pp tugas b.inggris 2

8/10/2019 Pp Tugas b.inggris 2

1/33

ASSESSMENT OF RESPIRATORY

SYSTEMGroup 3:

Ressy angella

Mardanis

Andesta

Fristy maizal

Saripah rein a

Frydola


2/33

Outlines anatomy and physiology of

respiratory system

Assessment of respiratory system

]

1 Position/Lighting/Draping 2 Inspection

2.1 Chest wall deformities 2.2 Signs of respiratory distress

3 Palpation

4 Percussion

5 Ausculation 5.1 Vocal fremitus (not usually done)
http://en.wikipedia.org/wiki/Respiratory_examinationhttp://en.wikipedia.org/wiki/Respiratory_examinationhttp://en.wikipedia.org/wiki/Respiratory_examinationhttp://en.wikipedia.org/wiki/Respiratory_examinationhttp://en.wikipedia.org/wiki/Respiratory_examinationhttp://en.wikipedia.org/wiki/Respiratory_examinationhttp://en.wikipedia.org/wiki/Respiratory_examinationhttp://en.wikipedia.org/wiki/Respiratory_examinationhttp://en.wikipedia.org/wiki/Respiratory_examinationhttp://en.wikipedia.org/wiki/Respiratory_examinationhttp://en.wikipedia.org/wiki/Respiratory_examinationhttp://en.wikipedia.org/wiki/Respiratory_examinationhttp://en.wikipedia.org/wiki/Respiratory_examinationhttp://en.wikipedia.org/wiki/Respiratory_examinationhttp://en.wikipedia.org/wiki/Respiratory_examinationhttp://en.wikipedia.org/wiki/Respiratory_examinationhttp://en.wikipedia.org/wiki/Respiratory_examinationhttp://en.wikipedia.org/wiki/Respiratory_examinationhttp://en.wikipedia.org/wiki/Respiratory_examinationhttp://en.wikipedia.org/wiki/Respiratory_examinationhttp://en.wikipedia.org/wiki/Respiratory_examinationhttp://en.wikipedia.org/wiki/Respiratory_examinationhttp://en.wikipedia.org/wiki/Respiratory_examinationhttp://en.wikipedia.org/wiki/Respiratory_examination


3/33

Anatomy and physiology The respiratory tract extends from the nose to

the alveoli and includes not only the air-conducting passages also but the blood supply

The primary purpose of the respiratory systemis gas exchange, which involves the transfer ofoxygen and carbon dioxide between theatmosphere and the blood.

The respiratory system is divided into twoparts: the upper respiratory tract and the

lower respiratory tract


4/33

The nose

pharynx adenoids

tonsils

epiglottis

larynx,

and trachea.

The upper respiratory tract includes


5/33

The lower respiratory tract

consists of

the bronchi,

Bronchioles

alveolar ducts and alveoli

With the exception of the right and left

main-stem bronchi, all lower airwaystructures are contained within thelungs.


6/33

The right lung is divided into three lobes

(upper, middle, and lower)

the left lung into two lobes(upper andlower)

The structures of the chest wall

(ribs, pleura, muscles of respiration) arealso essential


7/33


8/33

Equipment Needed

A Stethoscope


9/33

Surface markings of the lobes of the lung:

(a) anterior, (b) posterior, (c) right lateral and (d) left lateral.

(UL, upper lobe; ML, middle lobe; LL, lower lobe).

Ul

ml

a

b ll

ul

ll

ul

ll

ml


10/33

Position Lighting Draping

Position patient should sit upright on the examination table.

The patient's hands should remain at their sides. When the back is examined the patient is usually

asked to move their arms forward ( hug themsel fposi t ion)so that thescapulaeare not in the way ofexamining the upper lung fields.

Lighting- adjusted so that it is ideal. Draping- the chest should be fully exposed.

Exposure time should be minimized.
http://en.wikipedia.org/wiki/Scapulahttp://en.wikipedia.org/wiki/Scapula


11/33

The basic steps of the

examination

can be remembered with the

mnemonicIPPA: Inspection

Palpation

Percussion Auscultation


12/33

Health History

Any risk factors for respiratory disease

smoking pack years ppd X # years exposure to smoke history of attempts to quit, methods, results

sedentary lifestyle, immobilization

age

environmental exposure

Dust, chemicals, asbestos, air pollution obesity

family history


13/33

Cough

Type dry, moist, wet, productive, hoarse, hacking, barking, whooping

Onset

Duration Pattern

activities, time of day, weather Severity

effect on ADLs Wheezing

Associated symptoms

Treatment and effectiveness


14/33

sputum

amount

color

presence of blood (hemoptysis)

odor

consistency

pattern of production


15/33

Respiratory infections or diseases(URI) Trauma

Surgery

Chronic conditions of other systems

Past Health History


16/33

yamily Health Histor

Tuberculosis

Emphysema

Lung CancerAllergies

Asthma


17/33

Assessment System ( Head to Toe )

Inspection

Inspection procedures performed by nurses is as follows :

1 ) Chest Examination begins from the posterior chest and the patient must be in a state of

sitting .

2 ) Chest observed by comparing one side to the other .

3 ) Actions done from top to bottom4 ) Inspection of the posterior chest skin color and condition ( scarring , lesion , and mass )

and disorders of the spine ( kyphosis , scoliosis , and lordosis )

5 ) Record the number , rhythm , respiratory depth , and symmetry of chest movement .

6 ) Observation pernapsan types such as : nasal breathing or diaphragmatic breathing

and the use of

accessory muscles of respira .

