Chest Flashcards
The primary purpose of the respiratory system is
gas exchange, which involves the transfer of oxygen and carbon dioxide between the atmosphere and the blood
The upper respiratory tract includes (8)
the nose, mouth, pharynx, adenoids, tonsils, epiglottis, larynx, and trachea.
Vibrational sounds originating in the ________ lead to vocalization.
larynx
The lower respiratory tract consists of the (4)
bronchi, bronchioles, alveolar ducts, and alveoli.
Surfactant ( think about blowing up a balloon so many times and how hard it was to blow it up the first time)
is a lipoprotein that helps to keep the alveoli open, thus preventing alveolar collapse.
Oxygenation
involves the delivery of oxygen from the atmospheric air to alveolar capillaries and eventual diffusion into the alveoli.
Ventilation
involves inspiration (movement of air into the lungs) and expiration (movement of air out of the lungs).
Inspiration
active or passive
is an active process, involving muscle contraction.
Expiration
is a passive process. When elastic recoil is reduced, expiration becomes a more active, labored process.
Compliance refers to
With decreased compliance, it is_________rfor the lungs to inflate.
the ability of the lungs to expand.\
harder
The respiratory defense mechanisms include
filtration of air, mucociliary clearance system, cough reflex, reflex bronchoconstriction, and alveolar macrophages.
abnormal =
(adventitious) sounds
Fremitus
vibration of the chest wall by vocalization
Determine the presence of absence of abnormal (adventitious) sounds,
including fine crackles, coarse crackles, wheezes, stridor, and pleural friction rub.
Determine the normal breath sounds:(3)
vesicular, bronchovesicular, and bronchial.
Determine air entry
Characteristics/4
adequate
slightly decreased
decreased
absent
stridor ( rubber duckyyyy)
an abnormal, high-pitched respiratory sound produced by irregular airflow in a narrowed airway during the inspiration phase
SQUEEZZYYYY
fine crackles
short, discontinuous, high pitched,
before end of inspiration
pleural friction rub ( state the other name hint= worsen…)
creaking or grating sound from roughned
worsen pneumonia
wheezes
continuous high-pitched squeaking or musical sound caused by rapid vibration of bronchial walls.
Increased fremitus may indicate
consolidation of lung tissue (e.g., pneumonia)
Decreased fremitus
may suggest obstruction or pleural effusion
Resonant:
Heard over normal lung tissue.
Dull:
Indicative of fluid or solid tissue (e.g., pleural effusion or consolidation).
Sound: Thud-like and less sustained compared to resonant.
Corresponding Tissue: Indicative of denser tissue or fluid, such as pleural effusion, consolidation, or liver tissue.
Hyperresonant:
indictes/sound
Indicates increased air (e.g., seen in emphysema).
Hyperresonant: hyper inflated
Sound: Very loud, booming, and prolonged.
Corresponding Tissue: Indicates increased air, often seen in conditions like emphysema.
Tympanic:
Resembles a drum-like sound (rare in chest percussion).
Sound: Resembles a drum-like, high-pitched sound.
Corresponding Tissue: Rare in chest percussion; may suggest air-filled structures, such as a pneumothorax.
Flat
Sound: Extremely dull and soft.
Corresponding Tissue: Indicates solid tissue, such as muscle or bone. Rarely heard in chest percussion
Bronchial Breath Sounds:
Characteristics:
Louder, higher-pitched, and shorter in duration.
Expiratory phase is longer than the inspiratory phase.
Location:
Normally heard over the TRACHEA and the major bronchi.
Should not be heard in the peripheral lung fields under normal conditions.
Vesicular Breath Sounds:
Characteristics:
Soft, low-pitched, and continuous.
Inspiratory phase is longer than the expiratory phase.
Location:
Heard over most of the lung fields.
Predominantly heard in the peripheral lung regions.
Crackles (Rales):
Description:
Causes:
Fine Crackles:
Coarse Crackles:
Description:
Discontinuous, popping or crackling sounds.
Causes:
Fine Crackles: Heard during late inspiration; associated with conditions such as pneumonia, heart failure, or interstitial lung diseases.
Coarse Crackles: Heard during early inspiration; indicative of conditions like bronchitis or bronchiectasis.
Wheezes:
Description:
Causes:
Locations:
Wheezes:
Description:
Continuous, high-pitched, musical sounds.
