Assessment of the Lungs and Thorax Flashcards
When would tactile fremitus increase?
when the patient has an advanced case of pneumonia
Subcutaneous Emphysema
when gas or air is in the layer under the skin
Bronchovesicular Breath Sounds
- inspiration to expiration periods are equal
- normal sounds in the mid-chest area or in the posterior chest between the scapula
Vesicular Breath Sounds
- heard across the lung surface
- lower-pitched, rustling sounds with higher intensity during inspiration
- Inspiration is normally 2-3 times the length of expiration
Broncheal Breath Sounds
- over the trachea
- higher pitch
- louder
- inspiration and expiration are equal and there is a pause between inspiration and expiration
Tracheal Breath Sounds
- sounds heard over the sternum
- louder and higher-pitched than vesicular sounds
- expiratory phase is as long as or longer than the inspiratory phase
Crackles
- “rales”
- occurs on inspiration
- fine
- coarse
Wheezes
- “ronchi”
- occurs on expiration
Stridor
- inspiration
- high-pitched, wheezing sound
- “musical”
- caused by block in trachea
Atelectatic Crackles
Late inspiratory crackles
How far do the lungs expand?
from apex of axilla down to 7th or 8th rib
Developmental Conditions: Aging Adult
- costal cartilages become calcified
- muscle strength declines
- decrease elasticity within lungs
- increased risk of postoperative pulmonary complications
- increased AP diameter “kyphosis”
- care with auscultation (allow rest periods)
Developmental Considerations: Infants and Children
- airways are smaller, cartilage is more elastic
- increased risk for airway obstruction related to disease processes
- smaller children tend to be abdominal breathers
- tongue is larger compared their airway (obstruction risk is higher)
- nasal breathing (mostly neonates)
- AP 1:1 in neonates
APGARS
test after birth to see how baby handled the birthing process
How long should you listen to a child’s resps?
- 1 min (too irregular for 30sec)
Developmental Considerations: Pregnant Women
- thoracic cage may appear wider
- more “aware” of breathing
- respirations may be deeper with other changes occurring in the body
- costal angle increases
- rib injury
Why do pregnant ladies experience dyspnea?
uterus pushes up on diagram
Atelectasis
- diaphragm elevates to fill in space left by shrunken section
- bronchial obstruction causing collapsed area
Lobar Pneumonia
- alveoli consolidated with fluid
- bacteria
- RBCs
- WBCs
Bronchitis
- inflated primary and secondary bronchi
- acute bronchitis usually results from an infection such as a cold or flu
- bronchial inflammation and copious secretions
- deflated alveoli beyond obstruction
Emphysema
- alveoli with emphysema
- microscopic view of normal alveoli
- over distended alveoli with destruction of sepia
COPD
- easily fatigued
- frequent respiratory infections
- use of accessory muscles to breath
- orthopneic
- wheezing
- pursed-lip breahting
- chronic cough
- barrel chest
- dyspnea
- prolonged espiratory time
- clubbing
Asthma
edema of bronchial mucosa/ thick mucus
Pleural Effusion
- build-up of excess fluid between the layers of the pleura
