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Health Assessment > Exam 3 - Thorax & Lungs > Flashcards

Exam 3 - Thorax & Lungs Flashcards

1
Q

What should you ask a pt if they have a cough?

A

If it’s productive / unproductive

If productive, need to know color, odor, and if there’s blood

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2
Q

Term for coughing up blood

A

Hemoptysis

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3
Q

Trouble breathing / shortness of breath (spelling)

A

Dyspnea

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4
Q

Trouble breathing while laying down (spelling)

A

Orthopnea

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5
Q

Sudden shortness of breath at night (spelling)

A

Paroxysmal nocturnal dyspnea

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6
Q

What do we do if pt has chest pain with breathing?

A

Assume cardiac first

Can differentiate from cardiac pain by the location and if pt is coughing a lot

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7
Q

If you suspect a pt has paroxysmal nocturnal dyspnea, what should you ask them?

A

1 - do you wake up suddenly gasping for air?

Not as important, but can also ask how many pillows they sleep with at night

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8
Q

What should you ask pt about respiratory infections?

A

If they have a history of RI, ask when last one was and what kind of treatment they had for it (usually steroids, antibiotics, and an inhaler)

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9
Q

What should you ask pt if they smoke?

A

How much?

What type of tobacco?

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10
Q

What does environmental exposure mean when asking pt about thorax and lungs?

A

What kind of work do they do and are they exposed to chemicals regularly?

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11
Q

What self-care behaviors do we ask about thorax and lungs?

A

Do they get an annual TB skin test? (Date/results)
Do they get the flu or covid vaccines? (Date of last one)
If pt is older or has other conditions, do they get pneumonia vaccine?

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12
Q

Reference line down center of chest

A

Midsternal line

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13
Q

Reference line passing under pt’s armpit

A

Anterior axillary line

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14
Q

Reference line passing next to pt’s nipple

A

Midclavicular line

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15
Q

Reference line passing down center of pt’s back

A

Vertebral line

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16
Q

Reference line passing down pt’s scapula

A

Scapular line

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17
Q

Reference line passing down middle of pt’s side

A

Midaxillary line

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18
Q

Reference line passing down back of pt’s armpit

A

Posterior axillary line

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19
Q

Order of exam for pt’s lungs and thorax

A 
Posterior
1 - inspection
2 - palpation
3 - percussion
4 - auscultation

Lateral chest

Anterior
1 - inspection
2 - palpation
3 - percussion
4 - auscultation
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20
Q

What do we look at during inspection?

A

Shape/configuration of chest wall
Anteriorposterior (AP) diameter
Position of person
Skin color and condition

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21
Q

What is AP diameter?

A

Shape of chest, related to chronic respiratory issues
Normal is 1 to 2
Barrel chest is 1 to 1

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22
Q

Why would a pt have a barrel chest?

A

Long term respiratory issues

Use accessory muscles to breathe, and over time, *compensatory hypertrophy occurs. Intercostal spaces become larger

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23
Q

What do we do during palpation?

A
  • Palpate the chest (look for lumps, bumps, anything abnormal)
  • Perform chest expansion
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24
Q

How do you perform chest expansion on pt?

A

Put hands like butterfly on pt’s back with thumbs along spine and have pt take deep breath
Should rise and fall at same time and feel equal

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25
Q

Normal finding for chest expansion

A

Symmetric

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26
Q

What could abnormal chest expansion mean?

A

Marked atelectasis
Lobar pneumonia
Pleural effusion
Thoracic trauma (fractured ribs or pneumothorax)

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27
Q

How many breaths during normal respiration?

A

10-20 breaths per min

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28
Q

What is tachypnea? How much per min?

A

Rapid shallow breathing with >24 breaths per min

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29
Q

What is bradypnea?

A

Slow breathing with <10 breaths per minute

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30
Q

When would tachypnea be normal?

A

Fever

Pt just ran

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31
Q

What could cause bradypnea?

A

Drugs
Altered LOC
Brain stem issue

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32
Q

How do you check for fremitus?

A

Use palm
Feel for vibration when pt says “ninety-nine”
Have to follow path 1,1,2,2,3,3,4,4,5,5, starting at apex and moving down. Ending with 5s which are toward pt’s laterals

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33
Q

What does normal fremitus feel like?

A

Felt most at apex
Decreases as move down chest
Symmetric

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34
Q

How would you document normal fremitus?

A

Symmetric fremitus, bilateral

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35
Q

What does consolidated fremitus feel like?

