Ch. 14 Chest and Lungs Flashcards
How many ribs do adults have?
11 and 12 are called
12
Floating ribs
The lateral diameter of the chest should__ the__
exceed, anterior-posterior diameter in adults.
The right bronchus is __ and __ also more vertically placed than the left making it more susceptible to __ and __.
wider, shorter
Aspiration of foreign bodies
The main bronchi is divided into __on the right and _ left.
These then divide into__bronchioles and __bronchioles
3 branches, 2
Terminal, and respiratory
Decrease in pulmonary pressure in fetus when takes first breathe causes __ to close
The increase in oxygen tension in arterial blood stimulates the contraction and closure of the __ __
foramen ovale in heart
Ductus arteriosus.
Chest of newborn is _ the AP diameter_ the _
Circumference is _ to head
Chest wall is more_ and _.
round, approximating, lateral diameter.
roughly equal
thin, cartilaginous and yielding. Xiphoid process more prominent.
Patent Ductus Arteriosus and the foramen ovale do not always close readily. Mostly occurs in__
Large PA can cause__and __
Preterm infants 30 weeks.
Mumur (machine-like) and left ventricular overload/heart failure.
Pregnant women’s lower ribs __and an increase in __diameter of about _ cm as well as an increase in __
flare, lateral 2 cm. Circumference of 5 to 7 cm.
AP chest diameter is _ in older adults
Alveoli become less__ and more __
increased (barrel chest). from loss of muscle strength in thorax and diaphragm.
stiffening and decreased expansion occurs as well.
Elastic, fibrous.
Older adults mucous membranes tend to become __ and less able to _ _
drier, clear mucus.
This causes retained mucus which encourages bacterial growth and predisposes to respiratory infection.
__ dyspnea that increases in upright position
Platypnea
Pack years of smoking calculated by
of years smoked X # of packs smoked per day.
__ can cause severe acute chest pain in adults/young adults.
cocaine.
Symptoms: Tachycardia, HTN, coronary artery spasm with infarction, pneumothorax (lung collapse)
thoracic ratio is usually _ to _
0.70-0.75
When AP diameter approaches or equals the lateral diameter, chronic condition is present.
Barrel chest occurs from _ _ _
Spine is
chronic asthma, emphysema or cystic fibrosis.
Kyphotic
Trachea posteriorly displaced
Pigeon chest also called
Funnel chest
Pectus Carinatum (sternal protrusion)
Pectus Excavatum (indentation)
Sequence of chest/lung assessment
Dullness on percussion=
Palpation of tactile fremitus if absent can mean
inspect, palpate, percuss, auscultate.
Pleural effusion or lobular pneumonia
effusion or can be increased with lobar pneumonia
Kussmaul breathing is _ and _ and is associated with
Cheyne- Stokes( periodic breathing) regular periodic pattern of breathing with periods of _ followed by _
deep and rapid, metabolic acidosis.
apnea, crescendo/decrescendo sequence (found in children/older adults when sleeping or someone seriously ill, damage to cerebral level with drug associated respiratory compromise or severe CHF.)
Air trapping occurs from _ _ _
Rate of respirations _ to compensate and lungs then _
Chronic bronchitis, emphysema, asthma
increase , Hyperinflate (chronically this can cause barrel chest).
Biot Respiration is when (or ataxic respiration)
Associated with _ _ _
This indicates _ _
irregular respirations vary in depth and interrupted by intervals of apnea, BUT lacking the repetitive pattern of periodic respiration.
increased intracranial pressure, drug poisoning, or brain damage at medulla
Poor prognosis
obstruction in high respiratory tree (laryngeal/trachea) is characterized by:
A foreign body in the bronchus (usually the _ side) causes _ retractions. Not seen in the _ _
Retraction of the lower chest occurs with _ and _
Stridor
Right, unilateral retractions , suprasternal notch
asthma, and bronchitis.
Primary apnea is
Can occur when a:
or:
Self limited
blow to head occurs or immediately after birth of newborn when carbon dioxide builds up spontaneously breathes.
secondary apnea is when
breathing stops and will not begin unless RESUSCITATIVE measures are immediately instituted (any limitation in oxygen will cause this to occur).
Reflex apnea is when
something irritating and provoking like vapor or gases is inhaled there is INVOLUNTARY or temporary halt in respiration.
A periodic apnea in the newborn is
normal finding and usually associated with rapid eye movement sleep. Pause is 10-15 seconds
(if prolonged and accompanied by cyanosis not normal)
apneustic breathing is when
prolonged inspiration occurs and pons and medulla affected causing a decrease in expiration because constrained.
Clubbing is associated with what:
emphysema, lung cancer, cyanosis of congenital heart disease, cirrhosis or cystic fibrosis.
