TINA JONES RESPIRATORY SHADOW HEALTH OBJECTIVE DATA

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tina jones respiratory shadow health objective data

tina jones respiratory shadow health objective data
Objective Data Collection: 6 of 6 (100.0%)
 Correct
 Partially correct
 Incorrect
 Missed
 Inspected chest
1 of 1 point
Symmetry (1/2 point)
 Symmetric
 Asymmetric
Appearance (1/2 point)
 No visible abnormal findings
 Rash or lesion
 AP diameter abnormal
 Intercostal retraction while breathing
 Excessive use of accessory muscles while breathing
 Pectus excavatum
 Evidence of trauma (scar, laceration, or bruising)
 Palpated chest expansion
1 of 1 point
Symmetry (1/1 point)
 Equal bilaterally
 Unequal bilaterally
 Palpated tactile fremitus
1 of 1 point
Symmetry (1/2 point)
 Equal bilaterally
 Unequal bilaterally
Vibration (1/2 point)
 Expected fremitus
 Decreased fremitus
 Absent fremitus
 Percussed chest wall
1 of 1 point
Observations (1/2 point)
 All areas resonant
 Some areas of dullness
Location (1/2 point)
 No areas of dullness
 Dullness, anterior right upper lobe
 Dullness, anterior right middle lobe
 Dullness, anterior right lower lobe
 Dullness, anterior left upper lobe
 Dullness, anterior left lower lobe
 Dullness, posterior right upper lobe
 Dullness, posterior right lower lobe
 Dullness, posterior left upper lobe
 Dullness, posterior left lower lobe
 Auscultated breath sounds
1 of 1 point
Breath Sounds (1/3 point)
 Present in all areas
 Diminished in some areas
 Absent in some areas
Adventitious Sounds (1/3 point)
 No adventitious sounds
 Wheezing
 Fine crackles
 Stridor
 Rhonchi
 Rales
Location (1/3 point)
 All areas clear
 Adventitious sounds in anterior right upper lobe
 Adventitious sounds in anterior right middle lobe
 Adventitious sounds in anterior right lower lobe
 Adventitious sounds in anterior left upper lobe
 Adventitious sounds in anterior left lower lobe
 Adventitious sounds in posterior right upper lobe
 Adventitious sounds in posterior right lower lobe
 Adventitious sounds in posterior left upper lobe
 Adventitious sounds in posterior left lower lobe
 Auscultated for bronchophony
1 of 1 point
Bronchophony (1/1 point)
 Positive
 Negative

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