chapter 16 part 2 Flashcards
What causes an abnormal increase in AP diameter (barrel chest)? What type of patient does this happen to?
causes the chest to expand and the lungs get overinflated, seen in patients with
emphysema (COPD)
- Explain the 5 different thoracic configurations.
Pectus carinatum; abnormal protrusion of sternum
Pectus excavatum; depression of part or entire sternum, which can produce a restrictive lung defect.
Kyphosis; spinal deformity in which the spine has an abnormal AP curvature
Scoliosis; spinal deformity in which the spine has a lateral curvature
Kyphoscoliosis; combination of kyphosis and scoliosis, which may produce a severe restrictive lung defect as a result of poor lung expansion.
Explain tracheal deviation.
- an important sign that can indicate serious underlying problems in the chest
- place both thumbs on each side of the suprasternal notch and press inward
- only soft tissue should be palpable
What do retractions indicate in a patient?
Retractions are an inward sinking of the chest wall during inspiration
○ Intercostal, supraclavicular, or subcostal retractions
● Occurs when inspiratory muscle contractions generate very large negative intrathoracic pressure
● Tracheal tugging
○ The downward movement of the thyroid cartilage toward the chest during
inspiration
■ typically happens when there’s an increased effort in breathing due to
airway obstruction or other forms of respiratory distress
Apnea.
● no respirations (respiratory arrest)
● - no breaths at all, no air moving in and out
Agonal
● intermittent prolonged gasps (cardiac arrest)
-these gasps are not effective for breathing usually last sign before respiratory
failure
Kussmaul
● Increased rate and depth
● metabolic acidosis (blood gas)
● diabetic ketoacidosis (blood sugar)
● renal failure (kidney)
Cheyne-Stokes.
● Respiratory rate and tidal volume increase in intensity, then decreases into apnea for several seconds
● Coma from cerebral lesions, brainstem injury, severe stroke, low cardiac output
Biot
● chaotic breathing with irregularity in rate and tidal volume which becomes agonal breathing
● Damage to the medulla by trauma or stroke
Wheezes. How do we fix it?
● consistent with airway obstructions
● helps us understand the severity and location of the airway obstruction, giving us a
clearer idea of how to approach the patient’s treatment.
- Monophonic wheezing indicates one airway is affected
● Polyphonic wheezing indicates many airways are involved
Stridor. How do we fix it?
● high pitched sound heard when upper airway is partially blocked
● usually occurs when the airways narrow due to swelling or an obstruction
● chronic stridor - laryngomalacia
● acute stridor - croup
● stridor - heard on inspiration
- Crackles. (What is it a sign of? How do we fix it?) ABNORMAL
a. Course.
● Airflow moves secretions or fluid in airways
● Usually clears when patient coughs or upper airway is suctioned (Loud sound)
b. Fine.
● Sudden opening of small airways in lung deep breathing
● Heard with pulmonary fibrosis and atelectasis (lung tissue becomes stiff or collapses)
Heart sounds.
a. S1. Closure of mitral and tricuspid (atrioventricular/AV) Valves (beginning of
ventricular contraction)
b. S2. Closure of the pulmonic and aortic valves (end of systole… as ventricles relax)
What causes murmurs?
● created by backflow of blood through an incompetent valve
● forward flow of blood through a narrowed valve
● rapid blood flow through a normal valve
- Match an abnormal increase in the anteroposterior diameter of the chest caused by hyperinflation of the lungs.
Patterns
A. Tachypnea- Abnormally high respiratory rate
B. Eupnea- Normal breathing
C. Platypnea- Labored breathing in upright position D. Hyperpnea- Deep breathing
E. Bradypnea- Abnormally low respiratory rate
F. Orthopnea- Difficulty breathing in supine position
- Write a description for the following six abnormal chest shapes. Abnormal chest shape Description
A. Barrel- an abnormal increase in the anteroposterior diameter of the chest caused by hyperinflation of the lungs.
B. Pectus carinatum- Abnormal protrusion of sternum
C. Pectus excavatum- Depression of part or entire sternum, which can produce a restrictive lung defect
D. Kyphosis- Spinal deformity in which the spine has an abnormal anteroposterior curvature
E. Scoliosis- Spinal deformity in which the spine has a lateral curvature
F. Kyphoscoliosis- Combination of kyphosis and scoliosis, which may produce a severe restrictive lung defect as a result of poor lung expansion
Explain the difference between vocal and tactile fremitus.
● Vocal fremitus are vibrations created by the vocal cords during speech. These vibrations are transmitted down the tracheobronchial tree and through the lung to the chest wall.
● When these vibrations are felt on the chest wall, it is called tactile fremitus.
Describe the difference between fremitus in emphysema and in pneumonia.
● Fremitus in pneumonia- is increased with pneumonia and atelectasis (yelling indoors, your voice bounces off the walls, making it louder.)
● Fremitus in emphysema- firmness is reduced when there is air or fluid in the plural space, such as emphysema, pneumothorax, and pleural effusion (yelling outdoors, there’s no structure to reflect the sound back, so it feels quieter.)
How does subcutaneous emphysema form? What is the feeling of air under the skin called?
Lung rupture often causes air to leak into the subcutaneous tissues of the chest and neck. Fine air bubbles collecting in subcutaneous tissues produce a crackling sound and sensation when palpated. This is referred to as subcutaneous emphysema.
The tactile sensation it produces is called crepitus
Complete the following chart by identifying the percussion notes for these conditions.
Emphysema: hyper-resonate note
Atelectasis:dull note
Pleural effusion: dull note
Pneumothorax:hyper-resonate note
Pneumonia: dull note
- Fill in the chart below with descriptions of your favorite breath sounds.
Vesicular- low pitch, soft intensity, peripheral lung areas
Bronchial- moderate pitch, moderate intensity, around upper part of sternum, between scapula
Bronchovesicular- high pitch, loud intensity, over trachea
How do you test for capillary refill? What is a normal capillary refill time?
pressing firmly on the patient’s fingernail until the nail bed is blanched, and then releasing the pressure.
The speed at which the blood flow and color return is noted. Healthy individuals with good cardiac output and digital perfusion have capillary refill times of 2 seconds or less.
Where should you check for edema caused by heart failure? Why?
the classic sign being “swollen ankles.” It is caused by the heart’s inability to pump blood effectively, with blood pooling in the gravity-dependent lower extremities as a consequence. The resulting increase in venous hydrostatic pressure pushes fluid into the interstitial space.
What is the specific cause of cyanosis?
Cyanosis is a bluish discoloration of the skin or oral mucosa resulting from respiratory or cardiac disease.