A

Vibrations are stronger from dense areas

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36
Q

What could consolidated fremitus be from?

A

Pneumonia or infection

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37
Q

What does decreased fremitus feel like?

A

No vibration

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38
Q

What could cause decreased fremitus?

A

Emphysema
Collapsed lung
Chronic respiratory issue
(Any disease that is causing collapse of some alveoli)

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39
Q

Explain the percussion technique

A

1- Place middle finger of non-dominant hand on pt with palm off of pt’s body
2- Use middle finger of dominant hand to percussion, Non-dominant finger should be firmly on pt’s chest
3- Use tip of finger and hit below fingernail using relaxed wrist motion. Percussion 2-3 times in each location

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40
Q

What does normal lung tissue in adults sound like with percussion? (Spelling)

A

Resonance

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41
Q

What does normal lung tissue in children sound like with percussion?

A

Hyper resonance

42
Q

Intensity of resonance

A

Loud

43
Q

Pitch of resonance

A

Low

44
Q

Duration of resonance

A

Long

45
Q

Quality of resonance

A

Hollow

46
Q

Normal location of resonance

A

Peripheral lung

47
Q

What is a sigh respiration pattern?

A
  • Occasional sighs: punctuate the normal breathing pattern and are purposeful to expand alveoli
  • Frequent sighs: may indicate emotional dysfunction and may lead to hyperventilation and dizziness
48
Q

What is a tachypnea respiration pattern?

A
  • Rapid, shallow breathing

- increased rage, > 24 per min

49
Q

When would tachypnea occur and still be normal?

A

In response to fever, fear, or exercise

50
Q

When would tachypnea occur and be abnormal?

A 
Respiratory insufficiency
Pneumonia
Alkalosis
Pleurisy
Lesions in the pons
51
Q

What is bradypnea respiration pattern?

A

Slow breathing

A decreased but regular rate <10 per min

52
Q

When would bradypnea occur?

A

Drug - induced depression of respiratory center in medulla
Increased intracranial pressure
Diabetic coma

53
Q

What is hyperventilation breathing pattern? What does it cause?

A

Increase in rate and depth

Blows off CO2 causing a decreased level in the blood (alkalosis)

54
Q

What could cause hyperventilation?

A

Extreme exertion
Extreme fear
Extreme anxiety
Diabetic ketoacidosis (Kussmaul respirations)
Hepatic coma
Salicylate overdose (prod, a respiratory alkalosis to compensate for the metabolic acidosis)
Lesions of the midbrain
Alterations in blood gas concentration (either increase of CO2 or decrease in oxygen)

55
Q

Hypoventilation respiration pattern definition

A

Irregular shallow pattern

56
Q

What causes hypoventilation?

A

Overdose of narcotics or anesthetics
Prolonged bed rest
Conscious splinting of chest to avoid respiratory pain

57
Q

Cheyne-Stokes respiration definition

A
  • Cycle in which respirations gradually wax and wane in a regular pattern, increasing in rate and depth and then decreasing.
  • Breathing periods last 30-45 seconds, with periods of apnea (20 seconds) alternating the cycle
  • Occurs normally in infants and older adults during sleep
58
Q

What causes Cheyenne-Stokes?

A 
Severe heart failure
Renal failure
Meningitis
Drug overdose
Increased intracranial pressure
59
Q

Biot’s respiration definition

A
  • Similar to Cheyne-Stokes respiration, except that the pattern is irregular
  • Series of normal respirations (3-4) is followed by a period of apnea
  • Cycle length varies from 10 sec to 1 min
60
Q

What causes Biot respiration?

A 
Head trauma
Brain abscess
Heat stroke
Spinal meningitis
Encephalitis
61
Q

Chronic obstructive breathing definition

A

Normal inspiration and prolonged expiration to overcome increased airway resistance

62
Q

What causes chronic obstructive breathing? And what happens during chronic obstructive breathing?

A

Occurs in a person with a chronic obstructive lung disease
Any situation calling for increased heart rate (exercise) may lead to dyspnea episode (air trapping) b/c person doesn’t have enough time for full expiration

63
Q

Explain technique for auscultation of thorax and lungs

A

Use same pattern every time, starting up at thorax
1,1,2,2,3,3,4,4,5,5,6,6,7,7,8,8,9,9
6 & 7 are start of lateral and 8&9 are lateral
Do this on posterior and anterior

64
Q

What can interfere with auscultation?

