STUDY - Technical - New Dacian's Medicine
barrel
chest (Classical / Allopathic Medicine)
With a barrel
chest, the normal elliptical configuration of the chest is
replaced by a rounded one in which the anteroposterior
diameter enlarges to approximate the transverse diameter. The
diaphragm is depressed and the sternum is pushed forward with
the ribs attached in a horizontal, not angular, fashion. As a
result, the chest appears continuously in the inspiratory
position. (See Recognizing barrel chest.)
Typically a late
sign of chronic obstructive pulmonary disease (COPD), barrel
chest results from augmented lung volumes due to chronic
airflow obstruction. The patient may not notice it because it
develops gradually.
Recognizing barrel
chest
For a normal adult chest, the ratio of anteroposterior to transverse (or lateral) diameter is 1:2. For a patient with a barrel chest, the ratio approaches 1:1 as the anteroposterior diameter enlarges.
HISTORY:
Ask the patient about a history of pulmonary disease. Note chronic exposure to environmental irritants such as asbestos.
Ask the patient if he smokes. If so, find out how much.
Ask the patient if he has a cough. Is it productive or nonproductive? If it's productive, have him describe the sputum color, amount, and consistency.
Ask the patient if he experiences shortness of breath. Is it related to the activity?
For a normal adult chest, the ratio of anteroposterior to transverse (or lateral) diameter is 1:2. For a patient with a barrel chest, the ratio approaches 1:1 as the anteroposterior diameter enlarges.
HISTORY:
Ask the patient about a history of pulmonary disease. Note chronic exposure to environmental irritants such as asbestos.
Ask the patient if he smokes. If so, find out how much.
Ask the patient if he has a cough. Is it productive or nonproductive? If it's productive, have him describe the sputum color, amount, and consistency.
Ask the patient if he experiences shortness of breath. Is it related to the activity?
PHYSICAL
ASSESSMENT:
Observe the patient's general appearance. Look for central cyanosis in the cheeks, nose, and mucosa inside the lips. Also, look for peripheral cyanosis in the nail beds. Note clubbing, a late sign of COPD.
Observe the patient for accessory muscle use, intercostal retractions, and tachypnea.
Auscultate for abnormal breath sounds, such as crackles and wheezes.
Percuss the chest; hyper resonant sounds indicate trapped air, whereas dull or flat sounds indicate mucus buildup.
SPECIAL CONSIDERATIONS:
To ease breathing, have the patient sit and lean forward, resting his hands on his knees to support the upper torso (tripod position).
Observe the patient's general appearance. Look for central cyanosis in the cheeks, nose, and mucosa inside the lips. Also, look for peripheral cyanosis in the nail beds. Note clubbing, a late sign of COPD.
Observe the patient for accessory muscle use, intercostal retractions, and tachypnea.
Auscultate for abnormal breath sounds, such as crackles and wheezes.
Percuss the chest; hyper resonant sounds indicate trapped air, whereas dull or flat sounds indicate mucus buildup.
SPECIAL CONSIDERATIONS:
To ease breathing, have the patient sit and lean forward, resting his hands on his knees to support the upper torso (tripod position).
PEDIATRIC
POINTERS:
In infants, the ratio of anteroposterior to transverse diameter normally approximates 1:1. As the child grows, this ratio gradually changes, reaching 1:2 by ages 5 and 6.
Cystic fibrosis and chronic asthma may cause a barrel chest in a child.
In infants, the ratio of anteroposterior to transverse diameter normally approximates 1:1. As the child grows, this ratio gradually changes, reaching 1:2 by ages 5 and 6.
Cystic fibrosis and chronic asthma may cause a barrel chest in a child.
AGING ISSUES:
In elderly patients, senile kyphosis of the thoracic spine may be mistaken for barrel chest. However, unlike barrel chest, patients with senile kyphosis lack signs of pulmonary disease.
In elderly patients, senile kyphosis of the thoracic spine may be mistaken for barrel chest. However, unlike barrel chest, patients with senile kyphosis lack signs of pulmonary disease.
PATIENT
COUNSELING:
Advise the patient to avoid bronchial irritants, especially smoking, which may exacerbate COPD. Tell him to report purulent sputum production. Instruct him to space his activities to help minimize exertional dyspnea.
Advise the patient to avoid bronchial irritants, especially smoking, which may exacerbate COPD. Tell him to report purulent sputum production. Instruct him to space his activities to help minimize exertional dyspnea.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)