Exam 2: Auscultation, Breathing Pattern and Cough Assessment

Question 1

What are the components of ventilation and gas exchange assessment?

Answer 1

1. RR- ventilation
2. SpO2- gas exchange
3. breathing pattern
4. breathing sounds
5. cough

Question 2

Should you observe or palpate the chest wall/breathing pattern first?

Answer 2

observe, view anterior, lateral, posteriorly

Question 3

During your inspection what types of things should you see anatomically?

Answer 3

1. lateral costal expansion- bucket handle
2. diaphragmatic excursion- expansion with ab during inhalation
3. anterior chest wall- pump handle
4. are accessory muscle being used?
5. Check posture!`

Question 4

What other types of things are you looking for during expansion?

Answer 4

1. Is the breathing symmetrical and coordinated?
2. Any retractions?
3. Normal I/E ratio is 1:2 seconds
4. nasal flaring, cyanosis, mouth breathing?

Question 5

What are retractions?

Answer 5

in pts with severe obstructive or moderate to severe restrictive dz they breath so hard you can see their bones

Question 6

What can your palpation confirm about your observations?

Answer 6

1. is diaphragm or upper chest wall moving more?
2. lateral costal expansion
3. accessory muscle usage
4. fremmitus- vibratory tremors felt

Question 7

What is the ratio between anterior chest wall and lateral chest wall?

Answer 7

anterior across should be double the lateral

Question 8

What are the 3 different areas to measure the chest wall?

Answer 8

1. angle of louis
2. xiphoid process
3. midpoint between umbilicus and xiphoid

Question 9

What are the three types of breath sounds in normal?

Answer 9

1. bronchial
2. vesicular
3. bronchovesicular

Question 10

What are characteristics of bronchial sounds?

Answer 10

1. over upper lobes to sternum (btwn shoulder blades posteriorly)
2. high pitched hollow and loud
3. expiration is longer and louder, with pause in between I and E

Question 11

What are characteristics of vesicular sounds?

Answer 11

1. entire chest wall distal to major airways
2. muffed, low pitched
3. inhalation is longer

Question 12

What are the characteristics of bronchovesicular?

Answer 12

1. over angle of louis and lower costosternal border
2. vesicular on inhalation, bronchial on exhalation
3. Equal I/E, no pause between them

Question 13

What is a decreased sound?

Answer 13

abnormal, decreased turbulent airflow due to mucus, edema, atelectasis, something clogging airflow

Question 14

What is a transposition air sound?

Answer 14

hearing a normal breath sound in an area it shouldn’t be in, meaning these is a consolidation of lung tissue

Question 15

What is an example of transposition air?

Answer 15

in some dz the alveoli enlarge so more air is getting in them but there is less gas exchange

Question 16

What is crackles or rales?

Answer 16

discontinuous lung sounds that sound like brief bursts of popping bubbles

more common in inspiration

Question 17

What causes these crackles?

Answer 17

opening of closed airways like atelectasis

movement of air through secretions or fluid

Question 18

How do you document crackles?

Answer 18

where it happened, when it happened, was it on inhalation or exhalation

Question 19

What is a wheeze or rhonchi?

Answer 19

musical like wheezes, continuous sound with a constant pitch and variable duration

can occur in both inhalation and exhalation

Question 20

What causes wheezing?

Answer 20

bronchoconstriction or decreased smooth muscle, movement of air through secretions that block airways

Question 21

What is a plural rub?

Answer 21

sounds like two pieces of leather rubbing together, heard on I or E

causes: pleural inflammation

Question 22

What are important things to remember when auscultating?

Answer 22

1. pt must breath in and out through mouth
2. listen to 2 breaths at each location
3. alternate left to right

Question 23

What are voice sounds used for?

Answer 23

used to confirm findings of abnormal auscultation

Question 24

What should a spoken word normally sound like?

Answer 24

• sound diminishes as it descends chest wall

- in abnormal would indicate consolidation of lung tissue due to pneumonia, fluid filled alveoli or severe fibrosis

Question 25

What is egophony?

Answer 25

Saying letter “e”, positive if it sounds like an “a”

Question 26

What is bronchophony?

Answer 26

pt says “99”, if positive 99 will sound loud and clear

Question 27

What is whispered pectoriloquy?

Answer 27

pt says “1, 2, 3” should be diminished, positive if not

Question 28

What are the three components of a cough?

Answer 28

inspiratory phase, compressive phase and expiratory phase

Question 29

What is the compressive phase?

Answer 29

isovolemic contraction, squeezing core to increase intra-abdominal pressure

Question 30

What will happen to inspiratory phase in pt with pathology?

Answer 30

they can’t initiate breath in

Question 31

What are other two components of cough?

Answer 31

1. productiveness-is mucus moved into area where it can be swallowed
2. effectiveness

NOT THE SAME THING

Question 32

What are 3 components of sputum culture?

Answer 32

1. color- should be white or clear, darker indicates it has been in lungs longer, hemoptysis
2. quantity
3. consistency- if thicker harder to come up

Question 33

What type of measurement is cough?

Answer 33

subjective but very important