Respiratory Assessment Inspection: y y y y y y y y Chest configuration Tracheal position Chest symmetry Skin condition, note any cyanosis Note

any nasal flaring Note any accessory muscle use Note any clubbing of fingers Assess respiratory rate and pattern

Palpation: y y Tactile fremitus- A palpable vibration. Use the palmer base (the ball) of the fingers of one hand and touch the persons hand while he or she repeats the words 99 or blue moon. Crepitus- A coarse, crackling sensation palpable over the skin surface. It occurs in subcutaneous emphysema when air escapes from the lung and enters the subcutaneous tissue Chest wall symmetry and expansion Pan, lumps, scars, lesions and ulcerations

y y

Percussion: y y y y Resonance (normal)- predominates in healthy lung tissue Hyperresonance- is found when too much air is present, as in emphysema or pneumothorax Dullness- signals abnormal density in lungs, as with pneumonia, pleural effusion, atelectasis or tumor Tympany

Ausculation: Three types of normal breath sounds can be heard over the lungs: y Bronchial- sound is harsh, hollow, tubular; location is in trachea and larynx y Bronchialvesicular- sound is mixed; location is over major bronchi where fewer alveoli are located; posterior, between scalpulae, especially on right; anterior, around upper sternum in first and second intercostals spaces y Vesicular-sound is rustling like the sound of the wind in the trees; location is over peripheral lung fields where air flows through smaller bronchioles and alveoli

Abnormal Breath Sounds Crackles: Light crackling, popping, intermittent, non-musical sounds, like hair rubbing together, heard on inspiration or expiration. Pleural friction rub; Low pitched, continual, superficial, squeaking or grating sound; like pieces of sandpaper being rubbed together; heard on inspiration and expiration. Rhonchi: Low-pitched, snoring, monophonic sounds heard primarily on expiration; may be heard throughout the respiratory cycle. Stridor: High-pitched, monophonic crowing sound heard on inspiration; louder in the neck than chest wall. Wheezes: High pitched, continual, musical or whistling sound heard on expirations; may be heard on inspiration and expiration