| Course | NR 306 Health Assessment |
|---|---|
| Week | 4 |
| Paper type | Respiratory examination write-up |
| Length | About 1,110 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | RN-to-BSN |
| Updated | October 2026 |
Free sample paper for NR 306 Week 4
Respiratory Assessment Write-Up: A 29-Year-Old Veterinary Technician With Childhood Asthma, Examined Across Before Down
Student Name
College of Nursing, Chamberlain University
NR 306: Health Assessment
Instructor Name
Month Day, Year
Respiratory Assessment Write-Up: A 29-Year-Old Veterinary Technician With Childhood Asthma, Examined Across Before Down
Setting and Method
The volunteer, Ms. L., is a 29-year-old veterinary technician with asthma diagnosed at age 7. She uses an albuterol inhaler about once a month, usually after cleaning cat kennels, and last used it nine days ago. She has never been hospitalized for asthma and has never smoked. The examination took place at 1015 in the skills laboratory, with Ms. L. sitting on the edge of the table, gown open at the back, arms folded across her chest for the posterior fields to move the scapulae apart. She gave verbal consent at 1010.
The sequence is inspection, palpation, percussion and auscultation (Jarvis & Eckhardt, 2024). At every level, the right side is compared with the left before the record moves lower, and each listening point is named by an intercostal space and a vertical line. Auscultation used the diaphragm of the stethoscope on bare skin, with Ms. L. breathing slowly and deeply through her open mouth. Sounds are named using the course vocabulary: vesicular, bronchovesicular and bronchial for normal breath sounds, and crackles, wheezes and rhonchi for added sounds, described by timing and location (Bohadana et al., 2014).
Inspection
Rate: 14 breaths per minute, counted for 60 seconds before she knew breathing was being observed.
Rhythm: regular.
Effort: unlabored; no use of sternocleidomastoid, scalene or trapezius muscles; no intercostal retractions; no nasal flaring; no pursed-lip breathing.
Posture: sitting upright, not leaning forward, not bracing on her arms.
Chest shape: anteroposterior diameter about half the lateral diameter; no pectus deformity; spine straight on inspection from behind.
Speech: full sentences without pausing for breath.
Skin and nails: lips and nail beds pink; no clubbing.
Palpation
Tenderness: none on palpation of the anterior and posterior chest walls.
Excursion, posterior, thumbs at the 10th rib: thumbs moved apart 5 centimeters on deep inspiration, symmetric.
Tactile fremitus, ulnar surface of the hand, patient saying ninety-nine, compared right then left at each level: posterior upper (between the scapulae at T3): equal. Posterior middle (below the scapulae at T7): equal. Posterior lower (T9): equal, slightly less than at the higher levels bilaterally. Anterior upper (2nd intercostal space, midclavicular lines): equal. Lateral (6th intercostal space, midaxillary lines): equal.
Percussion
Posterior, compared right then left from apices to bases: resonant at every level bilaterally.
Diaphragmatic excursion, posterior, scapular lines: level of dullness on full expiration at T10 bilaterally, on full inspiration at T12 bilaterally; excursion about 5 centimeters on each side.
Anterior and lateral: resonant bilaterally down to the 6th intercostal space at the midclavicular lines, where the right changed to the dullness of the liver; cardiac dullness at the left sternal border in the 3rd to 5th intercostal spaces.
Auscultation
Posterior, right then left at each level:
Apices (above the scapular spines): vesicular, soft, low-pitched, inspiration longer than expiration; equal bilaterally; no added sounds.
Between the scapulae, level of T3 to T4: bronchovesicular, medium pitch, inspiration and expiration about equal; equal bilaterally; no added sounds.
Below the scapulae, 7th intercostal space, scapular lines: vesicular; equal bilaterally; no added sounds on quiet deep breathing.
Bases, 9th intercostal space, scapular lines: vesicular; equal bilaterally; no added sounds on quiet deep breathing.
Forced expiration (asked to breathe in fully and then blow out as hard and fast as she could), repeated at the bases: right base, a high-pitched, musical, continuous sound in the last half of expiration, heard on two of three attempts; left base, the same sound, fainter, on one of three attempts. Not heard on quiet breathing at any level.
Lateral, 6th intercostal space, midaxillary lines, right then left: vesicular; equal; no added sounds.
Anterior, right then left at each level:
Supraclavicular areas: vesicular; equal.
2nd intercostal space, just beside the sternum: bronchovesicular; equal.
4th intercostal space, midclavicular lines: vesicular; equal.
6th intercostal space, midclavicular lines: vesicular on the right; on the left, partly obscured by heart sounds; no added sounds heard.
Trachea, above the sternal notch: bronchial, loud, high-pitched, expiration longer than inspiration with a short pause between.
Voice sounds (spoken ninety-nine, whispered one-two-three) at the posterior bases: muffled and indistinct bilaterally.
Summary
Respiratory rate, rhythm and effort were normal at rest, with symmetric excursion, fremitus, resonance and diaphragmatic movement. Breath sounds were normal for position and equal at every level. The only added sound was a high-pitched, continuous, musical sound late in forced expiration at both posterior bases, more often on the right, and absent with quiet breathing. Ms. L. was asked about her breathing afterward and said she felt normal; she had cleaned kennels the previous afternoon without using her inhaler. The finding was reported to the instructor and to Ms. L., who was reminded to discuss it with her primary care provider at her next visit.
