CHAMBERLAIN COLLEGE OF NURSING NR302 Health Assessment I Final Exam Study Guide

NR 302 FINAL EXAM STUDY GUIDE

Thorax and Lungs

-What data can be gathered on a patient in respiratory distress from general survey only?

   -Do they use accessory muscles when breathing? Position-tripod, Barrel chest, Nasal flaring, color 

-Structure and Function: The thorax

–Thoracic cage

   -Sternum, 12 pairs of ribs

   -12 thoracic vertebrae

   -Muscles and cartilage

–Thoracic Cavity

   -Mediastinium

   -Pleural cavity

   -Lung (Apex and base)

Structure and Function: Pleural Membranes

-Parietal pleura-lines the whole cavity

-Visceral pleura-lines the organs

-Pleural space/cavity-both above total

Structure and Function: The respiratory system

-Trachea

-Bronchi

-Bronchioles

-Alveolar Sacs

-Alveoli

Landmarks-Visualize what you cannot see!

-Anterior chest

   -Suprasternal notch “U shaped”

-Sternum

-Sternal angle (Angle of Louis) continuous with 2^nd rib

-Ribs & intercostals

-Costal angle (at xiphoid) 90 degrees

-Posterior chest

-Vertebra prominence C7

-Spinous processes T1 is 1^st rib

-T3 separates upper and lower lobes

-Inferior border of the scapula 8^th rib

-12^th rib

Subjective Data

-Difficulty breathing, sleeping, chest pain, cough and sputum (Rusty-TB), smoking history, environmental exposure

TO calculate smoking pack-years 

1. Multiple the number of cigarettes smoked per day by number of years smoked
2. Divide by 20

i.e 10 cigarettes smoked per day x 10 years / 20 = 5 pack years 

Objective Data

-Inspection of patient: Resp. rate & effort to breathe (Nasal flaring, accessory muscles, positioning) skin color, nails, configuration of chest (Chest deformities)

-Palpation of anterior and posterior chest: Tenderness, lumps, crepitus (Subcutaneous air-rice krispis under skin), tactile fremitus (99), respiratory expansion

-Percussion of lung fields: Resonance, hyper-resonance, dull, diaphragmatic excursion

-Auscultation of chest: Normal, adventitious, voice sounds, measurements of pulmonary function: For screening**Begin at the moment of contact

Normal breath sounds

-Bronchial (Tracheal) –Over trachea & larynx E>1

-Bronchovesicular—Over major bronchi I=E

-Vesicular—over peripheral lung fields I>E

Normal Assessment Findings

-Inspection: RR 14 reg,even & unlabored (eupnea), skin & nails pink, no cyanosis noted, relaxed posture, shape symmetric AP: Transverse 1:2, costal angle <90 degrees

-Palpation: Chest expansion symmetric, tactile fremitus symmetric, no tenderness, no crepitus, no lumps or masses

-Percussion: Resonance throughout, diaphragmatic excursion equal bilaterally

-Auscultation: Normal breath sounds

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