Thorax and Lung Assessment

Summary

Nurse Nancy introduces herself to Mr. Hoffman and explains that she will be assessing his respiratory system. She begins with a health history inquiry, noting he has no smoking history or lung problems. Nancy proceeds with a physical examination, observing normal respiratory rate and rhythm, symmetric chest shape, and absence of retractions. She palpates the chest for tenderness or abnormalities and checks for skin color changes. Nancy then auscultates lung sounds, moving from the trachea to the chest's anterior, lateral, and posterior areas, listening for normal vesicular breath sounds. The assessment concludes with normal findings.

Takeaways

• 😷 The nurse, Nancy, is conducting a respiratory system assessment for Mr. Hoffman.
• 🚬 Mr. Hoffman has no current or past history of smoking cigarettes or any other form of tobacco.
• 🏥 The patient denies any history of lung problems such as asthma, emphysema, or bronchitis.
• 🔍 The nurse begins with an inspection, noting Mr. Hoffman's respiratory rate and rhythm are within normal limits.
• 👀 The nurse observes no retractions or bulging of the interspaces, and the patient's posture is upright.
• 🔢 The anterior-posterior to transverse ratio of the chest is noted to be within the normal range of 2:1.
• 👐 During palpation, the nurse checks for tenderness, pain, and any abnormal bumps, bruises, or masses.
• 🌡 The nurse also inspects the skin for any signs of pallor, pick Hale, or cyanosis while palpating.
• 💪 The patient is asked to stand and perform a deep breath to assess chest expansion symmetry.
• 👂 Auscultation is performed to listen to lung sounds, starting at the trachea and moving across different lung areas.
• 🗣️ The patient is instructed to breathe deeply and through the mouth to facilitate clear lung sound auscultation.
• 🔊 Breath sounds heard over the trachea, sternum, and back are described as vesicular, indicating normal lung function.

Q & A

What is the purpose of the assessment being conducted by Nancy?

The purpose of the assessment is to evaluate Mr. Hoffman's respiratory system.

What are the two initial questions Nancy asks Mr. Hoffman?

Nancy asks if Mr. Hoffman currently smokes cigarettes and if he has ever smoked in the past.

What respiratory conditions is Nancy inquiring about in Mr. Hoffman's medical history?

Nancy inquires about any history of lung problems such as asthma, emphysema, and bronchitis.

What observations does Nancy make during the inspection phase of the assessment?

Nancy notes that Mr. Hoffman's respiratory rate is within normal limits, the rhythm is regular, respirations are deep, there are no retractions or bulging of the interspaces, and the chest is symmetric with a normal anterior-posterior to transverse ratio.

What does Nancy look for when she palpates Mr. Hoffman's chest?

Nancy palpates the chest to check for tenderness, pain, abnormal bumps, bruises, masses, and to observe the skin for any abnormalities such as pallor, pick Hale, or cyanosis.

How does Nancy assess the expansion of Mr. Hoffman's chest?

Nancy assesses chest expansion by placing her thumbs on the chest and asking Mr. Hoffman to take a deep breath in and out, observing the symmetrical movement of her hands.

What is the significance of auscultation in the respiratory assessment?

Auscultation is significant as it allows Nancy to listen to the lung sounds and identify any abnormal breath sounds that may indicate a respiratory issue.

What areas does Nancy auscultate during the assessment?

Nancy auscultates the trachea, the area near the sternum, the periphery of the chest, and the posterior area, comparing side to side as she goes down the chest.

What type of breath sounds does Nancy expect to hear over the trachea and the periphery of the lungs?

Nancy expects to hear bronchovesicular breath sounds over the trachea and vesicular breath sounds in the periphery of the lungs.

What does the absence of abnormal breath sounds during auscultation suggest about Mr. Hoffman's respiratory health?

The absence of abnormal breath sounds suggests that Mr. Hoffman's respiratory system is functioning normally, with no apparent respiratory issues detected during the assessment.

How does Nancy ensure that the auscultation process is thorough and accurate?

