NURS612 Key Points to Review for Exam 2
Key Point to STUDENT NOTES
Review – Chest
/ Lungs
What are Do you have a cough?
examples of Is your cough sudden, gradual?
appropriate What is the duration of your cough?
history of present Please describe your cough. Is it dry, moist, wet, hacking, hoarse, barking,
illness questions whooping, bubbling, productive, nonproductive?
you may ask a Do you have sputum when you cough? What does the sputum look like? Clear,
patient with a purulent, blood-tinged, mostly blood, foul odor?
chief complaint How often do you cough? Occasional, regular, paroxysmal?
of a respiratory
Are you your cough related to time of day, weather, activities like exercise,
issue?
talking, deep breaths, or change over time?
Does your cough disrupt your sleep or conversation? Does it cause chest pain?
Do you have any associated symptoms? Like shortness of breath, chest pain
or tightness with breathing, fever, nasal congestion, noisy respirations,
hoarseness, gagging?
Have you been taking in medication to treat your symptoms, over the counter
medication, prescribed medication, or vaporizers?
Describe how you Inspect the chest from the front and back.
would inspect the 1. Assess its size and shape. The anteroposterior diameter (AP) is ordinarily
chest. How do less than the transverse diameter. AP diameter is expressed in thoracic
you describe the ratio. The AP diameter is shorter than the lateral diameter, ex: 1:2
size shape (A/P 2. Check for symmetry. You can use one side to compare with the other.
diameter) and 3. Consider the thoracic landmarks and observe the costal angle, angle of
symmetry of the the ribs and intercostal spaces.
chest? What are 4. Note the color of the skin, noting any cyanosis or pallor.
the thoracic 5. Check for supernumerary nipples.
landmarks? 6. Look for superficial venous patterns, which may signal a cardiovascular
disease.
7. Observe the prominence of the ribs as a clue to general nutrition.
Thoracic landmarks: anterior thorax, right lateral thorax, posterior thorax
Describe how you Assess respirations for two characteristics
assess the rate 1. Count the respiratory rate, which should be 12 – 20 breaths/min.
and quality of 2. Note the pattern (or rhythm) or respirations. The patient should
respirations? breathe easily and regularly and without distress. Chest expansion
What is normal should be bilaterally symmetrical.
and abnormal? Abnormal respirations
Tachypnea – persistent respiratory rate approaching 25 breaths/min
Bradypnea – rate slower than 12 breaths/min
Hyperpnea – deep breathing
Kussmaul breathing – deep, usually rapid breathing associated with
metabolic acidosis
Hypopnea – abnormally shallow respirations
Cheyne-Stokes respiration – regular breathing with intervals of apnea
1|Page
,NURS612 Key Points to Review for Exam 2
Key Point to STUDENT NOTES
Review – Chest
/ Lungs
followed by crescendo-decrescendo breathing
Biot respiration – irregular breathing that varies in depth and is
interrupted irregularly by interval of apnea
Describe your Look for clues to respiratory problems in four peripheral areas.
assessment of 1. Inspect the lips and nails for cyanosis
peripheral areas 2. Observe the lips for pursing
such as the lips 3. Check the fingers for clubbing
and nails as this 4. Inspect the alae nasi for flaring
relates to a
respiratory Any of these peripheral clues suggests pulmonary or cardiac difficulty.
assessment. Pursing of the lips, nasal flaring, and clubbing of the fingers are all abnormal
What is normal findings.
and abnormal?
Describe how you Palpate the thoracic muscles and skeleton, feeling for pulsations, tender
palpate the chest areas, bulges, depressions, masses, and unusual movement or positions.
and trachea. Expected findings: bilateral symmetry, some rib cage elasticity,
What are normal relative inflexibility of the sternum and xiphoid, and a rigid thoracic
and abnormal spine.
findings? What is Unexpected findings: crepitus (a crackly or crinkly sensation) and
tactile fremitus? pleural friction rub (a palpable, grating vibration).
What is thoracic
expansion? Palpate the trachea by placing a thumb along each side of the trachea and
comparing the space between it and the sternocleidomastoid muscles. The
trachea should be midline. A slight, barely noticeable deviation to the right is
not unusual.
Abnormal findings: an anterior mediastinal mass may compress the
trachea and compromise respiration. Patient may develop the harsh
sound of stridor with ore difficulty breathing. Instinctively, the patient
may sit up and lean forward in an attempt to relieve the compression –
that action is a clue to the possibility of such a mass (this was a
colored box under Clinical Pearl).
Evaluate thoracic expansion by placing your thumbs at the 10th rib and
watching for them to diverge during quiet and deep breathing. Then face the
patient and repeat this action with your thumbs along the costal margin and
xiphoid process. Your thumbs should move symmetrically.
