Chapter 19 Flashcards
Alveoli
Functional unit of the lung
Thing-walled chambers surrounded by networks of capillaries that are the site of respiratory exchange of CO2 and 02
Angle of Louis
Manubriosternal angle, the articulation of the manubrium and body of the sternum, continuous with the second rib
Apnea
Cessation of breathing
Asthma
An abnormal respiratory condition associated with allergic hypersensitivity to certain inhaled allergens
Characterized by: Inflammation, bronchospasm, wheezing, and dyspnea
Atelectasis
An abnormal respiratory condition characterized by collapsed, shrunken, deflated sections of alveoli
Bradypnea
Slow breathing, fewer than 10 breaths per minutes
Bronchiole
On of the smaller respiratory passageways into which the segmental bronchi divide
Bronchitis
Inflammation of the bronchi with partial obstruction of bronchi due to excessive mucus secretion
Bronchophony
The spoken voice sound heard through the stethoscope, which sounds soft, muffled, and indistinct over normal lung tissue
Bronchovesicular
The normal breath sound heard over major bronchi
Characterized by: Moderate pitch, an equal duration of inspiration and expiration
Chronic obstructive pulmonary disease (COPD)
A functional category of abnormal respiratory conditions
Characterized by: Airflow obstruction
Cilia
Millions of hairlike cells lining the tracheobronchial tree
Consolidation
The solidification of portions of lung tissue as it fills up with infectious exudate
Ex. pneumonia
Crackles (Rales)
Abnormal, discontinuous, adventitious lung sounds heard on inspiration
Dead space
Passageways that transport air but are not available for gaseous exchange
Ex. Trachea, bronchi
Dyspnea
Difficult, labored breathing
Emphysema
Chronic obstructive pulmonary disease
Characterized by: Enlargement of alveoli distal to terminal bronchioles
Fissure
The narrow crack dividing the lobes of the lungs
Fremitus
A palpable vibration from the spoken voice felt over the chest wall
Friction rub
A coarse, grating, adventitious lung sound heard when the pleurae are inflamed
Hypercapnia
Increased levels of CO2 in the blood
Hyperventilation
Increased rate and depth of breathing
Hypoxemia
Decreased level of oxygen in the blood
Intercostal Space
Space between the ribs
Kussmaul Respiration
type of hyperventilation that occurs with diabetic ketoacidosis
Orthopnea
Ability to breathe easily only in an upright position
Paroxysmal Nocturnal Dyspnea
Sudden awakening from sleeping, with shortness of breath
Percussion
Striking over the chest wall with short, sharp blows of the fingers to determine the size and density of the underlying organ
Pleural Effusion
Abnormal fluid between the layers of the pleura
Rhonchi
Low-pitch, musical, snoring, adventitious lung sounds caused by obstruction from secretions
Tachypnea
Rapid, shallow breathing
More than 24 breaths per minute
Vesicular
Refers to soft, low-pitched, normal breath sounds heard over peripheral lung feilds
Wheeze
High-pitched, musical, squeaking adventitious lung sounds
Xiphoid process
Sword-shaped lower top of the sternum
What subjective thing would you ask about when assessing?
Cough Chest pain Respiratory infections Smoking Shortness of breath Environmental exposure
Pleura
Thing slippery serous membrane between chest wall and lungs
What structures are composed of dead space?
Trachea
Bronchi
What elements would you include in inspection of respiratory system?
Shape and configuration
Color
Respiration rate
Use of accessory muscles
What characteristics define barrel chest?
Costal angle >90
Appears as if in continuous inspiration
Hyperinflation of the lungs
What condition is barrel chest most common in?
COPD
Bronchial lung sound
High-pitch
Inspiration < expiration
Harsh, hollow, tubular
Trachea and larynx
Bronchovesicular lung sound
Moderate pitch
Inspiration = expiration
Over major bronchioles
Vesicular lung sounds
Low pitch
Inspiration > expiration
Rustling sound
Peripheral lung fields
The manubriosternal angle is also called ___
Angle of Louis
What is a normal costal angle?
90 degrees
Anteroposterior/ Tranverse diameter ratio
2:1
Condition if AP diameter is equal to transverse diameter
Barrel chest
A tripod position is common with which condition?
COPD
What type of sound is heard when percussing over lungs?
Resonance
What is the manubriosternal angle?
The articulation of the manubrium and the body of the sternum
The left lung is ___ compared to the right
Narrower
has only 2 lobes
The characteristic timing of the cough of chronic bronchitis is described as:
Productive cough for at least 3 months of the year for 2 consecutive years
How do you note symmetric chest expansion in an assessment?
Placing hands on the postriolateral chest wall with thumbs up pinching a small fold of skin
How do you correctly assess lung sounds?
Hold the diaphragm of the stethoscope against the chest wall
Listen for one full respiration in each location, being sure to do side-to-side compaeisons
Patient presenting: Fever, increased respiratory rate, decreases left side chest expansion, Dull percussion over left lower lobe, Fine crackles over left lobe
What is it?
Lobular Pneumonia
Clubbing and spongy nail bases are indicators of ____
COPD
You hear a coarse low pitched sound during inspiration and expiration and the patient report pain while breathing. What is this an indicator of?
Pleural friction rub
While using the technique egophony what would you ask the patient to do?
Say “eeee” each time the stethoscope is moved
When examining tactile fremitus what is important to do?
Palpate the chest symetrically
Pulse oxygen measure ___
Arterial oxygen saturation in hemoglobin
A pleural rub is best detected by what technique?
