Nursing Assessment of the Respiratory System: Theory

00:01 Now we're moving and we've gotten past our head and neck.

00:04 Now we're getting to our chest.

00:07 So here is the portion, when we're going to look at the thorax that includes the lungs and the heart.

00:12 So when we're looking at our lungs, don't forget to listen or auscultate, we're going to get our lung sounds, we're gonna see how hard their work of breathing is.

00:21 Is that labored? Is that fast? What's their pattern and what's their diaphragm doing? Also, we look at their heart, we're gonna look at what their pulses like, and also when he sort of heart tones? So now let's take a look at anatomical landmarks.

00:36 Now, these are meaningful points on the body, that they're the same in all people.

00:41 Now, this is really helpful in describing maybe where we auscultate the heart, for example.

00:47 So now, let's take a look at some really common landmarks that you might run across.

00:52 If you take a look at this image, you see the black line running through the middle of the chest.

00:57 Therefore, we call it mid.

00:59 And of course, you see it running here through the sternum.

01:01 All the time, we call this anatomical landmark, the midsternal.

01:06 Now, on this next line that you see here, notice that first word you see anterior.

01:11 Now as a nurse, a nursing student or any health care provider, it's really important that you remember anterior is front, posterior is back.

01:20 So here we're on the anterior side of the body, so towards the front.

01:24 And you also see axillary, so anytime you hear that term, think of armpit.

01:30 So this is the front side anterior axillary line.

01:34 And of course, you have one on both sides.

01:36 Correct? Right and left.

01:39 Now next, when you see midclavicular, think about mid, and you see that root word there in this it says clavicular, or otherwise clavicle.

01:49 So if you take a look at this anatomical landmark, you find the patient's clavicle and really just go down the middle here, this is what we call the midclavicular line.

01:59 And of course, this can repeat on the other side as well.

02:03 Now, taking a look at this next image, we're looking at a little bit different view here.

02:08 So we had talked about this before you remember anterior is towards the front.

02:12 And of course, as you see here, poterior is towards the back.

02:15 So this is just the other view of the axillary line.

02:18 So running through that armpit on the backside of the patient's body.

02:23 Now next, as you see here, this is another way to look at this is the anterior side and comparison of the axillary line as well, running through that armpit area.

02:33 Now also, you see here, if you split the difference between the two, especially when you see the patient in a side view like this, in the middle of the axillary, or where the armpit would run, we call this the midaxillary line.

02:49 Now, when assessing the patient's chest and their thorax, palpation is a great assessment method that we can use.

02:56 Now, before we listen or auscultate, we may need to feel the patient's chest and their ribs for asymmetry, but you've got to be really careful here like you see in the image.

03:08 So as you can imagine, if you assess the chest and you see asymmetry like this, that is not normal. So be careful when you palpate.

03:17 Now next, you may see retractions.

03:20 Now, retractions kind of mean that there's this skeletal like appearance when you look at the patient's chest.

03:26 Meaning you can see the ribs and part of the chest or the skin sinks in, that is not normal.

03:32 So asymmetry and retractions are not normal.

03:35 This can mean trauma, or the patients in respiratory distress.

03:40 Now, let's talk about auscultation of the lungs.

03:43 This is so important.

03:45 We're going to talk here on how we actually do the auscultation and perform this.

03:50 Now, please don't forget to compare both sides, meaning anterior and posterior, and the upper and lower lobes.

03:59 So this is really important.

04:01 And many times you're going to see this in nursing where you see the nurse just listen quickly and go.

04:07 Now, it's really important that you compare upper, lower, anterior, and posterior, because we need to check for what we call adventitious lung sounds.

04:17 Adventitious is just a fancy word of abnormal lung sounds.

04:22 So the reason why we want to listen to both: upper, lower,back, front, many times you'll actually catch in your pneumonia patients that crackles actually develop in the back in the bases of the lungs.

04:35 So, as you can imagine setting up and being able to listen to the front and the back, take some strength and mobility of your patient.

04:43 If they can't do this, you can always just have your patient roll and hold on to the side rail or get assistance and check their posterior lung fields.

04:53 Now, let's talk about adventitious lung sounds.

04:56 Or again, just a fancy word for abnormal lung sounds.

05:01 Now, just think about if you took your own stethoscope, put it to your chest, hopefully you have none of these and you breathe in, and breathe out.

05:09 You should just hear that normal inspiration and expiration.

05:13 That's one.

05:14 Now, if you hear some sort of popping sound or like rice crispy, we call that crackles.

05:20 That usually means there's some wetness or mucus in there and that's abnormal.

05:26 Next, you may hear the word a rhonchi.

05:28 This is more really low pitch more coarse, kind of like a snoring or a moaning sound, and this is also abnormal.

05:37 Now, you're probably going to hear rhonchi more on expiration like inhalation out, then breath in.

05:44 Now, wheezes are actually pretty common, and sometimes you're going to hear this high pitched.

05:49 You can hear this with your asthmatic patients.

05:52 Sometimes if I run too much, I may start wheezing myself.

05:55 It's that high pitch musical squeaking that's actually abnormal in your patients and we need to note this.

06:01 Now lastly, you may hear the word pleural rub.

06:04 This really just kind of sounds like two pieces of rubber rubbing together.

06:09 So again, if you take a look at this slide, all of these are adventitious lung sounds.

06:14 They need to be monitored, check for changes documented, and reported to the physician.