Barrel chest

In 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 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.

History and physical examination

Begin by asking about a history of pulmonary disease. Note chronic exposure to environmental irritants such as asbestos. Ask about the patient's smoking habits.

Then explore other signs and symptoms of pulmonary disease. Does the patient have a cough? Is it productive or nonproductive? If it's productive, have him describe the sputum's color and consistency. Does the patient experience shortness of breath? Is it related to activity? Although dyspnea is common with COPD, many patients fail to associate it with the disease. Instead, they blame “old age” or “getting out of shape” for causing dyspnea.

Auscultate for abnormal breath sounds, such as crackles and wheezing. Then percuss the chest. Hyperresonant sounds indicate trapped air; dull or flat sounds indicate mucus buildup. Be alert for accessory muscle use, intercostal retractions, and tachypnea, which may signal respiratory distress.

Finally, observe the patient's general appearance. Look for central cyanosis in the cheeks, nose, and mucosa inside the lips. In addition, look for peripheral cyanosis in the nail beds. Also note clubbing of the nail beds, a late sign of COPD.

Medical causes

Asthma.Typically, barrel chest develops only in chronic asthma. An acute asthma attack causes severe dyspnea, wheezing, and a productive cough. It can also cause prolonged expiratory time, accessory muscle use, tachycardia, tachypnea, perspiration, and flushing.

Chronic bronchitis.Barrel chest is a late sign in chronic bronchitis. This form of COPD may also cause productive cough, exertional dyspnea, cyanosis, tachypnea, wheezing, prolonged expiratory time, and accessory muscle use.

Emphysema.Barrel chest is a late sign in this form of COPD. Typically, emphysema begins insidiously, with dyspnea the predominant symptom. Eventually, it may cause chronic cough, anorexia, weight loss, malaise, accessory muscle use, pursed-lip breathing, tachypnea, peripheral cyanosis, and clubbing of the nail beds.

Osteoarthritis.Osteoarthritis of the rib and spine joints may cause rigidity of the chest wall, fixing the rib cage in the inhale position. Other signs and symptoms include joint pain that worsens after exercise, joint swelling, impaired movement, and stiffness in the morning.

Nursing considerations

▪ To ease breathing, have the patient sit and lean forward, resting his hands on his knees to support the upper torso (tripod position), thus allowing maximum diaphragmatic excursion, facilitating chest expansion.

▪ Assess pain and provide analgesics as appropriate.

Patient teaching

▪ Advise the patient to avoid bronchial irritants, especially smoking, which may exacerbate COPD.

▪ Tell him to report purulent sputum production, which may indicate upper respiratory tract infection.

▪ Instruct the patient to space his activities to help minimize exertional dyspnea.

▪ Explain the underlying disorder and treatment plan.

Pictures

Book Source Details

• Book Title: Nursing: Interpreting Signs and Symptoms
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Nursing: Interpreting Signs and Symptoms Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-668-7

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