Question

Daniel comes into office because he caught a cold a few days ago and this morning his temperature was 101 F. You note that Daniel has a productive cough. As you continue to do your assessment you note a HR of 108, a BP of 110/68, and respirations are 24 bpm and labored. What questions should you ask regarding Daniel's cough? What are the components of a respiratory assessment? What, if any, is the signficance of unequal chest expansion? On auscultation, you hear the following breath sounds: late inspiratory crackles. What are these breath sounds? Describe the pathophysiology. Which other abnormal breath sounds do you know? What condition do your assessment findings suggest?

Answer 1

1. The questions should ask regarding cough:

a. Do have a chest pain while coughing/ breathing ?

b. When you cough , do you bring up any sputum/ phlegm?

if yes , what colour of the sputum..?

c. Do you experience wheezing, while you cough?

d. Did your cough start with an illness or a lung infection?

e. Have you lost weight recently.?

2. Components of Respiratory Assessment :

Respiratory assessment is a major step in physical examination. The major components or Respiratory assessment are history collection, inspection, palpitation, percussion and Auscultation . History collection should include all the past and present illness that affected the patient. Any significant hereditary diseases, allergic diseases, past medical or surgical history and recent infection that affect respiratory system should collect by Healthcare Provider.

Inspection: A thorough observation of the chest area and respiration pattern should conduct. Check the rate and depth of respiration, symmetrical expansion of chest, pattern of breathing, evidence of trauma or injury etc.

Palpation: Palpate the chest symmetrically, check for any bulges or depression, soft tissue tenderness, crepitus etc.

Percussion : Check for any abnormal fluid collection through sounds. ( Tympanic sound: Pneumothorax or Asthma, Flat note : pleural effusion)

Auscultation: Check for any abnormal breath sounds like wheezing, whistling, rale , ronchi, crackles etc.

3. Significance of unequal chest expansion

Unequal chest expansion is abnormal as it may cause by any lung ( unilateral) or pleural disease. It may be due to Pneumothorax, pleural effusion, lage mass or rib fracture ( or due to hemiplegia, not in Daniel's condition).

4. Late inspiratory crackles

Crackles or rales are abnormal clicking rattling or crackling sound made by one or both lungs and heard with a stethoscope caused by the popping open of airways collapsed by fluid or exudate, or sometimes by pulmonary edema.   Late inspiratory crackles begin in late inspiration and increases the intensity, heard on posterior base of the lungs. It may indicate the presence of pnemonia, atelectasis and congestive cardiac failure .

5. Pathophysiology

Lung infection ( pneumonia) or Congestive heart failure

?( leads to)

Excessive fluid secretion in the airways ( exudate, transudate

?

Collapse of airways due to lack of aeration or loose secretions, during expiration

?

pop's open of small airways during inspiration

?

Inspiratory crackles . ( late inspiratory crackles indicates restrictive defect, whereas early inspiratory crackles indicates severe obstruction of airways. )

6. Abnormal breath sounds

Wheeze : whistling sound

Ronchi: continous lower musical sound