7 ) When observing respiration , record inspirsi duration of phase ( I) and phase ekprisari

8 ) Observe the symmetry of chest movement . Movement disorders or inadequate

chest expansion indicates disease in the lung or pleura .


18/33

Inspection

Trachealdeviation (can suggest oftension pneumothorax

Chest wall deformities [

Kyphosis - curvature of the spine - anterior-posterior Scoliosis - curvature of the spine - lateral

Barrel chest - chest wall increased anterior-posterior;normal in children; typical of hyperinflation seen inCOPD

Pectus excavatum

Pectus carinatum
http://en.wikipedia.org/wiki/Vertebrate_tracheahttp://en.wikipedia.org/wiki/Tension_pneumothoraxhttp://en.wikipedia.org/wiki/Kyphosishttp://en.wikipedia.org/wiki/Scoliosishttp://en.wikipedia.org/w/index.php?title=Barrel_chest&action=edithttp://en.wikipedia.org/wiki/COPDhttp://en.wikipedia.org/wiki/Pectus_excavatumhttp://en.wikipedia.org/wiki/Pectus_carinatumhttp://en.wikipedia.org/wiki/Pectus_carinatumhttp://en.wikipedia.org/wiki/Pectus_excavatumhttp://en.wikipedia.org/wiki/COPDhttp://en.wikipedia.org/w/index.php?title=Barrel_chest&action=edithttp://en.wikipedia.org/wiki/Scoliosishttp://en.wikipedia.org/wiki/Kyphosishttp://en.wikipedia.org/wiki/Tension_pneumothoraxhttp://en.wikipedia.org/wiki/Vertebrate_trachea


19/33

Kyphosis

Thoracoplasty

with secondary

changes in the

spine. Pectus exacavatum


20/33


21/33

Signs of respiratory distress

Cyanosis - person turns blue

Pursed-lip breathing - seen in COPD (used toincrease end expiratory pressure)

Accessory muscle use ( scalene muscles)

Diaphragmatic paradox - thediaphragmmoves

opposite of the normal direction on inspiration;suspect flail segment in trauma

Intercostal indrawing
http://en.wikipedia.org/wiki/Cyanosishttp://en.wikipedia.org/wiki/Scalene_musclehttp://en.wikipedia.org/wiki/Diaphragm_(anatomy)http://en.wikipedia.org/wiki/Diaphragm_(anatomy)http://en.wikipedia.org/wiki/Scalene_musclehttp://en.wikipedia.org/wiki/Cyanosis


22/33

Palpation

Tactile fremitus

is vibration felt by palpation. Place your open palms againstthe upper portion of the anterior chest, making sure thatthe fingers do not touch the chest. Ask the patient torepeat the phrase ninety-nine or another resonantphrase while you systematically move your palms overthe chest from the central airways to each lungsperiphery.You should feel vibration of equally intensity onboth sides of the chest. Examine the posterior thorax in a

similar manner. The fremitus should be felt more stronglyin the upper chest with little or no fremitus being felt in thelower chest


23/33

Assessing chest expansion in expiration (left) and inspiration (right).

Direct percussion of the clavicles for

disease in the lung apices

Percussion over the anterior chest.


24/33


25/33

percussion

Nurses do percussion to assess pulmonary resonance , organ around him , and

development (excursion ) Percuss for 1-2 minutes diaphragm.

Types of percussive sounds there are two types is :

1 ) Sounds normal percussion

Resonant ( resonant ) : produced in normal lung tissue generally resonate

and low-pitched

dullness : generated above the heart or lungs

Tympany : produced on air-filled stomach generally musical .

2 ) Sound percussion abnormal

Hiperresonan : resonated lower than the resonant and raised in the abnormal

lung contains uadara .

flatness : its tone is higher than the dullness and percussion can be heard on

the thigh , where throughout the area containing the network .


26/33


27/33

Auscultation

To assess breath sounds, ask the patient to

breathe in and out slowly and deeply through

the mouth.

Begin at the apexof each lung and zigzagdownward between intercostal spaces.

Listen with the diaphragm portion of the

stethoscope.


28/33

Normal breath sounds

Note

Pitch

Intensity

Quality

Duration


29/33


30/33

Normal Breath Sounds

Bronchial:Heard over the trachea and mainstem bronchi (2nd-4thintercostal spaces either side of the sternum anteriorly and 3rd-6thintercostal spaces along the vertebrae posteriorly). The sounds aredescribed as tubular and harsh. Also known as tracheal breath

sounds. Bronchovesicular:Heard over the major bronchi below the clavicles in

the upper of the chest anteriorly. Bronchovesicular sounds heard overthe peripheral lung denote pathology. The sounds are described asmedium-pitched and continuous throughout inspiration and expiration.

Vesicular:Heard over the peripheral lung. Described as soft and low-pitched. Best heard on inspiration.

Diminished:Heard with shallow breathing; normal in obese patientswith excessive adipose tissue and during pregnancy. Can also indicatean obstructed airway, partial or total lung collapse, or chronic lungdisease.


31/33

additional breath sounds are

Wheezing.

Ronchi.

Pleural friction rub Crackles , divided into two types:

i . Fine crackles .

ii . Coarse crackles.


32/33

Tactile Fremitus

Ask the patient to say "ninety-nine" several

times in a normal voice.

Palpate using the ball of your hand.

You should feel the vibrations transmitted

through the airways to the lung.

Increased tactile fremitus suggestsconsolidation of the underlying lung tissues


33/33

Tactile Fremitus

pp tugas b.inggris 2

Documents