Competency Palpation/Percussion

-pneumothorax could push trachea away (push heart, vena cava)

-atelectasis will pull towards (right side, whitened out on Xray)

• tracheal positioning

• ...

"butterfly" position

-place hands where fingers are slightly over clavicle, thumbs touching

-palpate for equal bilateral expansion

-do on back as well

• chest expansion

• ...

-palpate chest wall over each lung lobes while the patient says "99" feel for vibrations with the palm of hand.

• tactile fremitus

• ..

-percuss over solid structure such as heart, liver, thigh to create dull sound

-percuss over lungs to hear resonant note, compare bilaterally

-use middle finger to place between intercostals and use second middle finger to tap

• chest percussion

• ...

match

• resonant

• thudlike, livers, consolidated lung (pleural effusion) fluid, atelectasis

• flat

• hollow, normal lung

• dull

• flat, muscle/bone

• hyperresonant/tympanitic

• drumlike, hyperinflated lung (emphysema) pneumothorax, a lot of air

= fluid, will clearly hear "99" (sound doesn't travel over air)

• vibrations

• nothing

Tags

NGSS.MS-PS4-1

NGSS.MS-PS4-2

Knock on door

introduce yourself, wash hands

check patients wristband

tell them why you are there

vital signs (HR, RR, O2, BS)

• before every competency

• ...