How are lungs assessed?

9livesRN, BSN, RN · May 20, 2009

I am new to the nursing program and having trouble with a question...
How are lungs assessed? Describe the Methods? Describe the Techniques (for shape of the thorax/ sequence for auscultation)
I am confused between what to put for how lungs are assessed and methods? I initially put they are assessed by physical assessment of inspection of thorax, palpating the thorax, and percussing the thorax.
But then as I moved to methods it appears to be the same thing.
Can anyone help me differentiate and answer this properly? :typing

k these are the ones that i have on the top of my head, I just started medsurge, so i am "on the basics" still, but if you just started, you are not going to be so in deph!

so...

you want to observe the chest rising, if is symetric, count respiratory rate, see if it is labored or ok, shallow or deep, regular or irregular, then you check to see if they have a barrel formed chest (expanded lungs), if che chest raises when they are breathing, (on children the abdomen raise ) if there is pain on inspiration,

then you want to listen to the lungs start on the right side, because as a beginner at the hospital when i got a "noise lung" my stethoscope would pick the sound up and mix with hear sounds,

so i start on the right side, then left, and if it is too noise, i hear their neck (throat) so for i could find if what i was hearing was the echo of a nasal upper congestion

then i listen to the back - starting from left to right from top to bottom going like that game "snake"

you might hear a wheezing on the top portion

on the midle you hear the broncho visicular sounds, so if they have bronchitis you might hear something there

and cracle on the bottom- lower lobes (pneumonia)

you also want to see if they are using accessory muscles like around the clavicula, the intercostal (muscle between ribs) or the one under the sternum,

then you check their oxygen saturation, and if on oxygen, make notes on concentration, liters, and form like nasal canula, mask and so on.

then if they are coughing, I ask how often, is it dry? a lot coming out? which color (it should not have any color on the rainbow!) is there blood on it? does it hurt to cough? where does it hurt? do you cough all the time? only when you are trying to sleep? is it less when you are sitting up?

then ask them if they are drinking ok (that is if no fluid restriction) encourage hydration to thin out secretions, discourage viscous - thick drinks...

check on the meds that they are on...

and that is what I can think for now, hope it helped!

TheSquire, DNP, APRN, NP · May 20, 2009

Beyond the mantra of "Inspection, Palpitation, Percussion, and Auscultation" which is universal for every system (except abdominal, but you'll cover that later) you look for and use specific tests for each system. For example, under Inspection you'd do (just off the top of my head):

Inspection

Central Cyanosis

Peripheral Cyanosis

Capillary Refill Time

Nail Clubbing

Size/symmetry of the thoracic cavity

AP:width of thoracic cavity (should be 1:2 - if 1:1 then barrel chest)

Respiratory Rate

Use of accessory muscles for breathing

Paradoxical motion

Each of the other three sections have their own list of things to look for/evaluate. I'm sure your assessment textbook covers them in detail.

chare · May 20, 2009

respiratory assessment: adult and child

respiratory assessment in adults

respiratory assessment

i have only glanced at these, but they seem to be complete. hope these help. :specs:

Daytonite, BSN, RN · May 20, 2009

the nursing student assistance forum has a sticky thread specifically on physical assessment that you should check: https://allnurses.com/nursing-student-assistance/health-assessment-resources-145091.html - health assessment resources, techniques, and forms. my particular favorite for assessment skills is the ucsd practical guide to medicine website because it also includes pictures: http://meded.ucsd.edu/clinicalmed/introduction.htm

lung sounds can be heard and learned on these websites:

http://www.rale.ca/ - the r.a.l.e. lung sounds
http://www.med.ucla.edu/wilkes/intro.html - the auscultation assistant
http://medicine.osu.edu/exam/ - objective ii, listen to breath sounds

CarolS Boyz123 · May 20, 2009

A lot of information... Thanks for the help. I am certain some portions are going to show up on our written exams let alone checkoff assessments.