(f) The ability to discriminate can be tested several ways. One way is
stereognosis (the ability to recognize objects by touching them). Place small, familiar
objects such as a coin, paper clip, or key in the patient's hand and ask him to identify it.
Another way is the one- and two-point stimuli. Alternate touching the patient's fingertip
with two pinpoints simultaneously and then with one pin. Have the patient discriminate
between the one- and two-point stimuli.
e. Respiration. Respiration is assessed using inspection, palpation, and
auscultation. Have the patient remove all clothing to the waist and assume a sitting
position. Inspect the chest for posture, shape, and symmetry of expansion. Warm the
diaphragm of the stethoscope in the palms of your hands and place it firmly against the
patient's chest wall. Ask the patient to breath quietly with the mouth open.
(1) There are three types of normal breath sounds: vesicular, bronchial, and
bronchovesicular. Vesicular sounds are soft, like a quiet rustle or swish. Bronchial sounds
are loud, harsh, hollow blowing sounds usually heard over the trachea and major bronchi.
Bronchial sounds are louder during expiration. Bronchovesicular sounds are a
combination of the other two and are heard in the upper anterior chest on each side of the
sternum and posteriorly between the scapulae. Deep breathing converts vesicular sounds
into bronchovesicular sounds.
(2) Assess the respirations for rhythm. Note whether the patient's breathing is
regular, irregular, labored, or non-labored.
(3) Respiratory rate is the number of breaths in one minute. Bradypnea is
less than 10 breaths per minute. Dyspnea is difficult or painful breathing. Orthopnea is
difficult breathing except in an upright position.
(4) Lung sounds include breath sounds, voice sounds, and abnormal sounds.
Assess lung sounds by auscultation, using a stethoscope. Auscultate the anterior and
posterior upper, middle and lower lobes. Rales are crackling, tinkling sounds that occur
when fluid or secretions are trapped in the smaller bronchioles or alveoli. Rhonchi are the
rumbling, rattling, or snoring sounds due to mucous and secretions in the bronchial tree. A
wheeze is the raspy whistling or high-pitched sound that occurs as air moves through a
constricted or obstructed passage in the upper airway or bronchioles.
(5) Note whether the patient has a cough and whether it is persistent,
occasional, productive or nonproductive. If the cough is productive, note the amount and
character of the secretions.
f. Cardiovascular Assessment. Palpation and auscultation are used in
assessment of the cardiovascular system, which includes blood pressure, peripheral
pulses, heart sounds, and circulatory perfusion. The patient's blood pressure is usually
taken at the onset of the assessment and the pulses are palpated while the skin is being