Denise Coffey MSN, RN. Respiratory Assessment Structure and Function Subjective DataHealth History...
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Transcript of Denise Coffey MSN, RN. Respiratory Assessment Structure and Function Subjective DataHealth History...
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Denise Coffey MSN, RN
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Respiratory AssessmentStructure and FunctionSubjective Data—Health History QuestionsObjective Data—The Physical ExamAbnormal Findings
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Anterior Thoracic Cage
Slide 18-3
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Posterior
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Reference LinesMidsternal lineMidclavicular lineScapular lineVertebral lineAnterior, posterior,
midaxillary lines
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Reference Lines Anterior
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Reference Lines Posterior
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Lateral
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Structure and FunctionThoracic cavity
Mediastinum defined
Lobes of the lungs Anterior Posterior Lateral
Pleurae
Trachea and bronchial tree Location of trachea
and bronchi Dead space
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Structures of the Respiratory System
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Mechanics of RespirationFour functions of respiratory system
Changing chest size during respirationInspirationExpirationControl of respiration
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Mechanics of Respiration
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Subjective DataWhat would you want to know?
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Subjective DataCoughShortness of breathChest pain with breathingHistory of respiratory infectionsSmoking historyEnvironmental exposureSelf-care behaviors
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Objective Data- The Physical ExamPreparation
PositionDrapingTiming during a complete examinationCleaning stethoscope endpiece
Equipment neededStethoscopeSmall ruler marked in centimetersMarking penAlcohol swab
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Objective Data- The Physical ExamPosterior Chest—InspectThoracic cage
Shape and configuration of chest wallAnteroposterior/transverse diameterPosition of personSkin color and condition
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Objective Data- The Physical ExamPosterior Chest—PalpateSymmetric expansionTactile (or vocal) fremitus
TechniqueFactors that affect normal intensity of tactile fremitus
Palpate the entire chest wallPosterior Chest—PercussPredominant note over lung fieldsDiaphragmatic excursion
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Objective Data- The Physical ExamAnterior Chest—PalpateSymmetric chest expansionTactile fremitus Palpate the anterior chest wall
Anterior Chest—PercussPredominant note over lung fieldsBorders of cardiac dullness
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Objective Data- The Physical ExamAnterior Chest—AuscultateBreath sounds Abnormal breath sounds
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Objective Data- The Physical ExamAnterior Chest—AuscultateBreath sounds Abnormal breath sounds
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Expected Breath SoundsBreath sounds
TechniqueBronchial breath sounds—
characteristicsBronchovesicular breath sounds—
characteristicsVesicular breath sounds—
characteristics
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Abnormal Breath SoundsRhonchiWheezesCracklesStridorCroupPleural friction rub
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Listenhttp://www.youtube.com/watch?v=NnuaHGW
1cwU
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Measurement of Pulmonary FunctionPulse oxABGsPulmonary Function Tests
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Abnormal Findings Barrel chestScoliosisKyphosis
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Barrel Chest
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Scoliosis
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Kyphosis
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Abnormal FindingsCommon Respiratory ConditionsAtelectasisLobar pneumoniaBronchitisEmphysemaAsthma (reactive
airway disease)Pleural effusion thickening
Congestive heart failure
PneumothoraxPneumocystis carinii
pneumoniaTuberculosisPulmonary embolismAcute respiratory
distress syndrome (ARDS)
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InterventionsAmbulationIncentive Spirometer ( IS)RepositioningCoughing and Deep BreathingMedicationsEducation
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Case scenarioYou are caring for Mrs. Brown, a 75-year-old
retired school teacher who underwent repair of a right fractured femur. This is her first postoperative day on your clinical unit.
Upon auscultation of her posterior lung field bases, you hear a crackling noise upon inspiration. What is this sound, and what does it indicate?
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