Flaring of the alae nasi during inspiration=
air hunger
sweet smelling breath
pulmonary infection
diabetic ketoacidosis
malodorous smell
Palpation of crepitus can be found with
Pleural friction rub is caused by… feels like
rupture in respiratory system or by infection organism that produces gas (can mimic allergic reaction because it can go to the face/arms the swelling)
inflammation of pleural surfaces , coarse grating vibration .
thoracic expansion is observed by placing thumbs at the level of the
10th rib
Tactile fremitus is when you
If decreased or absent means
increased if:
palpate for vibration during verbalizations such as “99” or “Micky mouse”
excess air in lungs (emphysema, pleural thickening or effusion, or bronchial obstruction).
(coarser or rougher) in presence of fluids or solid mass within the lungs and heavy but non-obstructive bronchial secretions or compressed lung.
gentle tremulous fremitus
infections cause or inflammation some lung consolidations
Dullness and _ fremitus to chest percussion makes the probability that this can be
decreased, pleural effusion
Resonance is found where
Hyperresonance is found when
Dullness or flatness
normally in the lungs
hyperinflation, emphysema, pneumothorax, asthma.
pleural effusion, pneumonia, atelectasis asthma
diaphragm of the stethoscope used for
high pitched sounds better because it provides broader area of sound.
(Sounds of middle lobe of right lung and the lingula on the left are best heard in the respective axillae.
Vesicular breath sounds are
low pitched, low intensity, heard over health lung tissue
diminished in obese or overly muscular person
Bronchovesicular breath sounds are heard
_ pitch
expiration _ inspiration
SHOULD NOT BE HEARD OVER PERIPHERAL TISSUE
over main bronchus and over upper right posterior lung field
MEDIUM pitch and intensity
=
Bronchial/Tracheal breath sounds
_pitch
SHOULD NOT BE HEARD OVER PERIPHERAL TISSUE
over trachea
Highest in pitch
loud and long expirations sometimes longer than inspiration.
Rhonchi vs Crackles big way to distinguish is …
Rhonchi are more pronounced during
Crackles heard more often during
with Rhonchi cough causes noise to disappear, Crackles do not disappear.
expiration
inspiration
wheezing can be heard during
If bilaterally
unilaterally
inspiration or expiration (through a narrowed or obstructed airway).
The longer the wheeze and higher the pitch the worse the obstruction. (No wheeze does not mean there is no obstruction).
bronchospasm of asthma causes or acute/chronic bronchitis.
foreign body or tumor compressing
Friction rub
Over pericardium means
Over lungs
heard over heart and lungs caused by inflammation, roughened surfaces rubbing together.
Endocarditis
Pleurisy (respiratory rub disappears if breath held, but not cardiac rub).
Mediastinal crunch also called _ _ is found with _ _
heard best when patient on _ _
Hamman sign , mediastina emphysema. (synchronous with heart beats not respiration.
left side laying or leaning.
normal range of decent of the diaphragm is
3-5 cm.
Percussion is not done on
Auscultation and inspection occurs
Coughing is
Sneezing and Hiccups are
infants
at the same time.
rare (considered a problem).
normal (Hiccups if excess could mean withdrawal from drugs, encephalopathy, seizures).
Crepitus in newborn is
common with forceps delivery around fractured clavicle.
Crackles and rhonchi in newborns are
if asymmetric suspect
If respiratory distress and constant gurgling in chest suspect
Stridor suspect
common after birth because fetal fluid not completely cleared.
Meconium aspiration.
diaphragmatic hernia.
Croup or epiglottitis
_ lung sounds is common in children
Children have a _ chest wall
breath sounds may sound
hyperresonance
thinner
louder and harsher and more bronchial sounds as well as bronchovesicular throughout the chest.
Acute bronchitis commonly caused by
Chronic bronchitis
Inflammation leads to increased
infection
Smoking
mucus production
Pleurisy is an inflammatory process involving the _ and _ _
Associated with chest pain when
Caused by:
Viceral and parietal pleura
taking a deep breath!
PE, infections bacterial or viral, or lupus.
Pleural effusion is _ _ in the pleural space
Causes can be:
_ to percussion and _ tactile fremitus
areas of affected area sound _
non purulent fluid
heart failure, renal insufficiency, neoplasm, infection, trauma and connective tissue disease.
DULLNESS and DECREASED most useful findings (percussion above area hyperresonance).
Muted.
Pregnant people become short of breath because of the rise in _
Also their _ rises
progesterone
diaphragm
diaphragmatic excursion is usually _ to _ in length
3 to 6 cm
S1 is the closure of _ and _
time between _ and _ is systole
Tricuspid and mitral
S1 to S2
S2 is the closure of _ and _
time between _ and _ is diastole
Pulmonic and aortic valves
S2 to S1 (usually two times longer than systole). When Ventricles relax
in infants apex is _ because it lies _
higher, horizontally
