N104: Essentials of Nursing Care - Health Safety

N104: Essentials of Nursing Care – Health Safety Study Guide an examination of the posterior chest followed by the anterior and lateral. Equipment needed for the chest and thorax exam includes a stethoscope and ruler. Information and abnormal findings provided by unlicensed personnel should be verified during this exam. Implementation • Wear gloves and any other appropriate infection control gear (mask, protective eyewear, gown, etc.). • Wash hands before starting the exam, any time the hands or gloves become soiled, and upon completion of the exam. • Provide a quiet, well-lit, and private place for theexam. • Ensure that the examination room is warm, since the patient will be exposed during different parts of the assessment. • Explain each step of the exam: what will happen, why the exam is being done, andhow the patient can help during the exam. • Explain how the results of the exam will be used. • Ask about presence or history of: o History or family history of chest diseases (Tuberculosis, cancer,etc.) o Smoking o Environmental exposure to fumes, smoke, chemicals, etc. o Current signs or symptoms of illness (cough, pain, wheezing, etc.) • Assess the posterior thorax: The assessment of the posterior thorax is best donewith the patient in a seated position, except for the spinal assessment, which is done with the patient in a standing position. o Normal: Symmetric with anteroposterior to transverse diameter 1:2; spine aligned vertically with shoulders at the same height and hips at the same height; uniform temperature of back; no lesions or masses; chest wall intact; no tenderness; full and symmetric chest expansion when the patient takes a deep breath; bilateral vocal fremitus felt most strongly at apex of lungs when the patient speaks; percussion over lung areas elicits resonate notes; vesicular and bronchovesicular sounds auscultated and symmetrical bilaterally using the diaphragm of the stethoscope o Deviations from normal: Asymmetric with anteroposterior to transverse diameter greater than 1:2 (barrel chest); spine misaligned when patient bends forward at the waist (scoliosis); spinal curvatures exaggerated (kyphosis or lordosis); temperature of the back not uniform, with areas of increasedtemperature; lesions, lumps, depressions, or masses; chest wall tenderness; asymmetric or diminished chest expansion when the patient takes a deep breath; decreased, increased, or absent vocal fremitus felt when the patient speaks; asymmetry of percussion; percussion over lung areas elicits dullness or flatness; absence of breath sounds or adventitious sounds auscultated using the diaphragm of the stethoscope; adventitious sounds include:  Wheeze: This is a high-pitched, whistling sound heard at inhalation and exhalation.  Rhonchi: Rhonchi are low-pitched, snoring sounds heard primarilyon exhalation.  Rales or crackles: Rales or crackles are popping sounds heardduring inhalation and

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