Pulmonary Assessment Lungs sounds: 3 lobes in the right lung, 2 lobes in the left (one less due to the cardiac notch)

Focused interview: Inquire about respiratory conditions such as asthma or emphysema

Inspection: Observe for signs of visible respiratory distress, breathing patterns, chest wall abnormalities

Respirations: Assess rate (breaths/minute), note characteristics, including depth, quality, and use of accessory muscles. Normal respirations are usually between 12-20 breaths per minute in adults

Abnormal respirations: Tachypnea (rapid respiration rate), bradypnea (slow respiration rate)

Abnormal lung sounds/patterns: Diminished lung sounds, Kussmaul’s respirations (deep, exaggerated respirations with increased tidal volume), Cheyne-Stokes respirations (periodic breathing or deep respirations followed by diminished breathing or apneic episodes), tripoding, use of accessory muscles, pursed-lip breathing

Signs respiratory distress in infants: Nasal flaring, substernal and intercostal retractions, paradoxical breathing

Long-standing/chronic hypoxia: Clubbing of the fingernails (digital clubbing) with spongy appearance in nail beds, barrel chest, and cyanosis of the lips, nose, oral mucosa, and nail beds

Adventitious lung sounds: Crackles (fine- high-pitched/short, or course- low-pitched/longer-lasting), rales (synonymous to crackles), rhonchi (low-pitched), wheezes (whistling sound, heard in asthma), stridor (high-pitched, predominantly inspiratory, may be indicative of emergency)

Breath sounds: Apical (heard up high, above the clavicles), bronchovesicular (heard hear major airways, including the trachea and bronchi), tracheal or bronchial/tubular (heard in the upper airway, have a harsh and tubular quality with the same intensity on both inspiration and expiration and a distinct gap between each, presenting as air blowing through a hollow tube), vesicular or alveolar (auscultated in the posterior lower lobes and present as low-pitched, soft breath sounds)

Abnormal vocal sounds: Egophony (vocalization of the letter “E” sounds like an “A” to the examiner), bronchophony (sound is clearly transmitted through the chest wall), whispered pectoriloquy (whispering sound is clearly transmitted through the chest wall)

Other abnormal sounds: Crepitation (sounds like saran wrap being crinkled), pleural rub (grating or creaking)

Lung Palpation Chest expansion: Should be symmetrical and even on both anteriorly and posteriorly, 3-5cm upon inspiration Trachea: Palpate for any lumps, masses, or tenderness Tactile fremitus: Palpate with the palm or ulnar surface of the hand for vibratory tremors, should be felt over the main stem

bronchi and progressively decrease toward the periphery Whispered pectoriloquy: The hand is paced on the back and the patient is asked to whisper in order to detect a vibration

Abnormal Lung Palpation Findings Loud tactile fremitus or vibration Crepitus: a coarse, crackling sensation over the skin surface heard over the anterior chest wall Subcutaneous emphysema: a crackling sensation is produced rom air in the tissues under the skin Point tenderness: may suggest rib fracture or pleural inflammation

Adventitious (Abnormal) Lung Sounds Crackles, fine or course, discontinuous. Fine: High pithed and short. Course: Low-pitched, longer-lasting Rhonchi: Low-pitched, both inspiratory and expiratory. Possible cause: Obstruction from secretions such as bronchitis Rales: Synonymous to crackles Stridor: High-pitched, predominantly inspiratory Wheezes: Whistling. Possible cause: Asthma