Not done, with reasons: peak expiratory flow was not measured because the station had no peak flow meter, although it would have given a number to set beside the forced expiration finding; oxygen saturation was not measured for the same reason; egophony was not tested because voice sounds at the bases were muffled and there was no finding of consolidation to follow up. Each of these rows on the course form is marked not done rather than left blank.
Reflection
At work I listen to lungs many times a shift, usually four anterior points and two posterior points, and I usually chart clear or diminished. This week showed me how much that habit leaves out. I had not measured diaphragmatic excursion since nursing school, and I had never asked a patient to force an expiration while I listened. Writing each level right and then left, instead of finishing one side and starting the other, turned the record into a set of comparisons, and the forced expiration step produced the only abnormal sound I heard. Bickley et al. (2021) recommend the same across-then-down pattern, and I now think of it as the difference between listening to a chest and comparing two lungs.
Working in a hospital where breathing is charted in dropdowns, I also noticed how few of these entries our electronic record has a place for. Fremitus, excursion and voice sounds have no field at all, and I would have to write them in a narrative note. That is not a reason to skip them, but it explains why nurses rarely record them, and it is something I want to raise with our documentation committee.
References
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bates' guide to physical examination and history taking (13th ed.). Wolters Kluwer.
Bohadana, A., Izbicki, G., & Kraman, S. S. (2014). Fundamentals of lung auscultation. New England Journal of Medicine, 370(8), 744-751. https://doi.org/10.1056/NEJMra1302901
Jarvis, C., & Eckhardt, A. (2024). Physical examination and health assessment (9th ed.). Elsevier.
The Chamberlain NR 306 Week 4 instructions
Week 4 brings a complete chest examination of one volunteer, reported technique by technique from looking through listening. Expect the template to include rate, rhythm, effort, chest shape, excursion, tactile fremitus, percussion notes, diaphragmatic excursion, breath sounds at named positions, voice sounds and a summary. Compare right with left at each level before moving lower. Name each listening point by intercostal space and line. Count respirations before the person knows. If you hear an added sound, give its timing in the breath, the maneuver that produced it and how often it appeared. List anything you could not do and why. Do not record sounds you did not hear.
How this NR 306 Week 4 example is built
The write-up opens with Ms. L.'s history: asthma since age 7, albuterol about once a month after cleaning kennels. The method states the across-before-down rule from Jarvis and Eckhardt (2024). Inspection records rate, rhythm, effort and posture. Palpation gives excursion of 5 centimeters and fremitus at three posterior levels. Percussion records resonance and diaphragmatic excursion with levels. Auscultation lists each posterior, lateral and anterior point with sound type and comparison, and forced expiration produces a musical sound late in expiration at both bases on two of three tries, described with Bohadana et al. (2014). The summary lists tests not done, such as peak flow. The reflection contrasts six-point checks at work.
Reading the NR 306 Week 4 grading rubric
Respiratory rubrics usually reward correct sequence, bilateral comparison at each level, precise placement of findings, complete coverage including palpation and percussion, accurate description of any added sound and reflection. Placement carries the most marks, which is why every point is named by space and line. Comparison scores when right and left appear in the same entry. Coverage is credited when fremitus, excursion and percussion are included rather than skipped as optional. Added sound description earns points with timing, maneuver and frequency. Listing tests not done, with reasons, protects accuracy. Reflection on how dropdown charting leaves out many of these findings shows insight into practice.
NR 306 Week 4 help from the desk
The reliable loss is the unplaced sound: crackles heard is half a finding. Next is walking down one side and then the other, which loses the comparison. Rate without rhythm or effort, skipped fremitus and excursion, missing percussion, anterior fields done and posterior forgotten, unnamed positions and no note of how the person tolerated the exam all cost points. Writing a sound you did not hear costs more than any of these. Most templates want at least six posterior and four anterior points. A healthy volunteer still gets every position written out. Include oxygen saturation and smoking history if the template asks. Pass along what you heard and where, and the record can be set out level by level with both sides on each line.
Get a NR 306 Week 4 example written to your instructions
Send the Week 4 instructions and your respiratory template, and a custom example is written into it with the landmarks your section uses, returned inside 24 to 48 hours. The first one is free. The breathing you listened to belongs to a real person who agreed to it, and that part of the assignment is not ours to supply.
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- NR 307A Week 4: Organizational Assessment
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NR 306 Week 4 questions, answered
How many auscultation points does the template want?
As many as it prints, and each one filled. Forms vary between sections, and the count matters less than the pattern: paired points at each level, front and back, with the lateral fields included rather than assumed. If your form draws a diagram, mark it and describe it in words as well, since the written entry is what the rubric reads.
My volunteer is healthy and everything sounded the same. What do I write?
Write where you listened and what you heard, field by field. Vesicular sounds over the peripheral fields, bronchovesicular where they belong, nothing added, equal on both sides at each level. That is a complete finding and it earns full credit, because the record is being read for coverage of the fields rather than for the discovery of a problem.
Should I include oxygen saturation and smoking history?
Include the measurement if your template has a row for it, and keep the history brief. This week is about what the examination produced, so a long account of smoking years belongs to the interview course rather than here. One or two lines of relevant background is usually enough to set the findings up, and anything more starts competing with the fields for space.
Where can I find a free NR 306 Week 4 sample paper?
The full Week 4 respiratory write-up on Ms. L., with excursion, fremitus, percussion and breath sounds compared side to side at every level, appears on this page.
What added sound does the NR 306 Week 4 example find?
A high-pitched, musical, continuous sound in the last half of forced expiration at both posterior bases, heard on two of three attempts and absent on quiet breathing.