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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

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

Additional History for Pedi

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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)- Inspiration<Expiration Bronchovesicular (major bronchi)-

Inspiration = Expiration Vesicular (peripheral lung fields)-

Inspiration>Expiration

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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

� Round chest cavity in infants � Nose breathers until 3 mos � 30-40 breaths per minute for infants � Infants are belly breathers…

diaphragm is main muscle used � Look for nasal flaring, sternal and

intercostal retractions as signs of respiratory distress

� Remember: BACK TO SLEEP

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� Measures the arterial oxygenation saturation or SpO2.

� 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.

� A low saturation level could indicate a respiratory illness or other medical condition.

� Normal range for healthy person 97%-100%