inspect the chest
without clothes on; 1st assess shape and size; 2nd check for symmetry; 3rd thoracic landmarks; 4th color of skin; 5th check for
... [Show More] supernumerary nipples; 6th superficial venous patterns; and 7th observe for rib prominence
thoracic landmarks
midline trachea, costal angle, angle of ribs, intercostal spaces, suprasternal notch
symmetry of chest
thoracic expansion at costal angle, w/o use of accessory muscles
hx questions for cc of resp issue
What is the nature of your cough?; Do you produce any sputum?; Is your cough related to activity?; What position are you most comfortable in?; How many pillows do you sleep with at night?; Is your SOB related to activity?
normal respirations
rate between 12 to 20/min; ratio of resp to heart beats= 1:4; pt should breathe easily, regularly w/o apparent distress; pattern should be even, not too shallow or too deep
hypopnea
term for abnormally shallow respirations
tachypnea
term for resp rate greater than 20, but consistent and may occur during hyperventilation; often a symptom of pain
bradypnea
term for resp rate less than 12; may indicate neurologic or electrolyte disturbances, infection, or conscious response to protect against the pain of pleurisy or other irritative pneumonia. Can also be 2/2 level of cardio fitness
hyperventilation
term for fast and deep, heavy respirations, can be caused by exercise, anxiety, and CNS and metabolic diseases
hyperpnea
term for abnormally deep respirations
kussmaul respirations
deep and mostly rapid respirations, used to describe resp effort of metabolic acidosis
cheyne stokes respirations
regular breathing with intervals of apnea by crescendo decrescendo breathing; can be seen in sleeping pts, but mostly pts who are very ill, esp with brain damage
biot respirations
irregular breathing that varies in depth and is interrupted irregularly by intervals of apnea; associated with severe and persistent increased intracranial pressure, resp compromise from drug poisoning, or brain damage at the medulla and generally equals poor prognosis
peripheral areas related to respiratory assessment
observe the lips and nails for cyanosis or pallor; lips for pursing; fingers for clubbing; and alae nasi for flaring
pleural friction rub
dry, rubbing, or grating sound; palpable, coarse, grating vibration; usually on inspiration; caused by inflammation of the pleural surfaces; think feel of leather rubbing on leather
thoracic expansion
stand behind patient and place thumbs along spinal process at level of 10th rib, with palms lightly in contact with the posterolateral surfaces; watch the thumbs during quiet and deep breathing; loss of symmetry = problem on either 1 or both sides.
crepitus
crackly/crinkly sensation that can be palpated and heard, a gentle bubbly feeling; indicates air in the subcutaneous tissue from a rupture somewhere in the resp system, or infection with gas producing organism
palpating the chest and trachea
palpate the throracic muscles and skeleton; feeling for pulsations, areas of tenderness, bulges, depressions, masses, and unusual movement
tactile fremitus
palpable vibration of the chest wall that results from speech or other verbalizations. best felt posteriorly and laterally at the level of the bifurcation of the bronchi; have patient say "99" while you palpate with palmer surface of fingers or ulner aspect of the hand; use firm, light touch
abnormal tactile fremitus
decreased of absent fremitus may be caused by excess air in lungs or may indicate emphysema, pleural thickening, or effusion, massive pulm edema, or bronchial obstruction. Increased fremitus often coarser or rougher in feel, caused by presence of fluids or solid mass within the lungs.
7 characteristics of enlarged lymph nodes
location, size and shape, consistency, mobility, discreteness, tenderness, and warmth
occipital lymph nodes
lymph nodes at the base of the skull
postauricular lymph nodes
lymph nodes over the mastoid process, behind the ear
preauricular lymph nodes
lymph nodes in front of the ear
parotid and retropharyngeal lymph nodes
lymph nodes at the angle of the mandible (tonsillar)
submandibular lymph nodes
lymph nodes halfway between the angle and tip of the mandible
submental lymph nodes
lymph nodes in the midline behind the tip of the mandible
superficial cervical lymph nodes
lymph nodes at the sternocleidomastoid muscle
posterior cervical lymph nodes
lymph nodes along the anterior border of the trapezius muscle
cervical lymph nodes
lymph nodes deep to the the sternocleidomastoid, must probe gently w/ your thumb and fingers around the muscle
supraclavicular area lymph nodes
lymph nodes that you must probe deeply in the angle formed by the clavicle and sternocleidomastoid muscle, common sites for metastatic disease
axillary lymph nodes
lymph nodes found by supporting pt's forearm w/ your non exam arm; and by bringing the palm of your exam hand into the axilla. Let the soft tissues roll b/w your fingers and the pt's chest wall and muscles. Rotate your fingertips and palm to feel for the nodes.
epitrochlear lymph nodes
lymph nodes found by supporting pt's arm in one hand as you explore with your other hand in the groove of the elbow b/w the triceps and biceps muscles
inguinal lymph nodes
lymph nodes found by having the patient lie supine, feel for the superior inguinal lymph nodes (femoral) that lie close to the surface over the inguinal canals. Assess the inferior superficial inguinal lymph nodes which lie deeper in the groin
6 characteristics of skin assessment
color, uniformity, thickness, symmetry, hygiene, and lesions
popliteal lymph nodes
lymph nodes found by flexing the supine pt's knee and wrapping your hand around it and palpate the fossa with your fingers
5 characteristics of the skin
moisture, temperature, texture, turgor, and mobility
documentation of skin lesion
size, shape, color, texture, elevation, depression, attachment, exudate, configuration, location and distribution, subtle details, transillumination, and shine a wood's lamp on it
nevi
normal skin lesions [Show Less]