Nancy ensures thoroughness and accuracy by listening to a full breath in each spot, comparing side to side, and following a systematic pattern across the anterior, lateral, and posterior areas of the chest.

Outlines

00:00

👩‍⚕️ Nurse's Initial Assessment

The paragraph introduces a nurse, Nancy, who begins an assessment of Mr. Hoffman's respiratory system. She starts with a brief interview, asking about smoking habits and any history of lung conditions. Nancy proceeds with an inspection, noting Mr. Hoffman's respiratory rate and rhythm, the absence of retractions or bulging, and the symmetry of his chest. She also observes the anterior-posterior to transverse ratio of his chest, which is normal. Nancy then palpates Mr. Hoffman's chest, checking for tenderness, pain, or any abnormal bumps, and inspects his skin for pallor, pick Hale, or cyanosis. She asks Mr. Hoffman to stand and checks for symmetrical chest expansion. The assessment continues with auscultation, where Nancy listens to lung sounds at various points on the chest, comparing sides and using specific techniques for different areas.

05:14

👂 Auscultation Results and Conclusion

In this paragraph, Nancy concludes the auscultation part of the respiratory assessment. She listens for breath sounds over the trachea, the center near the sternum, and the upper back area, identifying vesicular breath sounds in these regions. She also auscultates the peripheral areas and the posterior, confirming vesicular breath sounds there as well. The paragraph ends with Nancy summarizing the findings of the respiratory assessment, indicating that the examination of the lungs is complete.

Keywords

💡Respiratory System

The respiratory system is a biological system consisting of specific organs and structures used for the process of respiration. In the video, the nurse is assessing the patient's respiratory system to ensure it is functioning properly. This system includes the lungs, trachea, bronchi, and other structures that facilitate the intake of oxygen and the release of carbon dioxide.

💡Assessment

Assessment in a medical context refers to the process of gathering information about a patient's health status. In the video, the nurse is conducting an assessment of Mr. Hoffman's respiratory system to determine its condition. This involves asking questions, observing, and performing physical examinations.

💡Smoking

Smoking is the act of inhaling and exhaling the smoke of burning tobacco or other substances. It is a significant risk factor for respiratory diseases. The nurse inquires about Mr. Hoffman's smoking history as part of the assessment, as smoking can lead to conditions like chronic obstructive pulmonary disease (COPD) and lung cancer.

💡Lung Problems

Lung problems refer to a range of conditions that affect the lungs, such as asthma, emphysema, and bronchitis. The nurse asks Mr. Hoffman about his history of lung problems to identify any pre-existing conditions that might affect his respiratory health.

💡Respiratory Rate

Respiratory rate is the number of breaths taken per minute. It is an important indicator of respiratory health. The nurse notes that Mr. Hoffman's respiratory rate is within normal limits, indicating that he is breathing at a healthy pace.

💡Rhythm

In the context of respiration, rhythm refers to the regularity and pattern of breathing. The nurse observes that Mr. Hoffman's breathing rhythm is regular, which is a sign of a healthy respiratory system.

💡Retractions

Retractions are the inward pulling of the chest wall during inhalation, often a sign of respiratory distress. The nurse notes the absence of retractions in Mr. Hoffman, which is a positive finding in the assessment.

💡Chest Expansion

Chest expansion refers to the outward movement of the chest wall during inhalation. The nurse checks for symmetrical chest expansion by having Mr. Hoffman take deep breaths, which is a measure of the lung's ability to fully expand and contract.

💡Palpation

Palpation is the act of examining by touch. In the video, the nurse palpates Mr. Hoffman's chest to check for tenderness, pain, or any abnormal lumps or masses. This is part of the physical examination to assess the condition of the respiratory system.

💡Auscultation

Auscultation is the medical practice of listening to the internal sounds of the body using a stethoscope. The nurse performs auscultation to listen to Mr. Hoffman's lung sounds, which can reveal information about the respiratory system's health. The nurse listens for normal breath sounds and any abnormal sounds that might indicate a problem.

