RN

Pulmonary Assessment: Becoming Efficient

Suzan Miller-Hoover DNP, RN, CCNS, CCRN-K

Pulmonary Assessment

Having a thorough knowledge of the upper and lower pulmonary structures, bronchial/systemic circulation, and gas exchange at the level of the lungs and tissue cells will make analyzing the assessment findings more meaningful.

When starting your assessment taking a history complete with past medical history, social and work history, and detailing current symptoms is essential to putting the puzzle pieces together.

History:
Understanding which medications are being taken, both over-the-counter and prescribed, may enable you to identify a medications adverse effect presenting as pulmonary symptoms. Did you know that more than 100 medications may adversely affect the pulmonary system? The most common drugs to watch out for are beta-blockers and angiotensin-converting enzyme inhibitors (ACE).

Determining a smoker’s pack per year history, can help you establish a patient’s risk for developing lung cancer. A patient with a 30 pack per year history has an increased risk for lung cancer. To calculate the Pack/Year history:

2 packs per day x 10 years = 20 pack-year history
1 pack per day x 20 years = 20 pack-year history
3 packs per day x 7 years = 21 pack-year history
(Cancer Treatment Centers of America, 2014)

Physical Exam:
Did you know that a cough may indicate an allergy or asthma? Or that a wheeze is not necessarily a pulmonary finding, but may indicate a cardiac condition? What about other breath sounds? Did you know you could hear rales/crackles and know that the patient is in heart failure even without a cardiac diagnosis? What about hearing rhonchi in the right upper chest? You could determine that the patient has aspirated (Jarvis, 2016).

Have you ever thought that you could find pneumonia by using palpation? By asking a patient to repeat a phase while you palpate can show pneumonia by the vibration of sound becoming increased over the area of consolidation. You can find evidence of an air leak by palpating for crepitus, that feeling of air popping under the skin (Jarvis, 2016).

Do you know when an assessment indicates a medical emergency? The assessment can guide you. When the patient breathes, is there a loud high-pitched crowing heard in the upper airway? This is called stridor, and usually indicated an obstruction of the upper airway. This is a medical emergency!

Has this article peaked your interest? Do you want to improve your assessment skills? Take the time to review the RN.com course: Focused Pulmonary Assessment. This course will help you align your assessment findings with alterations in ventilation, diffusion, oxygenation, and transport.



References
Jarvis, C. (2016). Physical Examination & Health Assessment (7th ed.). St Louis, Missouri: Elsevier Sunders.

Cancer Treatment Centers of America. (2014). Lung cancer risk factors. Retrieved from: Lung cancer risk factors

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