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Notes

History Cough (productive or nonproductive), dyspnea, hemoptysis, CP, swelling of lower extremities, energy level, sleep pattern, COPD (asthma, chronic bronchitis, emphysema), TB, pneumonia, URI, environmental allergies.
Medication Bronchodilators, acetylcysteine, aminophylline, theophylline, anticholinergics, corticosteroids.
Respirations
  • Rate, depth, effort, pattern.
Inspect
  • Signs of distress (nasal flaring or sternal retractions).
  • Size and shape of chest, symmetry of chest wall movement, and use of accessory muscles.
  • Lower extremities for edema and nail beds for cyanosis and clubbing indicating chronic hypoxia.
  • Trachea for scars, stomas, or deviation from midline.
Palpate
  • Anterior and posterior thorax for subcutaneous emphysema, crepitus, and tenderness.
  • Assess tactile fremitus; palpate chest as Pt says, "99."
Percuss
  • Anterior and posterior thorax for tympany (hollow organs), resonance (air-filled organs), dullness (solid organs), or flatness (muscle or bone).
Auscultate
  • All anterior and posterior lung fields, noting normal, abnormal, or absence of lung sounds.
  • Order of auscultation: begin at the top, near the shoulders, and work toward the bottom, near the diaphragm, moving from left to right working in a zigzag pattern.