphragmatic excursion 3 to 5 cm and equal
bilaterally PALPATION
Tactile Fremitus normal
AUSCULTATION
Vesicular over peripheral fields PERCUSSION
Bronchovesicular parasternally (anterior) and Resonant
between scapulae (posterior)
Infant and young child – bronchovesicular
AUSCULTATION
throughout
Normal Vesicular
Voice sounds normal
ADVENTITOUS SOUNDS
Chronic – prolonged expiration
None

ADVENTITIOUS SOUNDS
Crackles over deflated areas
May have wheeze
 ATELECTASIS (COLLAPSE)
CONDITION
Collapsed shrunken section of alveoli, or an
entire lung, due to (1) airway obstruction (e.g.,
the bronchus is completely blocked by thick
exudate, aspirated foreign body or tumor), the
alveolar air beyond it is gradually absorbed by
the pulmonary capillaries and the alveolar
walls cave in.
(2) Compression on the lung
(3) Lack of surfactant (hyaline membrane
disease)
INSPECTION
Cough
Lag on expansion on affected side
Increased respiratory rate and pulse
Possible cyanosis
PALPATION
Chest expansion decreased on affected side
Tactile fremitus decreased or absent over area
With large collapse, tracheal shift toward
affected side
PERCUSSION
Dull over area (remainder of thorax sometime
may have hyper resonant note)
AUSCULTATION
Breath sounds decreased vesicular or absent
over area
Voice sounds variable, usually decreased or
absent over affected area
ADVENTITIOUS SOUNDS
None if bronchus is obstructed
Occasional fine crackles if bronchus is patent
EMPHYSEMA
CONDITION
Caused by destruction of pulmonary
connective tissue (elastin, collagen);
characterized by permanent enlargement of air
sacs distal to terminal bronchioles and rupture
of interalveolar walls.
This increases airway resistance, especially
on expiration – producing a hyperinflated lung
and an increase in lung volume.
Cigarette smoking accounts for 80% to 90% of
cases of emphysema.
INSPECTION
Increased anteroposterior diameter
Barrel chest
Use of accessory muscles to aid respiration
Tripod position
Shortness of breath, especially on exertion
Respiratory distress
Tachypnea
PALPATION
Decreased tactile fremitus and chest
expansion
PERCUSSIOM
Hyper resonant
Decreased diaphragmatic excursion
 AUSCULTATION
Decreased breath sounds
May have prolonged expiration
Muffled heart sounds to secondary to
overdistention of lungs
ADVENTITIOUS SOUNDS
Usually none
Occasionally, wheeze
ASTHMA (REACTIVE AIRWAY DISEASE)
CONDITION
An allergic hypersensitivity to certain inhaled
allergens (pollen), irritants (tobacco, ozone),
microorganisms, stress, or exercise that
produces a complex response characterized
by bronchospasms, and inflammation, edema
in walls of bronchioles, and secretion of highly
viscous mucus into airways.
These factors gently increase airway
resistance, especially during expiration, and
produce the symptoms of wheezing, dyspnea,
and chest tightness.
INSPECTION
During sever attack: increased respiratory
rate, shortness of breath with audible wheeze,
use of accessory neck muscles, cyanosis,
apprehension, retraction of intercostal spaces.
Expiration labored, prolonged
When chronic may have barrel chest
PALPATION
Tactile fremitus decreased, tachycardia
PERCUSSION
Resonant
May be hyper resonant if chronic
AUSCULTATION
Diminished air movement
Breath sounds decreased, with prolonged
expiration
Voice sounds decreased
ADVENTITIOUS SOUNDS
Bilateral wheezing on expiration, sometimes
inspiratory and expiratory wheezing.
LOBAR PNEUMONIA
CONDITION
Infection in kung parenchyma leaves alveolar
membrane edematous and porous, so red
blood cells and white blood cells pass from
blood to alveoli.
Alveoli progressively fill up (become
consolidated) with bacteria, solid cellular
debris, fluid, and blood cells, all of which
replace alveolar air.
This results in decreased surface area of the
respiratory membrane, which causes
hypoxemia.
INSPECTION
Increased respiratory rate
Guarding and lag on expansion on affected
side
Children – sternal retraction, nasal flaring
 PALPATION
Chest expansion decreased on affected side
Tactile fremitus increased if bronchus patent,
decreased if bronchus obstructed.
PERCUSSION
Dull over lobar pneumonia
AUSCULTATION
Breath sounds louder with patent bronchus, as
if coming directly from larynx.
Voice sounds have increased clarity,
bronchophony, egophony, whispered
pectoriloquy present.
Children – diminished breath sounds may
occur early pneumonia.
ADVENTITIOUS SOUNDS
Crackles, fine to medium
PNEUMOCYSTIS CARINII PNEUMONIA
CONDITION
This virulent form of pneumonia is a protozoal
infection associated with AIDS.
This parasite P. carinii is common in the
United States and harmless to most people,
except to the immunocompromised, in whom a
diffuse interstitial pneumonitis ensures.
Cysts containing the organism and
macrophages from in alveolar spaces, alveolar
walls thicken, and the disease spreads
bilateral interstitial infiltrates of foamy, protein-
rich fluid.
INSPECTION
Anxiety, shortness of breath, dyspnea on
exertion, malaise is common; also, tachypnea;
fever; a dry, non-productive cough; intercostal
retractions in children; cyanosis.
PALPATION
Decreased chest expansion
PERCUSSION
Dull over areas of diffuse infiltrate
AUSCULTATION
Breath sounds may be diminished
ADVENTITIOUS SOUNDS
Crackles may be present but often are absent
TUBERCULOSIS
CONDITION
Inhalation of tubercle bacilli into the alveolar
wall starts:
(1) Initial complex is acute inflammatory
response – macrophages engulf bacilli but do
not kill them. Tubercle forms around bacilli
(2) Scar tissue forms, lesion calcifies and
shows on x-ray
(3) Reactivation of previously healed lesion.
Dormant bacilli now multiply, producing
necrosis, cavitation, and caseous lung tissue
(cheese-like)
(4) Extensive destruction as lesion erodes into
bronchus, forming air-filled cavity. Apex
usually has the most damage.
 SUBJECTIVE Air in pleural space neutralizes the unusual
negative pressure present, thus lung
Initially asymptomatic, showing as positive
collapses.
skin test or on x-ray
Usually, unilateral.
Progressive tuberculosis involves weight loss,
Pneumothorax can be (1) spontaneous (air
anorexia, easy fatigability, low-grade afternoon
enters pleural space through rupture in lung
fevers, night sweats.
wall)
May have pleural effusion, recurrent lower
(2) traumatic (air enters through opening or
respiratory infections.
injury chest walls) or
(3) tension (trapped air in pleural space
INSPECTION increases, compressing lung and shifting
Cough initially nonreproductive, later mediastinum to the unaffected side).
productive of purulent, yellow-green sputum,
may be blood tinged. INSPECTION
Dyspnea, orthopnea, fatigue, weakness
Unequal chest expansion
If large, tachypnea, cyanosis, apprehension,
PALPATION bulging in interspaces
Skin moist at night from night sweats
PALPATION
PERCUSSION Tactile fremitus decreased or absent
Resonant initially Tracheal shift to opposite side (unaffected
Dull over any effusion side)
Chest expansion decreased on affected side
Tachycardia, decreased BP
AUSCULTATION
Normal or decreased vesicular breath sounds PERCUSSION
Hyper resonant
ADVENTITIOUS SOUNDS Decreased diaphragmatic excursion
Crackles over upper lobes common, persist
following full expiration and cough. AUSCULTATION