A 
Stethoscope tubing
Tubing bumping together
Pt shivering
Hairy chest
Rustling of paper gown
65
Q

What does interference of auscultation sound like?

A

Crackles

66
Q

Term for breath sounds over peripheral lung fields (spelling)

A

Vesicular breath sounds

Aka clear breath sounds

67
Q

What do vesicular breath sounds sound like?

A

Low pitch
Breezy or rustling like sound of wind in trees
Soft amplitude
Duration I>E

68
Q

Term for normal sound over major bronchi

A

Bronchovesicular breath sounds

69
Q

What do bronchovesicular breath sounds sound like?

A 
Moderate pitch and amplitude
Mixed quality (wind, but inspiratory louder than expiratory)
Duration: I = E
70
Q

Normal sound heard over trachea or larynx

A

Bronchial breath sounds

71
Q

What do bronchial breath sounds sound like?

A

High pitched
Harsh or tubular quality
Loud amplitude
Duration: I

72
Q

Normal location for vesicular breath sounds

A

Peripheral lung fields

73
Q

Normal location for bronchovesicular breath sounds

A

Over major bronchi
Posterior - between scapulae
Anterior - upper sternum 1st - 2nd ICS

74
Q

Normal location of bronchial breath sounds

A

Trachea or larynx

75
Q

Abnormal location for bronchial breath sounds

A

Peripheral lung fields

76
Q

What does adventitious sounds mean?

A

Abnormal sounds

77
Q

What do fine crackles sound like?

A

Normal inspiration/expiration, just with crackles added (sound like rice crispies)

78
Q

Are crackles continuous or discontinuous?

A

Discontinuous because sound comes and goes

They are discrete

79
Q

Why do crackles in breath sounds occur, and what is the difference between fine and coarse crackles?

A

Fluid in lungs - bubbles popping
Depends on how much fluid present
Coarse = more fluid and bigger bubbles popping

80
Q

What does pleural friction rub sounds like?

A

Low pitched
Superficial
Grating quality
Like crackles, but close to the ear

81
Q

What is pleural friction rub caused by?

A

Inflamed tissue rubbing together causing friction

82
Q

What does stridor sound like?

A 
High-pitched
Monophonic
Inspiratory
Crowning sound
Louder in neck than over chest wall
83
Q

What causes stridor?

A

Originates in larynx or trachea, caused by upper airway obstruction from swollen or inflamed tissues (allergic reaction) or a lodged foreign body

In children: croup

84
Q

What does a high-pitched wheeze sound like?

A
  • High-pitched
  • Musical squeaking sounds
  • Predominate in expiration but may occur in both expiration and inspiration
85
Q

Another name for a high-pitched wheeze sound

A

Sibilant

86
Q

What causes a high-pitched wheeze sound?

A

Very constricted airways

Due to an obstruction, acute asthma, chronic emphysema

87
Q

What does a low-pitched wheeze sound like?

A 
Low-pitched
Monophonic
Single note
Musical snoring
Moaning sounds
More prominent on expiration
88
Q

Another name for low-pitched wheeze

A

Sonorous rhonchi

89
Q

What causes low-pitched wheeze sounds?

A

Airflow obstruction
Bronchitis
Single bronchus obstruction from airway tumor

90
Q

Tests that test voice sounds

A

Bronchophony
Egophony
Whispered pectoriloquy

91
Q

How do you do bronchophony test?

A

Ask pt to repeat “99” as you listen over chest wall

92
Q

Normal bronchophony result

A

Pt’s voice is “Soft, muffled, indistinct”

93
Q

Abnormal bronchophony result

A

Sound more distinct over areas of increased density (consolidated areas)

94
Q

What could consolidated areas indicate?

A

Pneumonia

Tumor

95
Q

How to perform the egophony test

A

Ask pt to repeat “E” while you listen over chest wall

96
Q

Normal result of egophony test

A

Pt sounds “soft, muffled, hear “E””

97
Q

Abnormal egophony result

A

Pt sounds louder, changes to “A” over area of consolidation

98
Q

How to perform whispered pectoriloquy test

A

Ask pt to whisper “1-2-3” as you listen over lungs

99
Q

Normal result of whispered pectoriloquy test

A

Pt sounds “faint, muffled, almost inaudible”

100
Q

Abnormal result of whispered pectoriloquy test

A

Pt sounds clear, distinct (like whispering directly into stethoscope) over areas of consolidation

Health Assessment (17 decks)

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