● Anatomy:
○ Right upper lobe, right middle lobe, right lower lobe, left upper lobe, left lower
lobe
● Subjective:
○ Cough: Is it productive, coughing anything up? What’s it look like: color, odor,
amount? When did it start? How long? (Chronic: it’s more than two months,
acute: 2-3 weeks) Associating factors?
○ Shortness of breath: When do you feel it, is it when you’re working out, is it
constant?
○ Chest pain with breathing: Is it inhalation or exhalation, both? Describe pain,
localized, radiating, etc?
○ History of respiratory infection: bronchitis, pneumonia, strep throat, etc.
○ Smoking history: not only if you smoke, or do you live with someone who
smokes? Second hand? How much/often?
○ Environmental exposures: at your job, cleaning at home, lead based paint, etc.
○ Self-care behaviors: do you use humidifiers, air purifiers, etc. Do you get flu shot,
other vaccines?
● Inspecting chest configuration, take gown off.
○ Expected: anterior to posterior (look from side) to transverse is 1 to 2 so looking
from side is half than what it is when looking at front
■ Barrel chest is abnormal - their a-p to transverse is 1 to 1
○ Cyanotic = blue mouth/lips
○ Clubbing nail = nail bed rises
○ Retractions = negative finding in breathing
○ Flared nostrils in children to get more o2
○ May see bradypnea during sedation, on narcotics
○ May see tachypnea due to anxiety
○ Cheyne-Stokes regular, periods of apnea (deeper periods of no breathing)
○ Biot’s irregular = shallow breaths
○ Normal respirations for newborn = 30-60 / min
○ Infants (under a year) = 25-55 / min
○ Toddlers = 20-30 / min
● Palpating
○ Palpate chest wall with thumbs centered, hands extended on back, test for
symmetric chest expansion while breathing
● Percussion
○ Air in lungs is what makes noise when we percuss
○ Should hear resonance - low pitched, clear
● Auscultation
○ When auscultating, instruct to deep breathe with mouth open
○ 12 anterior auscultation spots (symmetrical)
■ 1st anterior auscultation point is above clavicle!
■ 2-4 goes straight down to medial side of nipple
■ 5th lateral side of nipple
○ Right upper lobe, right middle lobe, right lower lobe, left upper lobe, left lower
lobe
● Subjective:
○ Cough: Is it productive, coughing anything up? What’s it look like: color, odor,
amount? When did it start? How long? (Chronic: it’s more than two months,
acute: 2-3 weeks) Associating factors?
○ Shortness of breath: When do you feel it, is it when you’re working out, is it
constant?
○ Chest pain with breathing: Is it inhalation or exhalation, both? Describe pain,
localized, radiating, etc?
○ History of respiratory infection: bronchitis, pneumonia, strep throat, etc.
○ Smoking history: not only if you smoke, or do you live with someone who
smokes? Second hand? How much/often?
○ Environmental exposures: at your job, cleaning at home, lead based paint, etc.
○ Self-care behaviors: do you use humidifiers, air purifiers, etc. Do you get flu shot,
other vaccines?
● Inspecting chest configuration, take gown off.
○ Expected: anterior to posterior (look from side) to transverse is 1 to 2 so looking
from side is half than what it is when looking at front
■ Barrel chest is abnormal - their a-p to transverse is 1 to 1
○ Cyanotic = blue mouth/lips
○ Clubbing nail = nail bed rises
○ Retractions = negative finding in breathing
○ Flared nostrils in children to get more o2
○ May see bradypnea during sedation, on narcotics
○ May see tachypnea due to anxiety
○ Cheyne-Stokes regular, periods of apnea (deeper periods of no breathing)
○ Biot’s irregular = shallow breaths
○ Normal respirations for newborn = 30-60 / min
○ Infants (under a year) = 25-55 / min
○ Toddlers = 20-30 / min
● Palpating
○ Palpate chest wall with thumbs centered, hands extended on back, test for
symmetric chest expansion while breathing
● Percussion
○ Air in lungs is what makes noise when we percuss
○ Should hear resonance - low pitched, clear
● Auscultation
○ When auscultating, instruct to deep breathe with mouth open
○ 12 anterior auscultation spots (symmetrical)
■ 1st anterior auscultation point is above clavicle!
■ 2-4 goes straight down to medial side of nipple
■ 5th lateral side of nipple
