Chapter 11: Lungs/Respiratory Flashcards
Tachypnea
rapid, shallow breathing
- fast breathing
- faster then 20 breaths per minute
Bradypnea
slow breathing
- slower than 12 breaths per minute
Occupational Hazards
hazards that include the air-borne ones
- exposure to irritants, asbestos, smoke, etc that affects your lung health
Dyspnea
shortness of breath
Orthopnea
difficulty breathing when lying down
- propping yourself up with pillows helps alleviate this
Pursed Lip Breathing
when you inhale with the nose and then exhale with pursed lips very slowly
- seen in chronic obstructive pulmonary disease (COPD) or asthma
What is Kussmauls ?
distressing, paroxysmal dyspnea
- patten of respiration that is rapid, deep, and labored
- also known as air hunger
- affects both inspiration and expiration
- body’s compensation to alleviate the high levels of acidosis
Cyanosis
bluish discoloration, especially of the skin and mucous membranes
- can be a sign of inadequate oxygenation of tissues
Auscultate
listen to the sounds within the body
- usually with a stethoscope
Barrel-Shaped Chest
rounded, bulging chest with abnormal increase in AP diameter
- AP diameter of 1:1
- can be due to chronic air trapping in the alveoli
- can be caused by emphysema
- shows little movement on respiration
Bronchovesicular
sounds heard over the main stem bronchi
- intensity of sound is moderate
- I=E
- moderate pitch sound
Adventitious
means involuntary/abnormal
- examples of these types of sounds are wheezing, crackles, rhonchi
Pectus Carinatum
occurs when abnormal cartilage growth causes the sternum to protude from the chest
- when the breast bones is pushed outwards
- also called pigeon chest
Pectus Excavatum
when the breast bones is sunken into the chest
Anterior-Posterior Diameter
where the front to back dimension of the chest is smaller than its lateral dimension
- normal is about 1:2 ratio to lateral diameter
Crepitus
unusual popping or cracking, etc
- indicates air in the subcutaneous tissue
Pleural Friction Rub
Superficial, low-pitched, coarse rubbing or grating sound
- sounds like two surfaces rubbing together
- heard throughout inspiration and expiration
- caused by pericardial pleura rubbing together
Vesicular Sounds
heard over the periphery (outside portions of lungs) of lungs
- I>E
- intensity of sound is soft because it’s the furthest site from the airway
- low pitch sound
Rhonchi
low-pitched wheezing sounds (can sounds like snoring or moaning)
- usually heard during expiration
- continuous
- can be heard if you have bronchitis, asthma, COPD
Bronchitis
inflammation of the bronchial tubes
- may become productive with sputum (muscus)
- can cause coughing, wheezing, etc
Asthma
hyperreactive airway disease characterized by bronchoconstriction, airway obstruction, and inflammation
Emphysema
Destruction of the alveolar walls causes permanent abnormal enlargement of the air spaces
- causes increased AP (anterior posterior) diameter
Pneumothroax
air or gas in the cavity between the lungs and the chest wall, causing collapse of the lung
- decreased chest wall movement on side of injury can occur
- breath sounds over affected area are absent
- tracheal deviation (moves away from the midline and must be seen immediately)
Retraction
when the area between the ribs and in the neck sinks in when a person with asthma tries to inhale
- Ex.) intercostal muscles are drawn inward between the ribs
- indicates airway obstruction
- may occur during pneumonia
Asymmetry
abnormal finding where the abnormal side of the chest expands less and lags behind the normal side
Pitch
how high or low the respiration sound is
Intensity
characteristic of the breath sound that is loud, moderate, or soft
Sputum
a mixture of saliva and mucus produced by the lungs in viral or bacterial infections
What does greenish/yellow sputum mean ?
bacterial infections
What does clear/whiteish sputum mean ?
viral infection
- like a cold or bronchitis
What does black sputum mean ?
smoke or coal dust inhalation
What does Rust/Red sputum mean ?
TB or pneumococcal pneumonia
What does foul smelling sputum mean ?
bacterial pneumonia, lung abscess, or bronchietasis
What does frothy sputum mean ?
pulmonary edema
What does thick sputum usually mean ?
cystic fibrosis
How do we document tobacco use ?
using pack-years
- # packs per day X # yrs smoked
- or # cigs per day X # yrs smoked/ 20
What does a Normal Lung Inspection look like ?
- Eupneic (easy, free respirations)
- no nasal flaring
- no lip, buccal mucosa cyanosis
- AP diameter of 1:2
- pink nail beds, capillary refill <3 secs, no clubbing
- chest wall symmetrical and mobile
Why does clubbing occur ?
sign of chronic hypoxia
What causes Barrel Chest to occur ?
