rhythmic pattern of breathing – dyspnea ▪ change in this patt
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Summary NURS 201 REVIEW FOR QUIZ 3
Chapter 16 (Respiratory)
Review picture from slide 8
• Respiratory cycle:
– Eupnea
▪ Regular, even, rhythmic pattern of breathing
– Dyspnea
▪ Change in this pattern producing shortness of breath or difficulty breathing
Slide 20,21,22,23,25, 26 (on this slide noted T3 spinous process, and 6th rib midaxillary line) (pictures
slides), 27
Patient positioned and gowned for assessment- Pt. should be in a siting position. Pt. should only have
a gown/drape. Stand in front of the pt. Lightening should be adequate to detect color differences,
lesions, & chest movements. Explain procedure & ask the pt. to breath normally. Observe skin color &
symmetry of structures. Inspect for chest configuration: The adult transverse diameter is twice that of
the anteroposterior diameter (AP: T=1:2)
Slide 46 (see picture) Pattern for palpating the posterior thorax- Explain that you will be palpating
(touching) the pt.s back to determine if there is any area of tenderness & to inform you if pain or
discomfort is felt in any area touched. Pain may occur with fibrous tissue or underlying structures:
pleura. Crepitus is a crunching feeling under the skin caused by air leaking into subcutaneous tissue.
Palpation for respiratory expansion- movement of the chest during breathing by placing the hands on
the lower chest & asking the pt. to take a deep breath. Place the palmar surface of your hand, with the
thumbs close to the vertebrae, on the chest at the T10. Pinch up some skin between your thumbs. Ask
the pt. to take & deep breath. The movement & pressure of the chest against your hands should feel
smooth & even. Your thumbs should move away from the spine & skin should move smoothly as the
chest moves with inspiration. Unilateral decrease or delay in expansion may indicate underlying
fibrotic or obstructive lung disease or pneumothorax.
Palpation for tactile fremitus using metacarpophalangeal joint area- Fremitus is the palpable vibration
on the chest wall when the client speaks (stronger over the trachea & diminishes over the bronchi &
almost non-existent over the alveoli. Use one palmar surface of the hand at the base of the fingers
surface; ask the pt. to repeat “ 99” or “1, 2, 3” in a clear loud voice. Decreased fremitus: sof t voice,
thick chest wall, obesity or underlying diseases: COPD, pleural effusion, fibrosis or tumor. Increased
fremitus occur with fluids in the lungs or infection
, Slide 49. Percussion of the posterior thorax
– Lungs
– Diaphragmatic excursion
( She mentioned slide 49)
Slide 50. There is the pattern of percussion (picture). Pattern for percussion: Posterior thorax. Place the
pleximeter in the intercostal space parallel to the ribs during percussion. Standing slightly to the side of
the pt.’s allows the pleximeter finger to lie more firmly on the chest as you move through the all the
thoracic areas. Percuss the apex of the left lung & then the apex of the right lung. Percuss from side to
side, comparing sounds. Percussion over solidified or fluid-filled areas will yield a dull sound.
Percussion over bone= flat sounds.
Slide 51. Diaphragmatic movement, percussion- (Diaphragmatic excursion)- It requires the use of a
marker & a ruler. As asymmetric diaphragm may indicate diaphragmatic paralysis or pleural effusion of
the elevated side. It involves two steps:
a) Determine the level of the diaphragm during quiet respiration by placing the pleximeter finger
above expected level of diaphragmatic dullness (T7 or T8) at the mid-scapular line. Percuss in steps
downward until dullness replace resonance on both sides of the chest. Mark those areas. (T10).
Asymmetric= diaph. Paralysis
Slide 52. Diaphragmatic movement, measurement-Measure the diaphragmatic movement by asking the
pt. to fully exhale. Starting at the previous markings on the left chest, percuss upward from dullness to
resonance. Mark that area. Then ask the pt. to inhale fully & hold it as you begin to percuss from the
level of the diaphragm downward moving from resonance to dullness. Mark that are and repeat the
other side.
Slide 54. There is picture for “Pattern for auscultation”. Posterior thorax- Posterior thorax- (the pattern
for auscultation is the same as that for percussion). In the obese pt. the skin folds must be moved & the
stethoscope placed firmly on the chest wall for auscultation. Asking the pt. to put the arm over the
head & lean toward the opposite side is often helpful in accessing the chest wall during auscultation.
Monitor pt.’s breathing: Prevent hyperventilation!
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