6. Anatomy Points to Remember
Lungs are symmetric
Lungs are divided into lobes
Right lung = 3 lobes
Left lung = 2 lobes
Primary muscles of respiration
Diaphragm – divides chest from abdomen
External intercostal muscles
Accessory muscles
7. Anatomy Points to Remember
Upper Airway
Nose, pharynx, larynx, intrathoracic trachea
Functions in respiration
Conduct air to lower airway
Filter to protect lower airway
Warm and humidify inspired air
8. Anatomy Points to Remember
Lower Airway
Trachea, bronchi, bronchioles
Functions in respiration
Conduct air to alveoli
Clear mucociliary structures
Alveoli
Functional unit
Gas exchange
Production of surfactant
9. Anatomy Points to Remember
Lower Airway
Trachea splits into left and right mainstem
bronchi which are further subdivided into
bronchioles
Right bronchus is shorted, wider and more
upright than the left
Functions in respiration
Conduct air to alveoli
Clear mucociliary structures
11. Cough
Onset – sudden, gradual
Duration
Nature – dry, moist, hacking, barking
Sputum – amount, color, odor
Severity – disrupts activities
Associated symptoms – sneezing, dyspnea, fever, chills,
congestion, gagging
What brings it on? – anxiety, talking, activity
What makes it better?
What has been tried? – medications, treatments
Anything similar in the past?
12. Shortness of Breath (SOB) /
Dyspnea
Onset – sudden, gradual
Duration
Severity – disrupts activities
Associated symptoms – night sweats, pain, chest
pressure, discomfort, ankle edema, diaphoresis, cyanosis
What brings it on? – position, time of day, exercise,
allergens, emotions
What makes it better?
What has been tried? – medications, inhalers, oxygen
Anything similar in the past?
13. History
Past Health History
Lung disease or breathing problems
Frequent severe colds, asthma, emphysema,
bronchitis, pneumonia, tuberculosis
Last PPD and/or chest x-ray
Allergies
Medication use
Family History
14. History
Personal and Social History
Tobacco
Alcohol
Drugs
Home environment
Occupational environment
Travel
Health Promotional Activities
21. Palpation
Thoracic Expansion (Excursion)
Place both thumbs at about 7th
rib
posteriorly along the spinal process
Extend the fingers of both hands
outward over the posterior chest wall
Have the person take a deep breath
and observe for bilateral outward
movement of thumbs
Normal: bilateral, symmetric
expansion
Abnormal: unilateral or unequal
Click on the pictures to view video
22. Palpation
Vocal (Tactile) Fremitus
Use palmar or ulnar surfaces of hands
Systematically position hands over both sides of
posterior chest
Have person repeat “1 – 2 – 3” or “99” as you
move from the apices to the bases
Normal: bilaterally symmetrical vibrations
Decreased or absent: obstruction of transmission
0bronchitis, emphysema)
Increased: consolidation (compression) of lung
tissue (pneumonia)
23. Auscultation
Auscultate in a systematic manner
Compare one side to the other
Listen one full respiration at each spot
Displace breast tissue to listen directly over
chest wall
DO NOTDO NOT listen through gowns, clothes, etc.
Place your stethoscope over bare skin
24. Auscultation
Evaluate posterior, lateral, and anterior chest
Instruct person to sit upright and breathe in
and out slowly through the mouth
This makes it easier to hear the air movement
Use the diaphragm of the stethoscope
Move from the apices to the bases
25. Auscultation
Evaluate for normal sounds
Sound Pitch Intensity Quality I:E Location
Bronchial High Loud Blowing/ hollow I < E Trachea
Bronchovesicula
r
Moderate Moderate Combination I = E Between scapulae,
1st
& 2nd
ICS lateral to
sternum
Vesicular Low Soft Gentle rustling/
breezy
I > E Peripheral lung
26. Auscultation
Evaluate for adventitious sounds
Sound Intensity/ Pitch I/E Quality Clear with Cough
Crackles/
Rales
Soft (fine)/ High
Loud (coarse)/ Low
I Discontinuous,
nonmusical, brief
Possibly
Wheeze High E Continuous musical
sounds
Possibly
Ronchi Low E Continuous snoring
sounds
Possibly
Pleural
Friction Rub
I & E Continuous or
discontinuous creaking or
brushing sounds
Never
Stridor I Continuous, crowing Never
27. Auscultation
Copy this URL into your Web browser to hear normal and abnormal lung sounds :
http://medocs.ucdavis.edu/IMD/420C/sounds/lngsound.htm
28. Developmental Variations
Neonates
Measure the chest circumference
Usually 2-3 cm smaller than head circumference
Chest is round (i.e. AP diameter = transverse)
Obligate nose breathers
Periodic breathing is common
Sequence of vigorous breathing followed by apnea
for 10-15 seconds
Only concern if it is prolonged or baby becomes
cyanotic
29. Developmental Variations
Neonates
Breathing is diaphragmatic and abdominal
Signs of compromise
Stridor (“crowing”)
Grunting
Central cyanosis
Flaring nares
30. Developmental Variations
Infants and Young Children
Roundness of the chest persist for first 2 years
Chest walls are thinner than the adult’s
Breath sounds may sound louder, and more
bronchial than the adult
Bronchovesicular sounds may be heard
throughout the chest
31. Developmental Variations
Pregnancy
Costal angle increases to about 105 degrees in
the third trimester
Dyspnea and orthopnea are common
Breathes more deeply
32. Developmental Variations
Older Adult
Chest expansion is often decreased
Bony prominences are marked
AP diameter is increased with respect to
transverse (but not 1:1)