Assess for tactile fremitus as the patient repeats numbers or words, such as
“99”. (Have a child repeat a phrase such as “Mickey Mouse” to encourage
cooperation.) Systematically palpate the front, back, and sides of the chest
with a light, firm touch and feel for chest wall vibration when the patient
speaks. Fremitus should be symmetrical.
Describe how you Percuss the chest directly or indirectly, comparing sides in three areas.
percuss the Posterior chest – percuss with the patient’s head bent forward and
2|Page
, NURS612 Key Points to Review for Exam 2
Key Point to STUDENT NOTES
Review – Chest
/ Lungs
chest. What are arms folded in front.
normal and Lateral chest – percuss with the patient’s arms raised.
abnormal Anterior chest – percuss with the patient in the same position. You
findings? What should hear resonance over all lung areas.
do the findings
indicate? Resonance, the expected sound, can usually be heard over all areas of the
lungs.
Hyperresonance associated with hyperinflation may indicate emphysema,
pneumothorax, or asthma.
Dullness or flatness suggests pneumonia, atelectasis, pleural effusion,
pneumothorax, or asthma.
How do you Measure diaphragmatic excursion (the movement of the thoracic diaphragm
measure that occurs with inhalation and exhalation):
diaphragmatic 1. Have the patient inhale deeply and hold their breath
excursion? What 2. Percuss down the scapular line to the lower border, where resonance
is a normal and changes to dullness
abnormal 3. Mark the point with a skin pencil
finding? What do 4. Have the patient take a few breaths, then exhale fully, and hold their
the findings breath
indicate? 5. Percuss up from the first point and mark where the tone changes from
dullness to resonance. Be sure to tell the patient to start breathing
6. Repeat these actions on the other side
7. Measure the distance between the marks on each side. Excursion
usually ranges from 3-5 cm.
The diaphragm is usually higher on the right than on the left because it sits
over the bulk of the liver. Its descent may be limited by several types of
pathologic processes; pulmonary (ex: as a result of emphysema), abdominal
(ex: massive ascites, tumor), or superficial pain (ex: fractured ribs).
What are the 3 Listen to the breath sounds, noting the intensity, pitch, quality, and
types of normal inspiratory and expiratory duration. 3 types of normal breath sounds:
breath sounds? 1. Vesicular sounds – low in pitch and intensity and occur over healthy
Where are they lung tissue
located on the 2. Bronchovesicular sounds – moderate in pitch and intensity and are
chest and heard over the major bronchi
describe the 3. Bronchial sounds – highest in pitch and intensity and should occur
sounds. only over the trachea
3|Page
Key Point to STUDENT NOTES
Review – Chest
/ Lungs
What are Do you have a cough?
examples of Is your cough sudden, gradual?
appropriate What is the duration of your cough?
history of present Please describe your cough. Is it dry, moist, wet, hacking, hoarse, barking,
illness questions whooping, bubbling, productive, nonproductive?
you may ask a Do you have sputum when you cough? What does the sputum look like? Clear,
patient with a purulent, blood-tinged, mostly blood, foul odor?
chief complaint How often do you cough? Occasional, regular, paroxysmal?
of a respiratory
Are you your cough related to time of day, weather, activities like exercise,
issue?
talking, deep breaths, or change over time?
Does your cough disrupt your sleep or conversation? Does it cause chest pain?
Do you have any associated symptoms? Like shortness of breath, chest pain
or tightness with breathing, fever, nasal congestion, noisy respirations,
hoarseness, gagging?
Have you been taking in medication to treat your symptoms, over the counter
medication, prescribed medication, or vaporizers?
Describe how you Inspect the chest from the front and back.
would inspect the 1. Assess its size and shape. The anteroposterior diameter (AP) is ordinarily
chest. How do less than the transverse diameter. AP diameter is expressed in thoracic
you describe the ratio. The AP diameter is shorter than the lateral diameter, ex: 1:2
size shape (A/P 2. Check for symmetry. You can use one side to compare with the other.
diameter) and 3. Consider the thoracic landmarks and observe the costal angle, angle of
symmetry of the the ribs and intercostal spaces.
chest? What are 4. Note the color of the skin, noting any cyanosis or pallor.
the thoracic 5. Check for supernumerary nipples.
landmarks? 6. Look for superficial venous patterns, which may signal a cardiovascular
disease.
