Beruflich Dokumente
Kultur Dokumente
18
Chapter Eighteen
PURPOSE
This chapter helps you to learn the structure and function of the thorax and lungs, to understand the
methods of examination of the respiratory system, to identify lung sounds that are normal, to describe the
characteristics of adventitious lung sounds, and to accurately record the assessment. At the end of this unit
you will be able to perform a complete physical examination of the respiratory system.
READING ASSIGNMENT
Jarvis, Physical Examination and Health Assessment, 5th ed., Chapter 18, pp. 361-382.
AUDIO-VISUAL ASSIGNMENT
Jarvis, Physical Examination and Health Assessment DVD Series: Thorax and Lungs.
GLOSSARY
Study the following terms after completing the reading assignment. You should be able to cover the defini-
tion on the right and define the term out loud.
Alveoli..........................................functional units of the lung; the thin-walled chambers surrounded by
networks of capillaries that are the site of respiratory exchange of carbon
dioxide and oxygen
Angle of Louis .............................manubriosternal angle, the articulation of the manubrium and body of
the sternum, continuous with the second rib
Apnea...........................................cessation of breathing
Asthma ........................................an abnormal respiratory condition associated with allergic hypersen-
sitivity to certain inhaled allergens, characterized by bronchospasm,
wheezing, and dyspnea
Atelectasis ...................................an abnormal respiratory condition characterized by collapsed, shrunken,
deflated section of alveoli
Bradypnea...................................slow breathing, 10 breaths per minute, regular rate
Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT, Fifth Edition, Student Laboratory Manual. 153
Copyright © 2008, 2004, 2000, 1996 by Saunders, an imprint of Elsevier Inc. All rights reserved.
154 UNIT 3 Physical Examination
Bronchiole ..................................one of the smaller respiratory passageways into which the segmental
bronchi divide
Bronchitis ...................................inflammation of the bronchi with partial obstruction of bronchi due to
excessive mucus secretion
Bronchophony............................the spoken voice sound heard through the stethoscope, which sounds
soft, muffled, and indistinct over normal lung tissue
Bronchovesicular .......................the normal breath sound heard over major bronchi, characterized by
moderate pitch and an equal duration of inspiration and expiration
Chronic obstructive
pulmonary disease (COPD) ......a functional category of abnormal respiratory conditions characterized
by airflow obstruction, e.g., emphysema, chronic bronchitis
Cilia..............................................millions of hairlike cells lining the tracheobronchial tree
Consolidation.............................the solidification of portions of lung tissue as it fills up with infectious
exudate, as in pneumonia
Crackles.......................................(rales) abnormal, discontinuous, adventitious lung sounds heard on
inspiration
Crepitus.......................................coarse crackling sensation palpable over the skin when air abnormally
escapes from the lung and enters the subcutaneous tissue
Dead space...................................passageways that transport air but are not available for gaseous
exchange, e.g., trachea and bronchi
Dyspnea.......................................difficult, labored breathing
Egophony ....................................the voice sound of “eeeeee” heard through the stethoscope
Emphysema.................................the chronic obstructive pulmonary disease characterized by enlarge-
ment of alveoli distal to terminal bronchioles
Fissure .........................................the narrow crack dividing the lobes of the lungs
Fremitus ......................................a palpable vibration from the spoken voice felt over the chest wall
Friction rub.................................a coarse, grating, adventitious lung sound heard when the pleurae are
inflamed
Hypercapnia ...............................(hypercarbia) increased levels of carbon dioxide in the blood
Hyperventilation........................increased rate and depth of breathing
Hypoxemia..................................decreased level of oxygen in the blood
Intercostal space.........................space between the ribs
Kussmaul’s respiration..............a type of hyperventilation that occurs with diabetic ketoacidosis
Orthopnea...................................ability to breathe easily only in an upright position
Paroxysmal
nocturnal dyspnea .....................sudden awakening from sleeping with shortness of breath
Percussion................................... striking over the chest wall with short sharp blows of the fingers in order
to determine the size and density of the underlying organ
Pleural effusion ..........................abnormal fluid between the layers of the pleura
Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT, Fifth Edition, Student Laboratory Manual.
Copyright © 2008, 2004, 2000, 1996 by Saunders, an imprint of Elsevier Inc. All rights reserved.
C H A P T E R 18 Thorax and Lungs 155
STUDY GUIDE
After completing the reading assignment and the audio-visual assignment, you should be able to answer
the following questions in the spaces provided.
1. Describe the most important points about the health history for the respiratory system.
Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT, Fifth Edition, Student Laboratory Manual.
Copyright © 2008, 2004, 2000, 1996 by Saunders, an imprint of Elsevier Inc. All rights reserved.
156 UNIT 3 Physical Examination
Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT, Fifth Edition, Student Laboratory Manual.
Copyright © 2008, 2004, 2000, 1996 by Saunders, an imprint of Elsevier Inc. All rights reserved.
C H A P T E R 18 Thorax and Lungs 157
12. When comparing the anterior-posterior diameter of the chest to the transverse diameter, what is the
expected ratio?
What is the significance of this?
15. During percussion, which sound would you expect to predominate over normal lung tissue?
17. List 5 factors that can cause extraneous noise during auscultation.
1.
2.
3.
4.
5.
Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT, Fifth Edition, Student Laboratory Manual.