Auscultation
What changes occur to the respiratory system in a pregnant woman?
Increased estrogen level relaxes chest cage ligaments
Circumference of chest increases
Tidal volume increase by 40%
Physiologic dyspnea
Physiologic dyspnea
An increased awareness of the need to breathe
What changes occur to the respiratory system as we age?
Costal cartilages become calcified > thorax less mobile
Barrel chest
Kyphosis
Hemoptysis
Blood in coughed up sputum
Decreased fremitus occurs with:
Any barrier that comes between the sound and your palpation
Obstructed bronchus, pleural effusion or thickening, pneumothorax, or emphysema
Increases fremitus occurs with:
Compression or consolidation of lung tissue
Ex. Lobar pnuemonia
Rhonchal Fremitus
Palpable with thick bronchial secretion
Pleural friction fremitus
Palpable with inflammation of the pleura
Crepitus
A coarse crackling sensation palpable over skin surfaces
When is crepitus most likely to happen?
After open thoracic injury or surgery
When would you hear hyperresonance in the lungs when percussing?
When there is too much air present
Ex. Emphysema or Pneumonothorax
When would you hear a dull sound in the lungs when percussing?
When there is an abnormal density present
Ex. pneumonia, mass, or pleural effusion
Decreased/Absent breath sounds occur when:
Bronchial tree obstruction
Emphysema - loss of elasticity of lungs
Anything obstructing transmission of sound to stethoscope
Increased breath sounds occur with:
With consolidation or compression of lung tissue
Symptoms of a strained, tired face and pursed-lipped breathing accompany ____
COPD
What does bulging of the intercostal spaces mean?
Trapped air
A palpable grating sensation with breathing indicates:
Pleural friction fremitus
6-Minute Walk Test
Recreating the patient’s everyday activities to measure respiratory rehabilitation
Measure of how far patient walks in 6 minutes without exerting themselves
A barrel shaped chest in an infant after 6 years may be an indicator of ___ or ___
Chronic asthma or Cystic fibrosis
What is the highest score on the APGAR scale?
10
You can only have 2 in each category
An infant with an APGAR score of 6 is considered:
Moderately depressed
Newborns are predominantly _____ breather until 3 months
Nose breathers
Normal respiratory range for newborn is:
30-40 breaths/minute
What type of lung sounds will you hear in the peripheral lung fields in a child until 5-6 years old?
Bronchovesicular
Crackles in the immediate newborn. Abnormal/Normal
Normal
The adaptation of extrauterine life: opening of the airways and clearing of fluid
Pectus excavatum
Sunken sternum
Congenital defect
Pectus carinatum
Forward protrusion of the sternum
Scoliosis may increase what risks regarding the thorax/lungs?
Reduce lung volume
Impair cardiopulmonary function
Tachypnea
Rapid shallow breathing
More than 24 breaths per minute
Bradypnea
Slow breathing
Less than 10 breaths per minute
Factors that would provoke bradypnea
Drug induce depression of the medulla
Increases intracranial pressure
Diabetic coma
Cheyne-Stokes Respiration
Cyclic pattern of increasing rate and depth then decreasing
Causes of Cheyne-Stokes Respiration
Heart failure*** Renal failure Meningitis Drug overdose Increased intracranial pressure
Hyperventilation
Increase in both rate and depth
Kussmaul respirations
Hyperventilation that occurs with diabetic ketoacidosis
What does hyperventilation cause regarding blood?
Alkalosis
Blowing off increase CO2 levels
Hypoventilation
Irregular shallow pattern
Hypoventilation is caused by:
Narcotics
Anesthetics
Prolonged bed rest
Chronic obstructive breathing
Normal inspiration and prolonged expiration to overcome increased airway resistance
Atelectatic crackles
Sound like fin crackles
Disappears after first few breaths or coughs
Wheezes are usually heard inspiration/expiration?
Predominate in expiration but could be heard in both
Stridor
Monophonic, inspiratory, crowing sound
Louder in the neck that over chest wall
Broncophony
Ask the person to repeat “99” while listening with a stethoscope
While using the techniques broncophony, you should hear a clear “99” like they are saying right into your ear. Normal/Abnormal
Abnormal
The sound hear through the stethoscope should be soft, muffled, and indistinct
Egophony abnormality
Hearing an “aaaa” sound instead of “eee”
Whispered Pectoriloquy
Ask the person to whisper a phrase “one-two-three” as you auscultate
Should be muffled and indistinct
Atelectasis
Collapsed, shunken lung
Breath sounds decreased, cough, lag on expansion of chest
Acute bronchitis is characterized by:
Cough lasting up to 3 weeks
Emphysema is characterized by:
Permanent enlargement of air sacs distal to terminal bronchioles and rupture of interalveolar walls Increased expiration resistance Barrel chest Tripod position SOB Tachypnea
What is chronic bronchitis usually caused by?
Cigarette smoking
Chronic Brontitis
Excessive mucus secretion
Inflamed bronchi with partial obstruction
Heart Failure causes __ ___
Pulmonary congestion
What adventitious sounds would you hear on a patient with heart failure
Crackles at lung bases
S3 heart sound
What adventitious sounds accompany a pulmonary embolism?
Crackles
Wheezes
Pleural effusion
Collection of excess fluid in intrapleural space with compression of overlying lung tissue
Symptoms of pleural effusion
Tactile fremitus Crackles Wheezing Breath sounds decreased Bronchophony Egophony Whispered pectoriliquy
