Thorax+lungs assesment steps PDF

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Summary

These notes cover how to conduct a thorax and lung assessment on a patient. This is one of the four topics for the practical assessment of the unit. ...

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THORAX AND LUNGS 1) Ensure Patient Stable - Do DRSABCD - Talk to pt. if responds have airway + adequate breathing +circulation - Do vital signs Patient scenario: has a cough 2) COLDSPA Assessment - Character: what does the cough feel like? - Onset: when did the cough begin? - Location: where does the cough feel most strong? Does it radiate? - Duration: how long do the coughing episodes occur for? - Severity: how bad is the cough on a scale of 1-10? - Pattern: is it worse during the AM or PM? - Associated factors: what other symptoms do you have

3) Obtain History Medical: Are you on any medication? If so, what and how often? Family: Does anyone smoke in your house or around you? Surgical: Have you had any surgeries, biopsies or traumas on the chest or thorax? Lifestyle: Are you a smoker? Of cigarettes? Drugs? Or vape? Drugs: Do you take any illicit drugs? Gyna: N/a

4) Gather equipment (examination gown and drape, gloves, lighting,

stethoscope) 5) Privacy + quite environment 6) Hand hygiene 7) Explain procedure + gain consent

8) Position patient appropriately (high fowlers)

9) Inspection a) Positioning

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N: sitting upright w hand byside + relax A: leaning forward and lifting chest to breathe in tripod position. Why: may be in respiratory distress

b) Accessory muscles - Look at MS + clavicle line, trachea, trapezius, sternum, rib retraction - N: not using accessory muscles - A: using accessory muscles for inspiration. Using trapezius or shoulder. Why: chronic airway obstruction c) Quality of respirations - pattern, depth, effort, rate - N: equal insp + exp, relaxed, effortless, regular rhythm, regular RR of 12-20 - A: tachypnoea (increase effort, depth, rate, RR of over 24) d) Cough - Productive or non-productive? Sputum? e) Skin colour + condition - Assess face, lips, chest - N: even tone, no unusual discolouration - A: pallor, due to infection f) Assess peripheries + nails - N: warm, well perfused, cap refil < 2s, angle 2s. Why: dehydration + angle of > 180. Why: oxygen def g) Facial expression + nasal flaring - N: no nasal flaring or pursed lip breathing - A: flaring. Why: hypoxia h) Level of consciousness - Has deteriorated from when started - A: alert - A: drowsy. Why: hypoxia

11)

Palpate

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How: use 2 fingers in circular motion, starting above clavicles, move down and across then to lateral aspects

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Palpate for tenderness, sensation, warmth, pain, surface characteristic changes. Compare bilaterally N: no tenderness, pain, unusual sensations, no masses A: pain in intercostal spaces. Why: inflamed pleura

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10)

Percussion

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How: same as palpation. 2 TAPS EACH SPOT

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Done to produce sound waves to assess underlying structures N: resonance over lungs + dullness on dull structures A: abnormal dullness, indicating fluid or consolidation

11)

Auscultation

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Do on each spot for 1 inspiration + 1 expiration N: o Bronchial sounds over trachea & larynx. High pitch, hollow qual. Shorter insp, longer exp o Bronchovesicular over major bronchi. Moderate pitch, mixed qual. Insp same as exp o Vesicular over peripheral lung fields. Low pitch, breezy qual. Insp longer + louder than exp

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A: o Wheeze. High pitched musical sound, primarily on exp. It is where air passes through constricted passaged. Could be heard on acute asthma.

12)

Hand hygiene

13)

Document findings

14) ISOBAR handover...