Ch. 19- Thorax and Respiratory Assessment Flashcards
Where is the suprasternal notch located?
At top of sternum (u-shaped)
Explain the sternum anatomy?
“breastbone” has three parts; manubrium, body, xiphoid process
“Angle of Louis” continuous with what?
2nd rib
Each intercostal space is numbered by what?
rib above it
Where is the costal margin?
Bottom of rib cage
What is the measurement of a normal costal angle?
70 degrees (gets larger with age?)
When you flex the neck forward, what is that body prominence?
C7 (two bumps =C7 and T1)
How do you find the spinous processes?
count down knobs on vertebrae, which stack together to form spinal column
What should you check the scapula for bilaterally?
symmetry and skin break down
What are the anterior reference lines?
- Anterior axillary line
- Midsternal line
- Midcalvicular line
What are the posterior reference lines?
- Scapular line
- Vertebral line
What are the lateral reference lines?
- Anterior axillary line
- Posterior axillary line
- Midaxillary line
What respiratory subjective data is important?
- CC
- HPI
- Patient ROS
- Patient past history
- Patient social history
- Patient family history
- Immunization status
In what order do you obtain objective respiratory data?
- Inspect
- Palpate
- Percuss
- Auscultate
What things are you inspecting in a respiratory assessment?
- Position of trachea
- shape and configuration of chest wall
- anteroposterior diameter should be less than transverse diameter
- quality of respirations
What is kyphosis?
forward flexion of chest
What things are you doing during palpation of a respiratory assessment?
- Symmetric chest expansion: hands of T9-T10
- Tactile fremitus: Sounds generated from larynx are transmitted through lung where you feel vibrations
- Entire chest wall: crepitus, temp, tenderness, masses
What things are you doing during percussion of a respiratory assessment?
- Start at apices, move side to side at interspaces, 2 inches apart
- Lungs should sound resonance (clear/low pitched)
What things should you instruct patient to do when auscultating during a respiratory assessment?
Instruct pt to breath through mouth, a little deeper than usual
You should use the diaphragm for auscultation of a respiratory assessment and do what?
- Hold it firmly on persons chest wall; listen at least one full respiration in each location
- compare side to side
What is the procedure of auscultation during a respiratory assessment?
- Anterior from the apices above the clavicle to the 9th rib
- Laterally from axilla down to 7th or 8th rib
- posterior from apices at C7 to bases around T10
What are normal breaths sounds for adults?
- Bronchial
- Bronchovesicular
- Vesicular
- Diminished
Explain bronchial breaths sounds:
(tracheal or tubular)
- harsher, over trachea
- higher pitch, louder, inspiration and expiration are equal and there is a pause between inspiration and expiration
Explain bronchovesicular breath sounds:
Over major bronchi
-Bronchovesicular sounds are heard in the posterior chest between the scapulae and in the center part of the anterior chest. Bronchovesicular sounds are softer than bronchial sounds, but have a tubular quality.
Explain vesicular breath sounds:
- lower and softer, over majority or peripheral lung tissue
- heard over the thorax, lower pitched and softer than bronchial breathing
Explain Diminished lung sounds:
not normal but common
What are adventitious lung sounds?
- Sounds that are not normally heard
- moving air colliding with secretions in tracheobronchial passageways
- popping open of previously deflated airways
What are types of adventitious lung sounds?
- Crackles
- Wheezes
- Stridor
- Pleural friction rub
Explain crackles:
Inspiratory/expiratory or just inspiratory, fine or coarse
- Crackles are the sounds you will hear in a lung field that has fluid in the small airways.
- Crackles are abnormal lung sounds characterized by discontinuous clicking or rattling sounds. Crackles can sound like salt dropped onto a hot pan or like cellophane being crumpled or like velcro being torn open.
Explain Wheezes:
Mostly expiratory, high-pitched or low-pitched
-A wheeze might have a low or higher frequency sound. Higher frequency wheezes are similar to squeezing or whistling. A lower frequency wheeze can seem similar to snoring or gurgling. Low frequency wheezes are sometimes called rhonchi.
Explain Stridor:
Inspiratory, think croup or foreign object
-a harsh or grating sound.
Explain Pleural friction rub:
Inspiratory/Expiratory grating sound
-Pleural Rubs. Pleural rubs are discontinuous or continuous, creaking or grating sounds. The sound has been described as similar to walking on fresh snow or a leather-on-leather type of sound.
What assessment technique do you use to determine quality of voice sounds or vocal resonance?
Auscultation
Voice sounds assessed via auscultation is only used when?
Pathology is expected
Explain bronchophony:
pt. repeats a phrase “99” while you auscultate
Explain Egophony:
pt. repeats a long “e” while you auscultate
Explain Whispered Pectoriloquy:
pt. whispers “1, 2, 3,” as you auscultate
What is commonly seen in an aging adult in relation to a respiratory assessment?
- Kyphosis
- Chest cage shows increased anteroposterior diameter
- tend to tire easily during auscultation when deep mouth breathing is required
