ch 19 - respiratory assesment Flashcards
how should the thoracic cage be upon inspection?
symmetric, elliptical shape, downward sloping ribs,
what disease would a barrel chest indicate?
COPD
what disease does hypertrophied neck muscles indicate?
COPD
what position would people with COPD likely sit in?
tripod position
what does unequal chest expansion occur with?
atelectasis, lobar pneumonia, pleural effusion, thoracic trauma
what is a fremitus?
a palpable vribration
what does decreased fremitus occur with?
obstructed bronchus, pleural effusion, thickening pneumothorax or emphysema
what does increased fremitus occur with?
compression or consolidation of lung tissue
what is rhoncal fremitus palpable with?
thick bronchial secretions
what is pleural friction premitus palpable with?
inflammation of the pleura
what is creciptus?
coarse, crackling sensation palpable over skin surface
what is resonance?
low pitched, clear, hollow sound that predominates in healthy lung tissue in the adult
what is hyperresonance?
lower pitched, booming sound found when too much air is present such as in emphysema or pneumothorax
what does a dull note indicate?
abnormal density in the lungs as with pneumonia, pleural effusion , atelectasis or tumor
what are bronchial sounds like?
inspiration is shorter than expiration
what are bronchovesicular sounds like?
inspiration is the same as expiration
what are vesicular sounds like?
inspiration is greater than expiration
a patient has obstruction in his bronchial tree. What do you expect to hear when auscultating his chest?
decreased or absent breath sounds
a patient has hyperinflated lungs due to emphysema. what do you expect to hear when auscultating his chest?
decreased or absent breath sounds
if fluid or pleural thickening are present in a patient’s lungs, what do you expect to hear upon auscultation?
decreased or absent breath sounds
what are the characteristics of increased breath sounds?
- high pitched tubular quality
- prolonged expiratory phase
- distinct pause between expiration and inspiration
you are auscultating a patient with pneumonia. what kind of sounds do you expect to hear?
increased breath sounds
you are auscultating a patient with fluid in the interpleural space. what do you expect to hear?
increased breath sounds
what caused adventitious breath sounds?
- moving air colliding with secretions in the airways
- popping open of previously deflated airways
what are atelectatic crackles? where are they usually heard?
- non pathologic sounds caused by aerating the alveoli that usually get deflated during sleep
- they last only a few breaths
- usually heard in the periphery
You are inspecting the anterior chest of a patient with emphysema. What do you expect to see?
hypertrophied abdominal muscles from increased effort to breathe
A patient comes in and you notice tense, strained, facies with pursed lipped breathing. What disease do you suspect this patient has?
COPD
A patient comes in with excessive drowsiness or anxiety and is restless. What do you suspect?
cerebral hypoxia
A patient comes in after a diagnosis of COPD. When inspecting his distal phalanx, what do you see?
clubbing because of growth of vascular connective tissue
what does noisy breathing occur with?
asthma or chronic bronchitis
what does retraction suggest?
obstruction of respiratory tract or that increased effort is needed for breathing
what does bulging indicate? what is it associated with?
- trapped air
- emphysema or asthma
when are accessory muscles used?
airway obstruction and massive atelectasis
in what condition are rectus abdominis and intercostal muscles used from breathing?
COPD
You are palpating the anterior chest of a patient with emphysema. What do you find?
abnormally wide costal angle with little inspiratory variation
You find a palpable grating sensation in your patient. What do you suspect he has?
pleural friction fremitus
When percussing a patient’s chest you find cardiac dullness. What disorder do you suspect the patient has and why?
- emphysema
- the lungs are hyper inflated which results in hyperresonance
what does dullness behind the right breast occur with?
right middle lobe pneumonia
a patient has an obstructive lung disease. What do you expect his forced expiration to be?
6 seconds or more
