Physical Assessment Skills for Pneumonia
Discussion for the Introductory Pharmacy Practice Experience
State why physical assessment skills are important in evaluation of pneumonia.
List information to obtain from medical record that may complement the physical examination.
How could physical assessment be used to monitor clinical improvement or deterioration of pneumonia?
Discussion for the Advanced Pharmacy Practice Experience
What clues does the sputum color give as to the cause of the pneumonia?
How may sepsis present on physical examination?
Physical findings for 26-year-old African American with pneumonia: RR: 28
Tachypnea: an increased respiratory rate with normal depth of breathing
Positive whispered pectoriloquy
Whispered pectoriloquy is the sound of whispered words by the patient while the chest is being auscultated. The patient is asked to whisper “ninety nine” while the lung fields are auscultated. When a consolidation is present, such as with pneumonia, the whispering is transmitted through the chest wall more clearly. Radiographs and computed tomography have led to a decrease in the use of this physical assessment skill.
Egophony is the increased resonance of voice sounds, with a high-pitched or nasal quality of normal voice tones heard through the chest wall during auscultation. An “E” spoken by the patient should sound like an “E” in the absence of underlying lung pathology. In the presence of a consolidation, the “E” sound will change to an “A” sound.
Positive tactile fremitus
Fremitus is a palpable vibration. It may be created by the vocal cords during speech. To assess for tactile fremitus, ask the patient to repeat the word “ninety nine” while you palpate the thorax with the ulnar sides of your hands. Increased fremitus is caused by any condition that increases the density of the lung as with consolidation that occurs in pneumonia.
Dullness to percussion
Percussion of the chest wall produces a sound useful in evaluating the underlying lung tissue. Percussion over normal lung is described as normal resonance. Decreased resonance is due to increase lung tissue density such as pneumonia.
Bronchial breath sounds and inspiratory crackles
Auscultation of the lungs should include all lobes on the anterior, lateral, and posterior chest. It is best to compare side-to-side and evaluate at least one full ventilatory cycle at each stethoscope position. Bronchial breath sounds are harsh and higher pitched with approximately equal inspiratory and expiratory components. This is the sound heard over a major bronchus during normal breathing. Adventitious breath sounds are not normal sounds and include wheezes, rhonchi, and crackles. Crackles are probably produced by the bubbling of air through the airway secretion or by the sudden opening of the ...