COPD
Is Chest Retraction a good sign ?
no, it indicated airway obstruction that can occur because of an asthma attack or pneumonia
How do we check for crepitus ?
palpation
What is Vocal (tactile) Fremitus ?
feeling the vibrations of the anterior or posterior thorax
- should be equal bilaterally
- may be absent in a healthy person with a high-pitched or soft voice
Fine Crackles
- high-pitched popping sounds
- not continuous
- can occur because of pneumonia, bronchitis, fluid in lungs
Coarse Crackles
- low-pitched popping
- more of a rippling sound
- not continuous
- can occur because of pneumonia, fluid overtake
Do crackles clear with a cough ?
no
Wheeze
high-pitched snoring sound
- continuous
- musical-like sound
- heard during expiration and inspiration
- occurs during asthma
Plural Friction Rub
caused by inflamed parietal and visceral pleura rubbing against each other
- sounds like a coarse, grating sound
Stridor
high-pitched crowing, honking sound
- heard over the larynx
- heard during both inspiration and expiration
- can occur because of respiratory obstruction of larynx or trachea and they aren’t getting enough 02
Bronchial
heard over the trachea and thorax
- high-pitch sound
- intensity of sound is loud because it’s the closest to the airway
- I<E
What are the Chronic Pulmonary Diseases ?
- Asthma
- COPD (emphysema and chronic bronchitis)
Acute Bronchitis
- inflammation of the mucous membrane
- cough is initially non-productive but after a few days it becomes productive
- rhonchi heard on auscultation with wheezing heard after coughing
Chronic Bronchitis
- long-term cough with mucous (sputum history)
-chronic, cyanosis, may hear rhonchi, obesity, clubbing, wheezes
Is Nasal Flaring a good sign in infants ?
infants are abdominal breathers, so a little flaring is okay but if it’s excessive then it’s an emergency
Atelectasis
collapsed alveoli caused by external pressure from a tumors, fluid, or air in the pleural space
- diminished breath sounds and fremitus, low 02 Sat
What are common childhood illnesses ?
asthma, acute bronchitis, pneumonia, and cystic fibrosis
What are illnesses are associated with Fine Crackles ?
pneumonia, bronchitis, fluid in lungs
What illnesses are associated with Coarse Crackles ?
pneumonia, fluid overtake
What illnesses are associated with Wheezes and Rhonchi ?
asthma, bronchitis, COPD,
What are abnormal findings of Vocal (tactile) fremitus ?
Diminished/Absent:
- pneumothorax, pleural effusion, obesity, and bronchial obstruction
Increased:
- pneumonia
- tumor if it’s solid
What is the Pitch, Intensity, Duration, and Expected location of Bronchial sounds ?
- high-pitched
- loud (closest to the airway)
- Expiration is longer than Inspiration
- over the trachea and thorax
What is the Pitch, Intensity, Duration, and Expected location of Bronchovesicular sounds ?
- moderate pitch
- moderate
- Inspiration=Expiration
- over the main stem bronchi
What is the Pitch, Intensity, Duration, and Expected location of the vesicular sounds ?
-low pitched
- soft (furthest from the site of airway)
- Inspiration is longer
- periphery of lungs (outside portions of the lungs)
What are some symptoms of chronic bronchitis ?
- chronic, productive cough
- cyanosis (due to hypoxia)
- crackles, wheezes
- obese
- prolonged expiration
- peripheral edema
What are some symptoms of emphysema ?
- dyspnea
- minimal cough
- pink skin, pursed-lip breathing
- accessory muscle use
- hyperinflation, barrel chest
- tachypnea
- increased minute ventilation
- weight loss (due to work of breathing)
What is placement of hands during thoracic expansion ?
anterior: costal margin and xiphoid process
posterior: T9 or T10 ; 10th rib
How do you calculate pack years ?
- # packs smoked a day x # years smoked
- # cigs smoked per day x # years smoked/ 20
When can wheezes be heard ?
during inspiration and expiration
When can rhonchi be heard ?
expiration
When can stridor be heard ?
during inspiration and expiration
Where is stridor usually heard ?
over the larynx
What adventitious lung sounds are continuous and be cleared with a cough ?
wheezes, and rhonchi
What causes stridor ?
respiratory obstruction of larynx or trachea
- not getting adequate O2
- associated with croup
- very dangerous and must act quickly
What causes fine and coarse crackles ?
fluid in lungs
- pneumonia or bronchitis
What patient do we prioritize seeing ?
ABC
- airway
- breathing
- circulation
- respiratory issues are always a priority
