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respiratory effort”.“Respiratory rateis 16, skin color is appropriate for ethnicity, no audible sounds of breathing”, “I will inspectthe neckduring inspirationfor contraction of accessory muscles, Sternocleidomastoid (SCM) & Scalene muscles or supraclavicular retraction”, “No contraction of the accessory muscles noted”, “Duringexpirationinspecting the intercostal or abdominal oblique muscles”. “No intercostal retractions noted”SupraclavicularIntercostalPercuss lung fields: Posterior chest Location of diaphragm(Percussion helps you establish whether the underlying tissues are air-filled, fluid-filled, or consolidated)“Now I willpercuss the lung fields of the posterior chest;I will have you cross your arms in front of your chest”, “I will hyperextend the middle finger of my L hand (pleximeter), with a quick sharp motion I will strike the pleximeter finger with theR pleximeter the R middle finger (plexor) hitting the distal interphalangeal joint using the same for each strike”, “I will percuss one side of the chest & then the other in a ladder like pattern from medial scapular bone level to 10thrib”, “Healthy lungs areresonant”, “Abnormal is dullness replaces resonance when fluid or solid tissue replaces air-containing lungs or pleural space like a tumor, hemothorax”“Now to assesslocation of the diaphragm(descent of the diaphragm or) diaphragmatic excursion”, “1stdetect the level of diaphragmatic dullness during quiet respiration by holding the pleximeter finger (left middle) above & parallel to the expected level of dullness, percussing downward in progressive steps until dullness clearly replaces resonance comparing medially & laterally”, “Now estimating the extent of diaphragmatic excursion by determining the distance betweenthe level of dullness on full expiration & the level of dullnesson full inspiration, normally about 3-5.5cm”, “repeating it on other side”. “Abnormally high level suggestspleural effusion or elevated hemidiaphragm from atelectasis or phrenic nerve paralysis”Auscultate breath sounds: Anterior:Comment on findings /adventitious sounds Posterior:Comment on findings/ adventitious sounds(Perform voice transmission tests (indicates consolidation) bronchophony, egophony, & whispered pectoriloquy; “Scooby doo” (bronchophony) or any change from “ee” sound to “ay” sound (egophony) or a clearer whispered voice (whispered pectoriloquy)“Now I will auscultate breath soundsusing diaphragm while you breathe deeply through anopen mouth”. “1stAnteriorlung sounds” “Vesicular lung sounds heard, with no adventitious sounds”“2nd Posteriorlung sounds”. “Vesicular lung sounds heard, with no adventitious sounds”“Example, Wheezes arise in the narrowed airways of asthma, COPD, and bronchitis”Voice sounds:EgophonyORbronchophony“Next to assess Bronchophony, I will have you say “99” “I hear muffled & indistinct sound which is normal”,