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PHYSICAL EXAMINATION THORAX AND LUNGS Learning Objectives THE AGEING ADULT Respiratory muscle strength decreases after age 50. Decrease in elastic properties. The ageing lung is a more rigid structure that is harder to inflate.
Decreased vital capacity Increased residual volume Gradual loss of intraalveolar septa and decreased number of alveoli. Lung bases less ventilated – increases older person’s risk of dyspnoea with exertion beyond his/her usual workload.
The histological changes increase the older person’s risk of: Postoperative pulmonary complications - infection
SUBJECTIVE DATA
A clinical nurse specialist performs an assessment on a 57-year old male with dyspnoea: Duration – daily for 1 month Other symptoms – no complaint of chest pain; complains of fatigue; colour pink Respirations – 28/min, non-laboured Auscultation – diminished breath sounds in the bases with expiratory wheezing Analyse the above data and determine what relevant data are missing, and explain the importance of collecting the additional data.
Objective data
Configuration of the thorax ATELECTASIS (IMPAIRED EXPANSION)
The Posterior Chest
Inspect the posterior chest Neck and trapezius muscles should be developed normally for age and occupation Note the position the person takes to breathe Assess the skin colour & condition Confirm symmetric chest expansion. Unequal chest expansion occurs with marked atelectasis or pneumonia, pneumothorax or thoracic trauma such as #ribs. Pain accompanies deep breathing when the pleurae are inflamed. Tactile fremitus
Auscultate the posterior chest Bronchial – high pitch, loud, inspiration<expiration, located – trachea & larynx. Bronchovesicular – moderate pitch, moderately loud, insp.=exp., over major bronchi.
Vesicular – low pitch, soft, insp.>exp., rustling - like wind in trees.
Decreased or absent breath sounds In emphysema due to loss of elasticity in the lung fibers and decreased force of inspired air.
When anything obstructs transmission of sound between the lung & your stethoscope, such as pleural thickening (pleurisy), air (pneumothorax) or fluid in the pleural space (pleural effusion).
Increased breath sounds Occur when consolidation or compression yields a dense lung area that enhances the transmission of sound from the bronchi. Adventitious sounds
Crackles (coarse) – loud, low-pitched, bubbling & gurgling sounds that start early in inspiration & may be present in expiration. Wheeze – predominate in expiration. Asthma, chronic emphysema, bronchitis.
Stridor – high-pitched, inspiratory, crowing sound. Originate in larynx or trachea, upper airway obstruction from swollen inflamed tissues or lodged foreign body.
Croup & acute epiglotitis in children, obstructed airway may be life-threatening. |