What is the best position for the client to assume for the physical exam? a.ĭuring the course of the preceding patient’s physical exam, auscultation of the lungs reveals rhonchi in the upper airways and coarse crackles in the right lower base. The nurse begins the physical examination of the respiratory system. Answers to interactive activity elements will be provided within the element as immediate feedback.) 1.Īn elderly client is admitted to the medical floor with increased shortness of breath, new productive cough, and low-grade fever.

(Answers to “Learning Activities” can be found in the “Answer Key” at the end of the book. *CRITICAL CONDITIONS to report immediatelyĭecreased level of consciousness, restlessness, anxiousness, and/or irritability Pain or tenderness with palpation, crepitus, palpable masses, or lumpsĬlear, low-pitched, hollow sound in normal lung tissueĭull sounds heard with high-density areas, such as pneumonia or atelectasisīronchovesicular and vesicular sounds heard over appropriate areasĪdventitious lung sounds, such as fine crackles/rales, wheezing, stridor, or pleural rub Respiratory rate within normal range for ageĪbsence of accessory muscle use, retractions, and/or nasal flaringĪnteroposterior: transverse diameter ratio 1:2Īccessory muscle use, pursed-lip breathing, nasal flaring (infants), and/or retractions Unexpected Findings (Document and notify provider if a new finding*) See Figure 10.5 and Figure 10.6 for landmarks of stethoscope placement over the anterior and posterior chest wall. This side-to-side pattern allows you to compare sounds in symmetrical lung fields. Listen to sounds from side to side rather than down one side and then down the other side. Avoid listening over bones, such as the scapulae or clavicles or over the female breasts to ensure you are hearing adequate sound transmission. The best position to listen to lung sounds is with the patient sitting upright however, if the patient is acutely ill or unable to sit upright, turn them side to side in a lying position. The stethoscope should not be performed over clothes or hair because these may create inaccurate sounds from friction. Listen to normal breath sounds on inspiration and expiration.Ĭorrect placement of the stethoscope during auscultation of lung sounds is important to obtain a quality assessment. If the patient is ready to quit, the five successful interventions are the “5 A’s”: Ask, Advise, Assess, Assist, and Arrange.Īsk – Identify and document smoking status for every patient at every visit.Īdvise – In a clear, strong, and personalized manner, urge every user to quit.Īssess – Is the user willing to make a quitting attempt at this time?Īssist – For the patient willing to make a quitting attempt, use counseling and pharmacotherapy to help them quit.Īrrange – Schedule follow-up contact, in person or by telephone, preferably within the first week after the quit date. Have you ever tried to quit smoking/vaping? What strategies gave you the best success?Īre you interested in quitting smoking/vaping? What products do you smoke/vape? If cigarettes are smoked, how many packs a day do you smoke? What have you used to treat the cough? Has it been effective? When you cough, do you bring up anything? What color is the phlegm?ĭo you have any associated symptoms with the cough such as fever, chills, or night sweats?ĭoes anything bring on the cough (such as activity, dust, animals, or change in position)? How does the shortness of breath affect your daily activities? Is the shortness of breath related to a position, like lying down? Do you sleep in a recliner or upright in bed?ĭo you wake up at night feeling short of breath? How many pillows do you sleep on? What makes the shortness of breath go away? How long does the shortness of breath last? Is the shortness of breath associated with chest pain or discomfort? Note: If the shortness of breath is severe or associated with chest pain, discontinue the interview and obtain emergency assistance.Īre you having any shortness of breath now? If yes, please rate the shortness of breath from 0-10 with “0” being none and “10” being severe?ĭoes anything bring on the shortness of breath (such as activity, animals, food, or dust)? If activity causes the shortness of breath, how much exertion is required to bring on the shortness of breath? Have you had any feelings of breathlessness (dyspnea)? Please identify what you are taking and the purpose of each. Please describe the conditions and treatments.Īre you currently taking any medications, herbs, or supplements for respiratory concerns? Have you ever been diagnosed with a respiratory condition, such as asthma, COPD, pneumonia, or allergies?ĭo you use home respiratory equipment like CPAP, BiPAP, or nebulizer devices?

High pitched lung sounds