RPTH 445

Homework – Answer Key

Breath Sounds / SOAP Charting

Under which abnormal conditions are bronchial breath sounds noted as adventitious?

When there is consolidation or atelectasis.

Explain why these bronchial breath sounds manifest when those abnormal conditions identified in the previous question manifest.

Though the gas molecules have no opportunity to move through to the atelectatic or consolidated lung unit, sounds produced in this are louder. This is because those sounds emanating from the tracheobronchial tree transmit easier through dense tissue even though gas does not fill those units.

Under which abnormal conditions would breath sounds be diminished?

When there are disorders which lead to alveolar hypoventilation such as chronic obstructive pulmonary disease or patients who breathe shallowly.

For each number listed, identify the specific location of those breath sounds identified:

Refer to Egan, p. 177 for help.

1. Anterior apical left upper lobe 3. Anterior right upper lobe 5. Anterior basal left lower lobe 7. Anterior right lateral middle lobe
2. Posterior apical right upper lobe 5. Posterior superior left lower lobe 7. Posterior lateral basal right lower lobe 10. Posterior anterior basal right lower lobe

SOAP Charting Case Study

You are called to the medical floor on the night shift by the head nurse because a patient has awakened short of breath. At 12:45 a.m. you find a 65 year old man sitting upright in his bed, disoriented, leaning forward on the nightstand. He is using accessory muscles to breathe, pursed lipped, prolonged expiratory phase, at a rate of 20-22 per minute. In the dim light of his semiprivate room it is hard to see his color, but his skin is warm and moist over his upper torso and his chest has an increased anteroposterior (AP) diameter. His Sp02 is 86% on room air. Upon auscultation you hear crackles in the right base and expiratory rhonchi in the upper lung fields bilaterally. Breath sounds in the left lung base are very diminished. He has expectorated at least 4 teaspoons of thick greenish-yellow sputum; no blood is seen. By palpation his pulse is rapid and occasionally irregular. He was admitted 6 hours before for a fractured knee following a fall in the afternoon. Upon interviewing he relates that he has COPD, but hasn’t been taking anything for it for the last 6 months. When he was taking medications, it was only one meter dose inhaler (MDI), four puffs in early morning and afternoon, but he doesn’t remember the name of the medication. The physician has been paged, but it is 1:00 a.m. You and the nurse agree the following should be done:

1. Start oxygen therapy at 2 l/m via nasal cannula
2. Repeat Sp02 following 02 therapy
3. Page the physician again and call the nursing and respiratory supervisors

Immediately after completing these interventions and telling your supervisor what you have done, you sit down to chart your assessment.

Using the charting sheet provided, chart the information stated in SOAP format.

1/20/2003

00:45

12:45am

S: c/o shortness of breath. States has not been taking medication for COPD illness, but was taking MDI 4 puffs, cannot recall name of medication.

O: Awake, alert, sitting upright, leaning forward. Use of accessory muscles, pursed lip breathing, exp. phase. RR-22, B.S. crackles RLL, exp. rhonchi upper lobes, diminished in LLL. Skin warm moist over upper torso. AP diameter. Sp02 86% on RA. HR rapid, occasionally irregular. Cough productive 4 teaspoons thick green yellow.

A: Tachypnea, mild hypoxemia, moderate respiratory distress with sputum production.

P: Physician paged, has not responded. Spoke with nurse and the following will be done: 02 therapy 2 l/m nasal cannula with Sp02 assessment, page physician again and call nursing and RT supervisor.