Copyright © 2008, 2004, 2000, 1996 by Saunders, an imprint of Elsevier Inc. All rights reserved.
158 UNIT 3 Physical Examination
Draw in the lobes of the lungs and label their landmarks on the following two illustrations.
Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT, Fifth Edition, Student Laboratory Manual.
Copyright © 2008, 2004, 2000, 1996 by Saunders, an imprint of Elsevier Inc. All rights reserved.
C H A P T E R 18 Thorax and Lungs 159
REVIEW QUESTIONS
This test is for you and is intended to check your own mastery of the content. Answers are provided in
Appendix A.
Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT, Fifth Edition, Student Laboratory Manual.
Copyright © 2008, 2004, 2000, 1996 by Saunders, an imprint of Elsevier Inc. All rights reserved.
160 UNIT 3 Physical Examination
6. Auscultation of breath sounds is an impor- 9. Upon examining a patient’s nails, you note
tant component of respiratory assessment. that the angle of the nail base is > 160 degrees
Select the most accurate description of this and that the nail base feels spongy to palpa-
part of the examination. tion. These findings are consistent with:
a. Hold the bell of the stethoscope against the a. adult respiratory distress syndrome.
chest wall, listen to the entire right field, b. normal findings for the nails.
then the entire left field. c. chronic, congenital heart disease and
b. Hold the diaphragm of the stethoscope COPD.
against the chest wall; listen to one full res- d. atelectasis.
piration in each location, being sure to do
side-to-side comparisons. 10. Upon examination of a patient, you note a
c. Listen from the apices to the bases of each coarse, low-pitched sound during both inspi-
lung field using the bell of the stethoscope. ration and expiration. This patient complains
d. Select the bell or diaphragm depending of pain with breathing. These findings are
upon the quality of sounds heard; listen consistent with:
for one respiration in each location, mov-
a. fine crackles.
ing from side to side.
b. wheezes.
c. atelectatic crackles.
7. Select the best description of bronchovesicu-
d. pleural friction rub.
lar breath sounds:
a. high pitched, of longer duration on inspi- 11. In order to use the technique of egophony, ask
ration than expiration. the patient to:
b. moderate pitch, inspiration equal to expi-
a. take several deep breaths, then hold for
ration.
5 seconds.
c. low pitched, inspiration greater than expi-
b. say “eeeeee” each time the stethoscope is
ration.
moved.
d. rustling sound, like the wind in the trees.
c. repeat the phrase “ninety-nine” each time
the stethoscope is moved.
8. After examining a patient, you make the follow-
d. whisper a phrase as auscultation is per-
ing notation: Increased respiratory rate, chest
formed.
expansion decreased on left side, dull to percus-
sion over left lower lobe, breath sounds louder
12. When examining for tactile fremitus, it is
with fine crackles over left lower lobe. These
important to:
findings are consistent with a diagnosis of:
a. have the patient breathe quickly.
a. bronchitis.
b. ask the patient to cough.
b. asthma.
c. palpate the chest symmetrically.
c. pleural effusion.
d. use the bell of the stethoscope.
d. lobar pneumonia.
13. The pulse oximeter measures:
a. arterial oxygen saturation.
b. venous oxygen saturation.
c. combined saturation of arterial and
venous blood.
d. carboxyhemoglobin levels.
Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT, Fifth Edition, Student Laboratory Manual.
Copyright © 2008, 2004, 2000, 1996 by Saunders, an imprint of Elsevier Inc. All rights reserved.
C H A P T E R 18 Thorax and Lungs 161
CLINICAL OBJECTIVES
1. Demonstrate knowledge of the symptoms related to the respiratory system by obtaining a regional
health history from a peer/patient.
3. Using a grease pencil, and with peer’s permission, draw lobes of the lungs on a peer’s thorax.
4. Demonstrate correct techniques for inspection, palpation, percussion, and auscultation of the respira-
tory system.
Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT, Fifth Edition, Student Laboratory Manual.
Copyright © 2008, 2004, 2000, 1996 by Saunders, an imprint of Elsevier Inc. All rights reserved.
162 UNIT 3 Physical Examination
6. Record the history and physical examination findings accurately, reach an assessment of the health
state, and develop a plan of care.
INSTRUCTIONS
Gather your equipment. Wash your hands. Clean the stethoscope endpiece with an alcohol wipe. Practice
the steps of the examination of the thorax and lungs on a peer or on a patient in the clinical area. Record
your findings using the regional write-up sheet. The front of the sheet is intended as a worksheet; the back
of the sheet is intended for a narrative summary using the SOAP format.
NOTES
Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT, Fifth Edition, Student Laboratory Manual.
Copyright © 2008, 2004, 2000, 1996 by Saunders, an imprint of Elsevier Inc. All rights reserved.
C H A P T E R 18 Thorax and Lungs 163
Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT, Fifth Edition, Student Laboratory Manual.
Copyright © 2008, 2004, 2000, 1996 by Saunders, an imprint of Elsevier Inc. All rights reserved.
164 UNIT 3 Physical Examination
Objective (Physical exam findings) Use the drawing to record your findings
Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT, Fifth Edition, Student Laboratory Manual.
Copyright © 2008, 2004, 2000, 1996 by Saunders, an imprint of Elsevier Inc. All rights reserved.