Assessment Flashcards
What 7 things should be assessed when examining the chest?
- Body type
- Overall posture
- Chest type
- Symmetry
- Coloration
- Scars
- Abnormal movements
- Muscle contractions
What are the BAD CAT signs of respiratory problems?
- Breathing that is audible
- Active accessory muscles
- Dyspnea
- Cyanosis/ clubbing
- Anterior/ posterior diameter > 1
- Trachial deviation from midline
Where is the apex of the lung found on the anterior chest?
2 - 4 cm above the middle clavicle
Where is the lower medial border of the lungs on the anterior portion of the chest?
6th rib.
What is the level of the lateral border of the lungs on the anterior chest?
8th rib.
What are the superior and inferior borders of the lungs on the posterior thorax?
Superior: T3/T4
Inferior: T10
What are landmarks of the oblique fissue?
T3 spinous process to 6th intercostal space.
What position should a patient be in when assessing respiratory rhythm?
Seated.
What should be assessed when evaluating respiratory rhythm?
- Regularity/ irregularity
- Expiration length vs inspiration
- Number of sighs
How long should it take to assess respiratory rhythm?
30 - 60 seconds
How are the length of expiration and inspiration related?
- Expiration 2 times longer than inspiratoin
How often is normal for an adult to sigh?
9 - 10/ hr.
What is eupnea?
Normal breathing
What is hypernea?
Increased breathing
What is dyspnea?
Labored/ difficult breathing
What is apnea?
Temporary cessation of breathing.
What is apneusis?
Sustained, gasping inspiration followed by short, inefficient expiration
What causes apneusis?
- Lesion to respiratory center in brain
What is respiratory arrest?
- Discontinuation of breathing following apnea or apneusis
What is cheyne-stokes respiration?
- Period of abnormal breathing
- Progressively deeper, sometimes faster breathing
- Temporary apnea
- Pattern repeats
In what type of patients does cheyne-stokes breathing typically occur?
Brain damaged patients.
How long is each cycle of cheyne-stokes breathing?
30secs - 2 minutes
What is biot’s breathing?
Repeated sequences of deeps gasps and apnea.
How is respiratory depth/ symmetry of movement measured?
- Seated
- Hands placed at shoulders with hands on SC joint
or - Hands cup lateral chest with thumbs under line of pectorals
or - Hands cup lateral chest with thumbs in line with inferior border of scapula
What is a normal finding of respiratory depth/ symmetric movement?
3 - 5 cm of expansion
What are abnormal findings of respiratory depth/ symmetric movement?
- Less than 3 cm of movement
- Unilateral delay
What does unilateral delay of respiration suggest? (3 possibilities)
- Atelectasis
- Pneumonia
- Post operative gaurding
How is thoracic excursion with a tape measure performed?
- Patient standing
- Place tape measure along circumference of upper and lower chest
- Patient takes a full inspiration, and holds; exhales and holds
What is a normal finding in the upper and lower chest of an adult male of thoracic excursion with a tape measure?
Upper: 3.6 cm +/- 0.6
Lower: 4.9 cm +/- 0.6
What is a abnormal finding of thoracic excurison?
> 1.7 cm
How should the patient be prepared for an assessment of breath sounds?
- Instruction of deep breathing through the mouth
- Assess dizziness/ fatigue during deep breathing
What causes breath sounds?
Vibration and turbulence of air flowing in and out of the airways and lung tissue during respiration.
What are the 4 normal breath sounds?
- Tracheal
- Bronchial
- Vesicular
- Bronchovesicular
Describe a tracheal breath sound.
- High-pitched and loud
- Wind blowing through pipe
- Measured at trachea
Describe the sound and location of bronchial breath sounds.
- Adjacent to sternum over major airways
- Similar to tracheal, but less loud
During what phase of respiration are bronchial breath sounds louder?
- Expiration > Inspiration
Describe the sound and location of vesicular breath sounds.
- Low pitch and muffled
- Found in all areas of the lung except trachea
Is inspiration or expiration greater in vesicular breath sounds?
- Inspiration louder, longer, and higher pitched than expiratoin
Describe the sound and location of bronchovesicular breath sounds.
- Inspiration/ expiration similar lengths and pitch with a slight break inbetween
- Heard adjacent to sternum, costo-sternal border, and between scapulae at T3 - T6
Describe the order of lung sound location observations on anterior and posterior thorax.
Alternate listening to the same spot bilaterally on the body.
10 spots on posterior thorax Begining near superior scapula near midline of the back. Move downwards and outwards.
Listen adjacent to sternum on anterior chest
Where do bronchial sounds indicate a consolidated lung?
- When heard at a distance from large airways.
What is the most common breath sound heard in the absence of lung disease?
- Vesicular lung sounds
What do fine crackle lung sounds sound like?
- Discontinuous/ explosive
- High pitched
In what 3 conditions are fine crackles heard?
- Atelectasis
- Interstitial pulmonary fibrosis
- Healthy lungs
What do wheezing sounds/ rhonchi sound like?
- Continous high, medium or low pitched whistling
- Melodic
What causing wheezing sounds?
- Narrowed airways/ asecretions
Which phase of respiration contains more apparent wheezing?
- Expiration
What are coarse crackle lung sounds?
- Intermittent bubbling sound
What causes coarse crackle lung sounds?
- Secretions
What are voice sounds used to assess?
Presence/ absence of consolidation
What are the 4 lung sounds?
- Egophony
- Bronchophony
- Whispered pectoriloquy
- Fremitus
Describe the process of egophony.
- Patient says letter E
- In consolidated lung E will sound like A
Describe the process of bronchophony.
- Patient repeats a work (nintey-nine or sixty-six)
- Measure symmetrical areas on patient’s lung
- Should become quieter as stethoscope moves to the periphery of lungs
- Consolidation increases the sound
What conditions may lead to consolidation?
- Pneumonia
- Cancer
How may bronchophony be documented?
Increased breath sounds
Describe the process of whispered pectoriloquy.
- Patient whispers 1,2,3 repeatedly
- Should be faint or unintelligble
- If it can be heard, consolidation is indicated
Describe the process of voice fremitus.
- Compare vibration of patient during quiet breathing and speech
- Can be decreased or increased
What does increased fremitus indicate?
- Loss or decrease in ventilation
What does decreased fremitus indicate?
- Increased air within lung
- (Air poor conductor of sound)
What 3 sites should tactile fremitus be evaluated on?
- Posterior thorax between spinous processes and scapula
- Anterior chest at supraclavicular area
- Lateral to sternum
- Below T4
What are the normal testing positions of percussion of the anterior and posterior thorax?
Posterior: Seated with arms crossed
Anterior: Supine
Where are normal areas of dullness with percussion?
- Anterior right midclavicular line from T4 to liver, and 3rd to 5th intercostals (heart)
What tissue gives off a hollow, loud, low sound on percussion?
Lung tissue
What tissue gives off a loud, musical, high pitched sound on percussion?
- Stomach
- GI tract
- Air bubbles
What tissue gives off a medium loudness, medium-high pitched, thud-like sound upon percussion?
The liver
What tissue produces a soft, high-pitched, short-duration sound upon percussion?
- Muscle
