a nurse is auscultating the lungs of an adolescent who has asthma This is a topic that many people are looking for. caraimica.org is a channel providing useful information about learning, life, digital marketing and online courses …. it will help you have an overview and solid multi-faceted knowledge . Today, caraimica.org would like to introduce to you Lung Examination: A Practical Guide to the Physical Examination — BAVLS. Following along are instructions in the video below:
One exam is a physician skill essential to a high quality physician patient encounter. Examining examining each patient in a stepwise manner and similarly with every encounter reduces the chance missed important findings for good technique in practice. The physician can quickly locate abnormal findings that guide additional testing and management examination of the lungs includes the following components.
Preparation inspection. Auscultation. Percussion and palpation after the patients concerns have been discussed during the interview.
The physician asked permission to perform an examination. If not already done. It is appropriate to depart and ask the patient to change privately into an examination gown for the lung exam.
The patient should be disrobed from the waist up it is usually not necessary for female patients to remove their bra. So the information that youve provided is very helpful to get some more information. Id like to do a physical exam.
Now is that okay yes well what ill do is ill step out of the room. If you could remove all your clothes from the waist up you can leave your bra on and put on the gown that we have provided for you. And ill be back in a few minutes.
The examination should proceed in a stepwise manner and be performed the same way for each patient this systematic approach decreases the likelihood of missed. Findings inspection of the patient begins in the first moments of the patient encounter. The physician notices the ease with which the patient speaks as well as the pattern and depth of breathing during normal breathing and conversation.
The neck muscles are not visibly contracting in a patient. With normal respiratory effort during the examination. A closer view of these muscles can be obtained here.
The patient is intentionally breathing heavily to show the scalene and sternocleidomastoid muscles in action. This is referred to as accessory muscle use and as an abnormal finding indicating increased respiratory effort or respiratory distress.
So first im going to examine on your back. Why you breathe and do a few things here during visual inspection of a patients breathing. It is important to assess the symmetry of the patients chest wall.
Movement. During inspiration and exhalation just looking why you take a few deep breaths to make sure that both lungs inflate evenly can you make a few breaths chest expansion as the lungs volume increases during inspiration is referred to as chest excursion and a healthy patient chest excursion should always be symmetric in that the right and left sides of the chest wall expands. Equally asymmetric chest excursion suggests some type of lung or chest wall abnormality mention each new step of the exam to the patient just before its performance in terms that can easily understand avoiding medical jargon.
Im going to place my hands on your back. And ask you to breathe in a couple more times palpation of the patients chest wall. During deep breaths can enhance the physicians ability to detect asymmetry of chest excursion to do this place both of your hands on the patients mid back.
Using your thumbs to gently pull the skin toward the midline to create a visible skin fold. Then instruct the patient to take a few deep breaths and note. How the patients chest expands.
During inspiration and exhalation you stethoscopes are often cold to touch and can therefore be uncomfortable to patients once they are placed on the skin to ensure your patients comfort before touching the patient. With your stethoscope warm the diaphragm either by applying friction with your hand or by running it under warm water for a few seconds. Im going to take a listen to your breathing.
During auscultation instruct. The patient to take deep breaths through an open mouth. This minimizes air turbulence and sound generation from their upper airway auscultation of the chest is performed while firmly pressing the diaphragm of your stethoscope directly against the patients skin without any intervening clothing listen in a systematic pattern to all areas of the patients lungs starting from their upper chest wall and moving to the lower chest wall on the posterior lateral and anterior areas of their chest.
When auscultate in the patients posterior chest avoid listening over their scapula. Which can be displaced laterally by asking the patient to cross their arms in front of them would you please cross your arms in front of you in order to fully assess the patients posterior lung fields be sure to auscultate as far inferiorly as their eleventh or twelfth thoracic vertebra in female patients. This is usually inferior to their bra line for a lateral long auscultation listen to at least one location on each side of the lateral chest wall to preserve the patients modesty while allowing you to examine the anterior chest and stroke.
The patient on how to hold your gown. So now ill examine your front please use one hand to grab the bottom of your gown and bring it up to your collar as you breathe in i examine i may ask you to lift your breast with your other hand please make a few breaths through your mouth in and out can you slide your hand a little to the right there you go thank you for anterior lung auscultation.
Listen to at least two locations on each side of the upper anterior chest wall and at least one location on each side of the lower anterior chest wall. Please lift your breasts. Now now listen under female patients can use their hand to displace the breast upward to allow the physician to examine the entire interior law.
Thank you now we do the other side can you shift this hand over another couple deep breaths comparing exam findings from the left and right lungs is important diagnostically as this helps the physician to more easily identify areas of asymmetry. Which if present could indicate lung pathology. This can be accomplished by alternating lungs after each auscultation point or about auscultation of one complete lobe before moving to the same lobe on the other side now im just gonna tap on your back a little bit using my finger okay percussion of the chest wall provides information on the density of the underlying tissue.
The physician uses their third fingers to create a percussion note that is felt more than her percussionist performed using the physicians two middle fingers known as the flex emitter and the flexor. The flex scimitar is pressed firmly and directly against the patients skin. The plextor then strikes rapidly on our just distal to the di p.
Joint of the flex scimitar. The patient is not directly struck in this maneuver percussion is performed in the same locations. And with the same pattern as auscultation of the lungs.
Compare percussion notes from right to left to look for any evidence of asymmetry percussion is useful to help detect the presence and extent of pleural effusions. Which are flu collections in the intrapleural space. Just as tapping on a drum.
Feels and sounds differently from a bottle of water percussion of the chest varies from normal to abnormal conditions the last thing im gonna put my hands on your back while you talk and ill feel the vibrations that are made when youre speaking could you say blue balloon allow palpation of the chest wall is primarily used to assess vocal fremitus. Vocal fremitus refers to vibration in the lungs. And chest wall.
Created by speech. This provides information on the lungs ability to transmit sound vibrations may be increased. When the alveoli are filled with fluid such as in pneumonia.
Patients are asked to speak a diphthong or a two vowel sound. While the physician assesses the amount of vibration using their hands. When assessing fremitus press.
Firmly against the skin with either the ball of your palm or with your fifth metacarpal blue balloon assessing all lobes for vocal fremitus requires fewer examination sites than auscultation or percussion .
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