💡Vesicular Breath Sounds

Vesicular breath sounds are the normal lung sounds heard during auscultation, indicative of air moving in and out of the alveoli. The nurse reports hearing vesicular breath sounds in Mr. Hoffman's lungs, which is a positive sign of healthy lung function.

Highlights

Introduction of the nurse and the purpose of the visit.

Consent obtained from Mr. Hoffman for the respiratory system assessment.

Inquiry about smoking habits to assess respiratory health.

Questioning about past lung problems to understand medical history.

Observation of respiratory rate and rhythm as part of the inspection.

Assessment of respiratory depth and absence of retractions or bulging.

Evaluation of the patient's posture and chest symmetry.

Measurement of the anterior posterior to transverse chest ratio.

Palpation of the chest to check for tenderness, pain, or abnormalities.

Inspection of the skin for pallor, pick Hale, or cyanosis.

Demonstration of chest expansion during deep breathing.

Auscultation of lung sounds starting at the trachea.

Use of a systematic pattern for listening to lung sounds.

Comparison of breath sounds side to side during auscultation.

Listening for vesicular breath sounds in the periphery and posterior.

Conclusion of the respiratory system assessment.

Transcripts

alright I'm entering the room and

washing my hands

hi mr. Hoffman my name is Nancy I'm

going to be your nurse this afternoon

and we're going to be doing a assessment

of your respiratory system is that okay

that's fine all right I want to start

out with two questions do you smoke

cigarettes no and have you ever smoked

snow do you have any history of lung

problems like asthma emphysema

bronchitis

okay all right good so I'm going to

proceed with the assessment first thing

that I'm going to do is I'm just going

to be observing and looking at the tests

and this is the inspection so I'm first

noting his respiratory rate is within

normal limits that's how fast he's

breathing and the rhythm is regular

meaning it's a nice normal regular

pattern I see respirations are deep I do

not see any retractions or bulging of

the interspaces I see you're sitting up

straight as opposed to leaning over

trying to catch your breath and I see

that the chest is symmetric I also

notice that the anterior posterior ratio

to the transverse ratio is two to one

which is

then I'm going to continue my inspection

also looking for terior Li at the

posterior chest same thing looking for

any abnormalities for the shape of the

chest which is within normal limits the

chest should be shaped like a cone all

right then I'm going to continue the

assessment by palpating the chest I'm

going to touch you and I'm going to

touch the chest all over things that you

know if you have any tenderness or pain

in any areas and lift up here and I'm

checking for anything abnormal bumps

bruises masses pain tenderness I'm

looking at the skin for anything

abnormal I'm looking at the color of the

skin while I'm doing this particularly

looking for pallor pick Hale or cyanosis

which would be blue and then can you

stand up for me so just turn around and

I'm going to check the expansion of the

chest by putting my thumb's right here

and then having can you take a big

breath in and out okay and you see my

hands move in and out do that one more

time in and out good

until the chest expands symmetrically

hempseed again

and then I'm going to continue with my

assessment by oskol teen lung sounds so

they start auscultation at the trachea

and then I want you to open your mouth

and breathe a little bit deeper than

normal in and out

not too deep this little bit deeper

but I'm going to continue

listening

I listen to a full breath in each spot

and I compare side to side as I go down

the chest

good are you okay filling my tent or

anything I feel fine

okay so just be normal for a second even

on a female patient you're going to

listen in this pattern okay round here

and then you can lift up to listen down

low so you can listen above the bra here

and below the bra across here and then

I'm going to listen on each side so left

lateral you lift your arm up listen in

two places big breath and again

all right you can you stand up for me

and then right laterally or not listen

in three spots

so on the right there's three lobes so

you listen in three places one two three

like a triangle and then posterior we're

going to listen starting at the very top

the AP sees of the lungs come way up

here a big breath open your mouth and

breathe in and out through your mouth

I compare side to side

and I'm going around the scapula

one more

okay good have a seat so over the

trachea I burn my fuel breath sounds

over this area the center near the

sternum and also in the back in the

upper area

I heard breckel vesicular breath sounds

and all the periphery out here and

posterior and all the periphery I hear

vesicular breath sounds alright so that

concludes our assessment of the farts

and lungs