Exam 2 Content Material Flashcards
In what order would you conduct a lung assessment?
- Inspection
- Palpation
- Percussion
- Auscultation
How would you ascultate lung sounds anteriorly?
Auscultate from the apices in the supraclavicular areas down to 6th rib.
How would you ascultate lung sounds posteriorly?
Auscultate from the apices at C7 to bases , around T10, and laterally from axilla to 7th or 8th rib.
When auscultating the lungs, a lung sound abnormal when what occurs?
The sound is abnormal if it is in the area where you are not supposed to hear it.
Ex: Hearing Vesicular sounds in an area when you are supposed to hear Bronchovesicular sounds.
What are some characteristics of Bronchial breath sounds?
- Pitch = High
- Amplitude = Loud
- Duration = Longer on expiration than inspiration
- Quality = Harsh, Hallow, tubular
- Normal location = Trachea and larynx
What are some characteristics of Bronchovesicular breath sounds?
- Pitch = Moderate
- Amplitude = Moderate
- Duration = Inspiration is equal to expiration
- Quality = Mixed
- Normal location = Over major bronchi where fewer alveoli are located
What are some characteristics of Vesicular breath sounds?
- Pitch = Low
- Amplitude = Soft
- Duration = Inspiration is greater than expiration
- Quality = Rustling (like the sound of wind in the trees)
- Normal location = Over peripheral lung feilds where air flows through the smaller bronchioles and alveoli
What is consolidation?
Compression of the lung tissue by an object (a mass, extra fluid, etc)
What 3 tests should you conduct if you hear abnormal breath sounds (Increased, Diminished, Silent or Absent breath sounds)?
- Bronchophony
- Whispered Pectoriloquy
How would you perform a Baronchophony?
- Ask Pt. to Say “99” ask you listen to chest wall with stethoscope
- Normally you should hear soft muffled sounds
- If you hear a clear “99” while auscultating a mass or some other pathology is present = bad.
How would you perform a Whispered Pectoriloquy?
- Ask Pt. to Whisper “1-2-3” as you auscultate
- You should hear muffled faint almost inaudible sounds
- If consolidation is present you will hear a very clear “1-2-3” when listening.
How would you perform an Egophony?
- Ask Pt. to say “Ee-ee-ee” when auscultating
- You should hear the sound “Ee-ee-ee” when listening
- If there is consolidation in the area of auscultation you will instead hear an “Aa-aa-aa” sound instead of an “Ee-ee-ee”.
What causes strider and what are some characteristics of this adventitious breath sound?
- Cause = Upper airway obstruction, Inflammed tissues or lodged foreign body
- Characteristics = Continuous High Pitch, Crowing sound, Monophasic, Louder in neck than over chest wall, Inspiratory
What causes Fine Crackles and what are some characteristics of this adventitious breath sound?
- CAUSE =
Early: Chronic Bronchitis, Asthma, Emphysema
Late: Atelectasis, Restrictive lung disease, Pneumonia, Heart Failure, Interstitial Fibrosis
- Characteristics =
Discontinuous, high pitch, short crackling during inspiration, Not cleared by cough.
On Insp: Inhaled air collides w/ previously deflated airways
On Exp: Sudden airway closing
What causes Coarse Crackles and what are some characteristics of this adventitious breath sound?
- Cause = Pulmonary edema, Pneumonia, Pulmonary fibrosis, Term. ill w/poor cough reflex
- Characteristics =
Discontinuous, loud, low pitch, bubbling and gurgling sounds, start in early inspiration & moving into early expiration. May decrease with cough or suctioning
Inhaled air collides with secretions in trachea and large bronchi
What causes Pleural Friction Rub and what are some characteristics of this adventitious breath sound?
- Cause = Pleuritis – occurs w/ pain on breathing
- Characteristics = Coarse, Low pitch, Discontinuous occurring with inspiration & expiration Leathery sound, Pleura rub together
What causes Wheeze-high pitch or sibilant and what are some characteristics of this adventitious breath sound?
- Cause = Diffuse airway obstruction, Asthma, Chronic Emphysema
- Characteristics = Continuous high pitch sound, musical squeaking sound, polyphonic, Mostly Expiratory, but in both insp/exp
What causes Wheeze- low pitch or sonorous rhonchiand what are some characteristics of this adventitious breath sound?
- Cause = Bronchitis, single bronchus obstruction from airway tumor
- Characteristics = Continuous low pitch sound, Monophasic, Musical snoring, Throughout entire cycle
What do you want to make sure to monitor with older adults in reference to the lungs?
- Increased risk for postop complications, atelectasis, and infection
- r/t decreased ability to cough,
- Loss of protective airway reflexes,
- Increased secretions
What should you always go over in a pulmonary R.O.S. (Review of systems)?
- Ask if pt has any Coughs
- Ask if pt has any shortness of Breath
- No dyspnea, orthopnea or paroxysmal nocturnal dyspnea
- Ask if pt has any Chest pain with breathing
- Ask if pt has any Past History of Lung disease
- Ask if pt has ever Smoked cigarettes, cigars, hookah smoking
- Ask if pt has any living or work conditions that affect breathing
- Ask if pt when was Last TB test, Chest x-ray
- Ask if pt when was Last Pneumonia and flu vaccine
What is a normal respiratory rate?
10-20 bpm
What is the range for a normal pulse?
- Normal = 50 – 90 bpm
- < 50 bpm=bradycardia
- > 90 bpm=tachycardia
What is the range for a normal blood pressure?
< 120 / < 80
What manifestations would you see in a patient with COPD?
- Pursed lips when breathing
- Tense, strained, tired faces
- Hypertrophied neck muscles
- Use of rectus abdominis, intercostal, and accessory neck muscles in expiration –> Tripod position