Causes:
Associated with airway narrowing or constriction, seen in conditions like asthma, bronchitis, or chronic obstructive pulmonary disease (COPD).
Locations:
Often heard during expiration but may be heard during both inspiration and expiration.
Rhonchi: ( not rt to bronchi)
Description:
Causes:
Locations:
Rhonchi:
Description:
Low-pitched, snoring or rumbling sounds.
Causes:
Result from airway obstruction due to mucus or secretions, common in conditions like chronic bronchitis or bronchiectasis.
Locations:
Typically heard during both inspiration and expiration.
Stridor: ( think buffalo issues here)
Description:
Causes:
Locations:
Description:
High-pitched, harsh, crowing sounds.
Causes:
Indicates upper airway obstruction of trachea, such as in croup( laryngotracheobronchitis) , epiglottitis, or foreign body aspiration.Thyriod issues realtions
Locations:
Predominantly heard during inspiration.
Pleural Friction Rub:
Description:
Causes:
Locations:
Description:
Dry, grating, or rubbing sound.
Causes:
Result from inflammation of the pleura, often seen in conditions like pleurisy or pneumonia.
Locations:
Heard over the anterior lateral chest wall, often near the lower lateral ribcage.
Thoracic Cavity (internal space)
think my lung area….
Mediastinum: trachea, esophagus, heart & great vessels
Smoking History
Pack year history:
packs per day X # of years smoked
*(ie: a patient who smoked 1 pack per day for 15 years has a 15 pack-year history)
Subjective
History of Complaint
Onset, provocative factors, frequency of occurrence
Dyspnea 🡪 Dyspnea on exertion
When?
Eating?
Talking?
Cough
Productive or non-productive?
Hemoptysis
LOC
Type- NC? O2 rate?
BiPAP or CPAP Machines ?
Biphasic Positive Airway Pressure
Continuous Positive Airway Pressure
Anterior Chest
Lateral Chest
Posterior Chest
Hypercapnia
Hypoxia
Hypercapnia
Increased blood CO2
Hypoxia
Decreased blood O2
tripod
helps expand lungs pull the diaphragm
SHAPE OF THE CHEST ?????
Document as: 1:2 (A-P:T) or 2:1
Pectus carinatum
is a deformity of the chest wall in which the breastbone and ribs are pushed outward. Pectus carinatum is sometimes called “pigeon breast” because of the birdlike appearance of the chest
Pectus excavatum
also known as concave chest or funnel chest, is a chest wall deformity in which a child’s breastbone (sternum) and some of the ribs grow inward
Kyphosis –
Scoliosis –
bending over compresses the lungs and decreases ability to expand ( cant expand lungs well enough)
can cause ribs to press against the lungs to restrict breathing
Tension Pneumothorax
to the left to the left….
collapse lungs …. my trachea shifts to the right
Tracheal Deviation
- tension pneumothorax
- atelectasis
- pulmonary fibrosis (scarring)
Crepitus –
palpable coarse crackling sensation
Tactile Fremitus ( define/normal)
” say 99”
Sound travels better through solid than air
Fremitus is the vibration created. BEST OVER BONT PROMINECE. not effective fo barrel chest pts any chest issues.
Normal: fremitus decreased toward bases
Thoracic Expansion
or Excursion
hint do this on your back
Also called thoracic excursion
Normal is 2-5cm
Movement should be symmetrical. Place hands on back )
Rales/Crackles –
Rhonchi –
which clears with a cough?vs small airways
secretions in small airways
Discontinuous, heard on inspiration
Does not clear with cough
secretions in large airways
Greater on inspiration
Encourage cough and listen again after cough
Wheeze –
Pleural friction rub –
Stridor –
Absent –
Diminished -
Wheeze – narrowing or inflammation of airway
Whistling, high pitched, musical on inspiration or expiration
Pleural friction rub – Inflamed pleural surfaces rubbing against each other
Grating or creaking sound on inspiration or expiration
Stridor – partial obstruction of upper airway
High pitched honking sound, usually during inspiration
Absent – air not moving – no sound
Diminished - faint
costal angle should be _____ than 90 degree
less
Bronchial-vesicular
heard over sternum anteriorly and between scapulae
If you hear abnormal sound nurse should have pt ____
cough and listen again
