Ch. 14 Chest and Lungs Flashcards by Maria Pseftelis

How many ribs do adults have?

11 and 12 are called

Floating ribs

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The lateral diameter of the chest should__ the__

exceed, anterior-posterior diameter in adults.

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The right bronchus is __ and __ also more vertically placed than the left making it more susceptible to __ and __.

wider, shorter

Aspiration of foreign bodies

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The main bronchi is divided into __on the right and _ left.

These then divide into__bronchioles and __bronchioles

3 branches, 2

Terminal, and respiratory

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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.

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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.

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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.

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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.

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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.

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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.

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__ dyspnea that increases in upright position

Platypnea

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Pack years of smoking calculated by

of years smoked X # of packs smoked per day.

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__ can cause severe acute chest pain in adults/young adults.

cocaine.

Symptoms: Tachycardia, HTN, coronary artery spasm with infarction, pneumothorax (lung collapse)

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thoracic ratio is usually _ to _

0.70-0.75

When AP diameter approaches or equals the lateral diameter, chronic condition is present.

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Barrel chest occurs from _ _ _

Spine is

chronic asthma, emphysema or cystic fibrosis.

Kyphotic

Trachea posteriorly displaced

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Pigeon chest also called

Funnel chest

Pectus Carinatum (sternal protrusion)

Pectus Excavatum (indentation)

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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

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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.)

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Air trapping occurs from _ _ _

Rate of respirations _ to compensate and lungs then _

Chronic bronchitis, emphysema, asthma

increase , Hyperinflate (chronically this can cause barrel chest).

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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

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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.

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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.

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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