Comprehensive Respiratory System Disorders Q 85

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A female client is undergoing a complete physical examination as a requirement for college. When checking the client’s respiratory status, the nurse observes respiratory excursion to help assess:

  

     A. Lung vibrations

     B. Vocal sounds

     C. Breath sounds

     D. Chest movements.

    

    

Correct Answer: D. Chest movements

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The nurse observes respiratory excursion to help assess chest movements. Normally, thoracic expansion is symmetrical; unequal expansion may indicate pleural effusion, atelectasis, pulmonary embolism, or a rib or sternum fracture. During the inspection, the examiner should pay attention to the pattern of breathing: thoracic breathing, thoracoabdominal breathing, coastal markings, and use of accessory breathing muscles. The use of accessory breathing muscles (i.e., scalenes, sternocleidomastoid muscle, intercostal muscles) could point to excessive breathing effort caused by pathologies.

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Option A: After asking the client to say “99,” the nurse palpates the vibrations transmitted from the bronchopulmonary system along the solid surfaces of the chest wall to the nurse’s palms. An increase in the tactile fremitus points towards an increased intraparenchymal density and a decreased fremitus hints towards a pleural process that separates the pleura from the parenchyma (pleural effusion, pneumothorax).

Option B: The nurse assesses vocal sounds to evaluate air flow when checking for tactile fremitus. Palpation should focus on detecting abnormalities like masses or bony crepitus. Of note, the fremitus can also be auscultated and can be referred to as vocal fremitus.

Option C: The nurse assesses breath sounds during auscultation. The movement of air generates normal breath sounds through the large and small airways. Normal breath sounds have a frequency of approximately 100 Hz. The absence of breath sounds should prompt the health care provider to consider shallow breath, abnormal anatomy, or pathologic entities such as airway obstruction, bulla, hyperinflation, pneumothorax, pleural effusion or thickening, and obesity.

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