LUNGS ASSESSMENT ASSOCIATED WITH
CARDIAC DISORDER
• The respiratory assessment is design to identify respiratory
manifestations seen in patients with heart disease.
• The room should be quiet and the patients chest exposed.
• Proceed in systematic manner- inspection, palpation , percussion and
auscultation.
• Always compare one side with the other.
• Begin the examination of the posterior chest then with the patient
sitting upright position and arms folded across the chest.
• Follow with assessment of the anterior chest with patient lying down.
Cont..
• Upper and lower lobes of the lungs are accessible by posterior chest
examination.
• The right middle lobe is assess through lateral and anterior chest
examination.
INSPECTION:
Respiratory rate, depth, rhythm and effort:
• Normally the respiratory rate is between 14 to 20 b/m and rhythm is
regular.
• Tachypnea : rapid, shallow breathing , may be noted in patients who
have heart failure.
Cont..
• Bradypnea : slow breathing, can be noted during sleep or after
administration of respiratory depressant agents, such as morphine or
anaesthesia.
• Chyne-stokes respiration: characterised by periods of alternating
deep breathing and apnoea, occur in patient with severe left
ventricular failure.
• Assess for the use of accessory muscles, forward leaning position and
purse lip breathing are the visible signs of respiratory effort.
• Dry, hacking cough from irritation of small airways is common in
patients with pulmonary congestion from heart failure.
Cont..
• Chest configuration: the normal anteroposterior to lateral diameter
ratio ranges from 1:2 to 5:7.
• With barrel chest the anteroposterior to lateral diameter ratio
increases to 1:1 or more.
• Assess for Kyphoscoliosis.
POSTERIOR CHEST ASSESSMENT:
PALPATION:
• To identify tenderness, respiratory excursion , and any observed
abnormalities and to elicit tactile fremitus.
• Respiratory excursion
• Fremitus
Cont..
PURCUSSION :
• Percussion causes vibrations in the underlying tissues, resulting in
sounds that indicate if the tissue are solid or filled with fluid or air.
• Normal lung tissues produces resonance.
• Dullness replaces resonance when fluid or solid tissue replaces air-
filled tissue.
Cont..
AUSCULTATION :
• Airflow , obstruction, and the condition of the lung and pleural space
can be assessed with auscultation.
• Use the diaphragm of the stethoscope press firmly on the skin in the
sequence.
• Ask the patient to breath slowly and deeply through his or her mouth.
• Listen through the full breath in each location for pitch , intensity, and
duration of inspiration and expiration.
• Normal breath sounds are soft, low-pitch , blowing sounds.
• The sounds are decrease in the obese patients and with shallow
breathing or pleural effusion and they increase in exercise .
Cont…
Cont..
• Bronchovesicular sound: heard in main bronchi below the clavicle
and between the scapula. This sounds are abnormal if its heard in
peripheral.
• Adventitious breath sounds: they are sounds which superimposed
over normal breath sounds.
-There are two categories of adventitious sounds: discontinuous
( crackles) and continuous ( wheeze).
-it persist from breath to breath , have the patient cough to note any
changes .
• Crackles : crackles are discrete , discontinuos sounds that are similar
to the sound generated by rubbing hairs together infront of the ears.
Cont..
-Crackles are associated with heart failure or ischemic heart disease.
• Wheezes: continuous, musical sounds from the rapid air movement
through constricted airways. Wheezing is associated with COPD,
asthma, and other conditions.
• Transmitted voice sound: louder and clearer the normal when heard
through chest. Such as bronchophony, whispered pectoriloquy.
• Pleural friction rubs: result from inflamed pleural rubbing together. It
produces grating , coarse sound.
ANTERIOR CHEST ASSESSMENT:
PALPATION :
• Tenderness of the pectoral muscles or costal cartilages suggest a
musculoskeletal origin of the chest pain.
• Respiratory excursion is assessed in the same manner like posterior chest
• Assess for tactile fremitus .
PERCUSSION :
• Gently place the fingers over the chest.
• the heart produces dull sound between the third and fifth intercostal
space.
Cont..
AUSCULTATION :
• Listen for the breath sounds over the patients anterior and lateral
chest.
• Place the stethoscope in sequence manner.
• Assess the transmitted voice sound.
Quadrants of abdomen
ABDOMINAL ASSESSMENT
• Purpose is to evaluation of the bowel tones, determination of liver
size, assessment of bladder distention, and auscultation for bruits.
• Presence of liver engorgement in right ventricular failure.
• Urine output is the important indicator of cardiac output.
• Assess for bladder distention.
INSPECTION:
• Observe the abdomen for symmetry and visible peristalsis.
• Note the distention of abdominal distention.
Cont..
• Abdominally localised obesity ( waist circumference is less then 35
inches for women and less then 40 inches for men) if greater then
that it is associated with coronary artery disease and adult onset
diabetes mellitus.
AUSCULTATION:
• Auscultate the abdomen after observation because palpation and
percussion can either increase or diminish bowel sound.
• Listen over the all quadrants , normal bowel sounds consist of clicks
and gargles.
• Assess for Borborymi which is prolonged gargles sound due to
hyperperistalsis .
Cont..
• Bowel sounds are increased diarrhoea and early intestinal obstruction
and decrease or absent with paralytic ileus and peritonitis.
PURCUSSION:
Determination of liver: Percussion of the liver should start in right mid-
clavicle line , at or below the umbilicus and proceed upward from an
area of tympany (intestine) to an area of dullness ( liver)
• Identify the lower edge of the liver in the mid-clavicle line.
• Assessment of bladder: percuss downward from the umbilicus to the
symphysis pubis.
Cont..
• Assessment of bladder: percuss downward from the umbilicus to the symphysis pubis.
• Supra pubic dullness may indicate a distended urinary bladder.
• If percussion does not confirm suspicious of a distended urinary bladder , palpate
gently above the symphysis pubis.
PALPATION:
• Determination of liver size: deep palpation is necessary to fell the liver.
• It is imperative that the patient is relaxed.
• Place the hand under the 11th and 12th ribs for support. The liver is easier to palpate if
the examiner pushes up with this hand.
• Place the right hand on the abdomen below the lower edge of dullness, with the
fingers pointing towards the right costal margin.
Cont..
• As the patients takes a deep abdominal breath and then exhales ,
gently but firmly push in and up with the fingers.
• With each exhalation, move the hand further toward the liver.
• The liver edge should come down to meet the fingers.
• Normally it feels firm with smooth edge.
• In right heart failure the liver is enlarge firm, tender and smooth.