PNEUMOTHORAX Breath sounds decreased or absent

Voice sounds decreased or absent

ADVENTITIOUS SOUNDS
None

OPEN [SUCKING] PNEUMTHORAX

(PATHOPHYSIOLOGY)

INSPIRATION

CONDITION
Free air in pleural space causes partial or
complete lung collapse.
 Air enters pleural cavity through open, sucking PATTERNS OF RESPIRATION
chest wound.
Negative pleural pressure lost, reducing
venous return to heart.
Mediastinum shifts, compressing opposite
lung.

EXPIRATION

NORMAL PATTERN
Breathing Rhythm
Normal respirations are regular and even
As chest wall contracts and diaphragm rise, air
expelled from pleural cavity via wound.
Mediastinum shifts to affected side and ABNORMAL PATTERN
mediastinal flutter impairs venous return by Cheyne – Stokes
distortion of venae cavae. o Respiratory Therapy wax and Wane in
regular pattern with periods of apnea
RESPIRATORY PATTERNS (20 sec)
o Biot’s or Ataxisic
NORMAL FINDING ➢ Similar to Cheyne
➢ Stokes but pattern irregular
Relaxed, Effortless, and Quiet
Regular Rhythm, and Normal Depth DEPTH
Normal Rate of 16-20 breaths / minute
No retractions or bulging of intercostal spaces
are noted NORMAL PATTERN
Not using accessory muscles On inspiration the normal depth is non
exaggerated and effortless.
BREATHING PATTERN

ABNORMAL PATTERN
ABNORMAL FINDING Shallow
Labored and Noisy Breathing Sighing – Purposeful to expand the alveoli
Tachypnea
Bradypnea SYMMETRY
Hyperventilation
Hypoventilation
NORMAL PATTERN
Cheyne’s Strokes Respiration
Biot’s Respiration Bilateral rise and fall of the chest with
Use of Accessory Muscles respirations
 AUDIBILITY

NORMAL PATTERN
Normally be heard by the unaided ear several
centimeters from the patient’s nose / mouth.

PATIENT’S POSITION

NORMAL PATTERN
Healthy person breathes comfortably in
supine, prone, or upright position.
Orthopnea

MODE OF BREATHING

NORMAL PATTERN
Normally Inhale / Exhale through nose

SPUTUM

Sample
Color
o Mucoid
o Clear
o Yellow / Green
o Rust / Blood Tinged
o Black
o Pink
Odor
Amount
Consistency