7. Observe the prominence of the ribs as a clue to general nutrition.
Thoracic landmarks: anterior thorax, right lateral thorax, posterior thorax
Describe how you Assess respirations for two characteristics
assess the rate 1. Count the respiratory rate, which should be 12 – 20 breaths/min.
and quality of 2. Note the pattern (or rhythm) or respirations. The patient should
respirations? breathe easily and regularly and without distress. Chest expansion
What is normal should be bilaterally symmetrical.
and abnormal? Abnormal respirations
Tachypnea – persistent respiratory rate approaching 25 breaths/min
Bradypnea – rate slower than 12 breaths/min
Hyperpnea – deep breathing
Kussmaul breathing – deep, usually rapid breathing associated with
metabolic acidosis
Hypopnea – abnormally shallow respirations
Cheyne-Stokes respiration – regular breathing with intervals of apnea
1|Page
,NURS612 Key Points to Review for Exam 2
Key Point to STUDENT NOTES
Review – Chest
/ Lungs
followed by crescendo-decrescendo breathing
Biot respiration – irregular breathing that varies in depth and is
interrupted irregularly by interval of apnea
Describe your Look for clues to respiratory problems in four peripheral areas.
assessment of 1. Inspect the lips and nails for cyanosis
peripheral areas 2. Observe the lips for pursing
such as the lips 3. Check the fingers for clubbing
and nails as this 4. Inspect the alae nasi for flaring
relates to a
respiratory Any of these peripheral clues suggests pulmonary or cardiac difficulty.
assessment. Pursing of the lips, nasal flaring, and clubbing of the fingers are all abnormal
What is normal findings.
and abnormal?
Describe how you Palpate the thoracic muscles and skeleton, feeling for pulsations, tender
palpate the chest areas, bulges, depressions, masses, and unusual movement or positions.
and trachea. Expected findings: bilateral symmetry, some rib cage elasticity,
What are normal relative inflexibility of the sternum and xiphoid, and a rigid thoracic
and abnormal spine.
findings? What is Unexpected findings: crepitus (a crackly or crinkly sensation) and
tactile fremitus? pleural friction rub (a palpable, grating vibration).
What is thoracic
expansion? Palpate the trachea by placing a thumb along each side of the trachea and
comparing the space between it and the sternocleidomastoid muscles. The
trachea should be midline. A slight, barely noticeable deviation to the right is
not unusual.
Abnormal findings: an anterior mediastinal mass may compress the
trachea and compromise respiration. Patient may develop the harsh
sound of stridor with ore difficulty breathing. Instinctively, the patient
may sit up and lean forward in an attempt to relieve the compression –
that action is a clue to the possibility of such a mass (this was a
colored box under Clinical Pearl).
Evaluate thoracic expansion by placing your thumbs at the 10th rib and
watching for them to diverge during quiet and deep breathing. Then face the
patient and repeat this action with your thumbs along the costal margin and
xiphoid process. Your thumbs should move symmetrically.
Assess for tactile fremitus as the patient repeats numbers or words, such as
“99”. (Have a child repeat a phrase such as “Mickey Mouse” to encourage
cooperation.) Systematically palpate the front, back, and sides of the chest
with a light, firm touch and feel for chest wall vibration when the patient
speaks. Fremitus should be symmetrical.
Describe how you Percuss the chest directly or indirectly, comparing sides in three areas.
percuss the Posterior chest – percuss with the patient’s head bent forward and
2|Page
, NURS612 Key Points to Review for Exam 2
Key Point to STUDENT NOTES
Review – Chest
/ Lungs
chest. What are arms folded in front.
normal and Lateral chest – percuss with the patient’s arms raised.
abnormal Anterior chest – percuss with the patient in the same position. You
findings? What should hear resonance over all lung areas.
do the findings
indicate? Resonance, the expected sound, can usually be heard over all areas of the
lungs.
Hyperresonance associated with hyperinflation may indicate emphysema,
pneumothorax, or asthma.
Dullness or flatness suggests pneumonia, atelectasis, pleural effusion,
pneumothorax, or asthma.
How do you Measure diaphragmatic excursion (the movement of the thoracic diaphragm
measure that occurs with inhalation and exhalation):
diaphragmatic 1. Have the patient inhale deeply and hold their breath
excursion? What 2. Percuss down the scapular line to the lower border, where resonance
is a normal and changes to dullness
abnormal 3. Mark the point with a skin pencil
finding? What do 4. Have the patient take a few breaths, then exhale fully, and hold their
the findings breath
indicate? 5. Percuss up from the first point and mark where the tone changes from
dullness to resonance. Be sure to tell the patient to start breathing
6. Repeat these actions on the other side
7. Measure the distance between the marks on each side. Excursion
usually ranges from 3-5 cm.
The diaphragm is usually higher on the right than on the left because it sits
over the bulk of the liver. Its descent may be limited by several types of
pathologic processes; pulmonary (ex: as a result of emphysema), abdominal
(ex: massive ascites, tumor), or superficial pain (ex: fractured ribs).
What are the 3 Listen to the breath sounds, noting the intensity, pitch, quality, and
types of normal inspiratory and expiratory duration. 3 types of normal breath sounds:
breath sounds? 1. Vesicular sounds – low in pitch and intensity and occur over healthy
Where are they lung tissue
located on the 2. Bronchovesicular sounds – moderate in pitch and intensity and are
chest and heard over the major bronchi
describe the 3. Bronchial sounds – highest in pitch and intensity and should occur
sounds. only over the trachea
3|Page
