Risk Factors for Pulmonary Disease

Smoking
Occupational/environmental exposure
Toxic fumes: chlorine, chemicals,
formaldehyde, plant nursery
chemicals, etc.
Dusts: carpentry work, asbestos, coal,
silica
Family hx: asthma
AIDS/ARDS

Books summary:
Vital Signs
 Pulse (HR) 60 to 100 Beats per minute.
 Respiratory rate 16 to 20 Breaths/min.
 Blood pressure (BP) 120/80
 Temperature 36-37.5

Observation:
 In what position is the patient (overall posture)?
o The trachea should be in midline, superior to the suprasternal notch.
o The right and left thorax should be symmetrical. Asymmetry
 What is the pattern of breathing?
 Is the patient using accessory muscles of inspiration for breathing at rest?
 Is the patient in pain?
 What is the patient's expression—relaxed, anxious and distressed?
 What equipment, drains or lines are attached to the patient?
 Are they obese?
 What is the shape of the chest wall?
 movement of the two sides of the chest
 Do they have a kyphosis or scoliosis?
 Color of skin, nail beds and mouth (cyanotic ... hypoxia).
 Is there edema?
 Digital clubbing?
PALPATION:
 Chest
o Symmetry
o Wall expansion (asking the patient to inspire deeply to total lung capacity)
o Pain over anterior, posterior, or lateral aspects of the chest wall can be identified
 Periphery
o Are the fingers and toes cold or warm to touch?
o Pain?
o Is there edema or Scars?

Auscultation
 Refers to the process of listening to sounds within the body
 Breath sounds occur when the air moves in the airways during inspiration
and expiration.
 A stethoscope is used to magnify these sounds.

Breath sound:
 Normal breath sounds occur in the absence of pathology termed vesicular.
This is soft low pitched.
 Abnormal Breath Sounds heard over unhealthy regions of the lung with
different pathologies:
o Bronchial Loud, hollow, or tubular high-pitched e.g. Consolidated
pneumonia, lobar collapse
o Decreased very quiet and barely audible e.g. emphysema,
contused lung, obese, elderly
 Adventitious Sounds "extra" lung sounds:
o Crackles are discontinuous sounds e.g. Atelectasis.
o Wheezes are continuous sounds e.g. asthma, COPD.
 Breath sounds may be totally absent or substantially diminished over a
portion of the lungs.

Patterns of Respiration
 Examination of the rate, rhythm, and depth of respiration.
 o Eupnea Is the term used to describe a normal
breathing pattern of 12 to 20 times per minute
o Hyperventilation Is an abnormally fast rate and depth of respiration .
o Hypoventilation Is a reduction in the rate and depth of respirations.
o Dyspnea Difficult or labored breathing.
o Orthopnea Is difficult breathing (dyspnea) when the patient is lying
down that is relieved by moving to a sitting or standing position.

o Tachypnea Is an abnormally fast RR, usually

greater than 24 breaths per minute.
o Bradypnea Is an abnormally slow RR,
usually 10 breaths or fewer per minute.
o Apnea Is the absence of respirations and is
usually transient.
o Cheyne-Stokes respiration Is characterized by
a period of apnea lasting 10 to 60 seconds, followed by gradually
increasing depth and frequency of respirations

Cough
 strength, depth, length, and frequency
 An effective cough is sharp and deep.
 A patient may have a weak, shallow cough as the result of pain or paralysis.

Cough Production
 Color (clear, yellow, green, blood-stained)
 Consistency (viscous, thin, frothy)
 Amount (minimal to copious)
 Odor (no odor to foul-smelling)