Health Assessment

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Reference Lines:



Midsternal line

Midclavicular line

Vertebral line

Scapular line

Anterior axillary line

Midaxillary line

Posterior axillary line

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The Thoracic Cavity



Mediastinum-middle section of the thoracic cavity



containing the esophagus, trachea, heart, and



great vessels



Pleural Cavities- located on either side of the

Mediastinum containing the lungs



Lung borders-



apex-anterior chest at the highest point



base-lower border

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The Lungs



Right Lung-



shorter than the left because of the underlying



liver





right lung has three lobes



Left Lung-



Narrower than the right because the heart



bulges to the left





left lung has two lobes

Pleurae



Pleurae- thin and slippery forms an envelope between

lungs and chest wall



Visceral pleura- lines outside of lungs



Parietal pleura- lines inside of the chest wall and

diaphragm



Costodiaphragmatic Recess-the pleurae extend 3 cm

below the level of the lungs, if this potential space

fills with air, lung expansion is compromised

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Trachea and Bronchial Tree



Trachea- lies anterior to the esophagus, beginning at

the cricoid cartilage in the neck and bifurcates just

below the sternal angle into the R & L bronchi. It

is about 10-11 cm long



Bronchi- two main branches leading from the trachea to the lungs

Functions of Respiration



Supplying oxygen to the body for energy production



Removing carbon dioxide as a waste product of energy reactions



Maintaining homeostasis (acid-base balance)





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Mechanics of Respiration:

Subjective Information:



History Questions

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Subjective Data



Dyspnea/Shortness of breath

Wheezes

Cough

Chest pain while breathing

Past history of respiratory infections

Past history of respiratory conditions

Lifestyle/Personal Habits



Smoking history



Environmental exposures



Medications – RX, OTC, herbal



Oxygen use or other breathing treatments



Additional History for Pedi

Subjective: Frequent colds? Coughing? Wheezing? Smokers in the home? Bottle feeding?

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Objective Information:



Physical Exam





Inspection:

Thoracic cage-



shape and configuration



AP to transverse diameter



neck and trapezius muscles





Respirations-



rate



effort



use of accessory muscles

Skin color

Person’s position

Facial expression

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Normal Adult AP to Transverse - 1:2 ratio

Pectus Excavatum – Funnel Chest

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Pectus Carinatum – Pigeon Chest

Scoliosis

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Palpation



Confirm symmetric expansion:

hands placed posterior chest wall with thumbs at

T9-T10 level (bottom of the rib cage)



Tactile fremitus:

increased=consolidation ie: pneumonia



decreased=obstruction ie: pneumothorax,

emphysema





Auscultation:

Assess normal Breath sounds

Identify adventitious sounds

Characteristics of normal breath sounds

Bronchial (Tracheal)- InspirationExpiration









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Note any adventitious (added) sounds





Discontinuous sounds (rales/crackles)

may indicate pneumonia, fibrosis, early heart

failure, bronchitis



• fine crackles: soft, high pitched, brief



• coarse crackles: louder, lower pitched

longer



listen in dependent areas, re-eval after cough





Continuous sounds: wheezes, rhonchi



• wheezes: narrowed airways (asthma,

COPD) high pitched, shrill



• rhonchi: secretions in large airways

low pitched, snore-like

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If there are any abnormal sounds and it is indicated assess for transmitted voice sounds - suggests consolidation





bronchophony: “99”





whispered pectoriloquy: whisper “1,2,3”





egophony: “ee” changes to “ay”







Bronchophony: have patient say 99 while listening with stethoscope over the chest wall

normal-muffled and indistinct

abnormal- clear (increased lungdensity/pathology)



Whispered Pectoriloquy; whisper phrase 1,2,3

normal-muffled and indistinct

abnormal-clear (increased lung density/pathology)

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Egophony: auscultate chest while patient phonates ee-ee-ee



Normal sound is ee-ee-ee

Abnormal sound is aa-aa-aa

ž Round

chest cavity in infants ž Nose breathers until 3 mos ž 30-40 breaths per minute for infants ž Infants are belly breathers… diaphragm is main muscle used ž Look for nasal flaring, sternal and intercostal retractions as signs of respiratory distress ž Remember: BACK TO SLEEP

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ž  Measures

the arterial oxygenation saturation or

SpO2. ž  Oxygen saturation refers to the level of oxygen carried by red blood cells through the arteries and delivered to internal organs. While red blood cells travel through the lungs, they are saturated with oxygen. ž  A low saturation level could indicate a respiratory illness or other medical condition. ž  Normal range for healthy person 97%-100%

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