Chapter 8 The Lungs Flashcards
Chest pain- myocardium
Angina pectoris, myocardial infarction
Chest pain- pericardium
Pericarditis
Chest pain- aorta
Dissecting aorta aneurysm
Chest pain- the trachea and large bronchi
Bronchitis
Chest pain- the parietal pleura
pericarditis, pneumonia
Chest pain- the chest wall, including the musculoskeletal system and skin
Costochonditis, herpes zoster
Chest pain- the esophagus
Reflux esophagitis, esophageal spasm
Chest pain- extrathoracic structures such as the neck, gallbladder, and stomach
Cervical arthritis, biliary colic, gastritis
Angina pectoris
a clenched fist over the sternum
Musculoskeletal pain
finger pointing to tender area on the chest wall
Cyanosis
Hypoxia
Audible stridor
high-pitched wheeze, a sign of airway obstruction in the larynx or trachea
AP diameter
May increase in COPD
Decreased or absent fremitus
COPD, bronchial obstruction, pleural effusion, fibrosis (pleural thickening), pneumothorax, tumor
Dullness to percussion
indicate lobar pneumonia, pleural effusion, hemothorax (blood), or empyema (pus), fibrous tissue, or tumor
Hyperresonance
COPD, large pneumothorax
Diaphragmatic excursion
diaphragmatic paralysis, pleural effusion, atelectasis, or normal variant
Vesicular auscultation
soft/low pitched; inspiratory>expiratory sounds
Bronchovesicular auscultation
moderate; inspiratory/expiratory sounds equal in length
Bronchial auscultation
louder or higher in pitch, with short silence (gap) between inspiratory and expiratory sounds; expiratory>inspiratory sounds
Late inspiratory crackles
fibrosis or CHF
Early inspiratory crackles
seen in asthma, chronic bronchitis (appear after the start of insiration)
Expiratory crackles
Could reflect bronchiectasis
Wheezes (high-pitched)
suggest narrow airways (partial obstruction), as in asthma, COPD, and bronchitis
Rhonchi (low-pitched)
suggest secretions in large airways
COPD- s/s & diagnosis
Findings include wheezing, hx of smoking, age, and decreased breath sounds. Diagnosis requires pulmonary function test such as spirometry. Persons with severe COPD may prefer to sit leaning forward with lips pursed during exhalation and arms supported on their knees
Bronchophany
when a normal lung becomes airless, transmitted voice sounds will change
Egophany
changes sound of a whispered “ee” to an “ay” as in lobar consolidation from pneumonia
Whispered pectoriloquy
when whispered numbers are clearer and louder than expected
Dullness
replaces resonance when fluid or solid tissue replaces air-containing lung or occupies the pleural space.
Pleural effusion
Because pleural fluid usually sinks to the lowest part of the pleural space (posteriorly in a supine pt), only a very large effusion can be detected anteriorly.
COPD
affected lung often displaces the upper border of the liver downward. It also lowers the level of diaphragmatic dullness posteriorly.
Chronic Bronchitis- Physical findings
Percussion note: Resonant Trachea: Midline Breath Sounds: Vesicular (normal) Adventitious Sounds: Wheezes or Rhonchi; scattered coarse crackles in early inspiration and expiration Tactile Fremitus/Voice Sounds: Normal
CHF (left sided)- physical findings
Percussion note: Resonant Trachea: Midline Breath Sounds: Vesicular (normal) Adventitious Sounds: Late inspiratory crackles; possibly wheezes Tactile Fremitus/Voice Sounds: Normal
Diffuse lymphadeopathy
HIV, AIDS
Consolidation- physical findings
Percussion note: Dull over the airless area
Trachea: Midline
Breath Sounds: Bronchial over the involved area
Adventitious Sounds: Late inspiratory crackles over the involved area
Tactile Fremitus/Voice Sounds: Increased over the involved area with bronchophony, egophony, and whispered pectroliloquy
Atelectasis- physical findings
Percussion note: Dull over the airless area
Trachea: May be shifted toward involved sided
Breath Sounds: Usually absent when bronchial plug persists. Exceptions include RUL atelectasis, where adjacent tracheal sounds may be transmitted
Adventitious Sounds: None
Tactile Fremitus/Voice Sounds: Usually absent when the bronchial plug persists.
Pleural Effusion- physical findings
Percussion note: Dull to flat over the fluid
Trachea: Shifted toward opposite side in a large effusion
Breath Sounds: Decreased to absent but bronchial breath sounds may be heard near top of large effusion
Adventitious Sounds: None except a possible pleural rub
Tactile Fremitus/Voice Sounds: Decreased to absent, but may be increased toward the top of a large effusion
Pneumothorax- Physical findings
Percussion note: Hyperresonant or tympanic over the pleural air
Trachea: Shifted toward opposite side if much air
Breath Sounds: Decreased to absent over the pleural air
Adventitious Sounds: None, except a possible pleural rub
Tactile Fremitus/Voice Sounds: Decreased to absent over the pleural air
COPD- Physical findings
Percussion note: Diffusely hyperresonant Trachea: Midline Breath Sounds: Decreased or absent Adventitious Sounds: None, or the crackles, wheezes, and rhonchi of associated chronic bronchitis Tactile Fremitus/Voice Sounds: Decreased
Asthma- Physical findings
Percussion note: Resonant to diffusely hyperresonant
Trachea: Midline
Breath Sounds: Often obscured by wheezes
Adventitious Sounds: Wheezes, possibly crackles
Tactile Fremitus/Voice Sounds: Decreased
CVA tenderness
Infection; kidney stones
Lymphadenopathy
Found in breast cancer
Causes of unilateral decrease or delay in chest expansion
chronic fibrosis, pleural effusion, lobar pneumonia, or bronchial obstruction
