Health assessment-test 2-thorax and lungs Flashcards
intercostal space
space between each of the ribs
sternum
aka breastbone
three parts: manubrium, the body and the xiphoid process
Angle of Louis
aka sternal angle
articulation of the manubrium an body of the sternum and is continuous with the 2nd rib
costal margin
located at the bottom of the rib cage; margin where the cartilage meets ribs
xiphoid process
point on the bottom of the breast bone
assessment skills of the lung include:
general inspection chest expansion tactile fremitus chest percussion lung auscultation
COPD can cause what type of chest?
barrel chest; chest appears as if help in continuous inspiration; occurs due to hyperinflation of the lungs (toddlers have this normally)
pectus excavatum
caved in sternum
pectus carinatum
(front of a ship is called carinatum); forward pertrusion of the sternum
scoliosis
lateral curvature of the spine
kyphosis
hunch back from old age or osteoporosis
normal chest ratio from anterior to posterior
1:2 (reach this by age 6)
hyperventilation
Kussmaul; increase in both rate and depth; occurs normally with extreme exertion, fear or anxiety; also occurs with DKA;
blows off CO2 causing a decreased level in the blood
Cheyne-Stokes respirations
cycle where respirations gradually wax and wane in a regular pattern, increasing in rate and depth and then decreasing; periods of apnea 20 sec are preceeded by 30-40 sec of breathing;
severe heart failure main cause; also renal failure, meningitis, drug overdose and increased intercranial pressure
normal for infants and aging adults during sleep
*light, deep, deeper, deep, light, stop and cycle again
Biot respirations
similar to Cheyne-Stokes; pattern is irregular; normal respirations followed by apnea; cycle length varies b/w 10 sec to 1 min head trauma, brain abscess, heat stroke, spinal meningitis and encephalitis
signs of respiratory distress:
- accessory muscles
- grunting
- head bobbing
- nasal flaring
- retractions
- tachpnea
- tripod position
- use if trouble breathing
- when breathing out
- head wiggle with breath; children
- breath fast
- hands on knees for diaphragm to move better (COPD)
test for chest expansion
place hands on posterolateral chest wall with thumbs pointing together at the level of T9 and T10; pinch a small fold of skin b/w thumbs; ask person to take a deep breath; thumbs should move apart symmetrically
Unequal expansion occurs with: atelectasis, lobar pneumonia, pleural effusion, thoracic trauma or pneumothorax
tactile fremitus
a palpable vibration
sounds generated from larynx are transmitted through patent bronchi and the lung parenchyma to the chest wall where you feel them as vibrations
move hand laterally to 5 positions across back while having pt. say “99”
Decreased fremitus: obstructed bronchus, pleural effusion or thickening, pneumothorax or emphasema
Increased fremitus: compression or consolidation of lung tissue like lobar pneumonia
chest percussion
determine predominant note over lung fields; avoid scapulae and ribs; should hear resonance (low pitch, clear, hollow sound that predominates in healthy lung tissue of the adult hyperresonance: lower pitched, booming sound found when too much air is present as in emphasema or pneumothorax Dull note (soft muffled thud) signals abnormal density in lungs as with pneumonia, pleural effusion, atelectasis or tumor
lung auscultation
directly on skin
pt. breathes through the mouth
listen to one full inspiration/expiration before moving to next site
use side-to-side pattern
normal lung sounds are ____ where normal frequency we hear best is ____ - ____
500 Hz
1000-1500 Hz
bronchial breath sounds
pitch?
which phase is longer?
explain phase…
aka tubal breath sounds
sound air makes when flowing through a tube (trachea)
relatively high pitch
expiratory phase is long
tiny gap between inspiration and expiration
vesicular breath sounds
sounds filtered by the alveoli (air filled vesicles)
frequency of vesicular breath sounds?
phases?
lower frequency
expiratory phase short (inspiratory longer)
no pause
bronchial breath sounds are only normal if heard over the _____
neck
if you hear bronchial breath sounds over the lung fields, the alveoli have either ____ or ___ with ____
collapsed
filled with fluid (blood, pus or pulmonary edema
crackles
important; presence always significant
discontinuous sounds; short in duration; can’t have musical characteristics; taken together though, they can have a long duration
if present, when do you hear crackles?
inspiration (if you pay attention, you may can tell if they occur in early, middle, or late inspiration
early crackles
mechanism?
possible meaning?
Mechanism: generated by air flowing through a large central bronchi covered in secretions. The mixing of the air and secretions creates a bubbling noise.
Low pitched
called Course crackles
often clear with coughing
meaning: bronchitis
mid inspiratory crackles
Mechanism: neither high nor low pitched
come from inflamed, partially dilated medium sized bronchi
Meaning: bronchiectasis (walls of bronchi thickened due to inflammation and infection)
late inspiratory crackles
Mechanism: small, distal airways that are partially collapsed
Collapsed due to high interstitial pressure (edema)
When pt. takes a deep breath, pressure in airway increases and pushes open bronchioli, causing a popping or crackling noise
sounds resemble undoing of velcro
Fine and high pitched
Meaning: scarring of lung tissue (pulmonary fibrosis) or there is fluid (pus, blood, or serum). Can indicate pulmonnary hemorrhage, pneumonia, or pulmonary edema
* how would you tell if late inspiratory crackles would be the result of fibrosis or fluid*
fluid would cause the underlying sound to be bronchial instead of vesicular
Wheezes
high pitched, typically expiratory and longer
cause: air flows rapidly through a narrow airway a sucking effect is created on the airway wall; so airway flutters
* kind of like whistling (bronchus vibrates)
in wheezing, it’s not necessarily the ___ of the ___ that causes wheezing; it is the ___ of air
narrowing of the airway
speed of air
Asthmatics on the brink of respiratory failure may not wheeze. What is this due to? What is the saying?
the speed of air (not the narrowing)
“beware of the silent asthmatic”
Normal clients may wheeze while you auscultate their lungs if…
you have them expire with too much force
so not everyone who ___ has ___ and not everyone who has ___ wheezes.
wheezes
asthma
asthma
Wheezes will be either ___ and ___ or ___.
inspiratory and expiratory
expiratory
Wheezes are never just ___
inspiratory
If you think you hear a wheeze only on inspiration, it is actually a ___
stridor
Stridor is the result of closing (___) of the ___ ___
adduction
vocal cords
Stridor is a ___ ___
medical emergency
Rhonchi are similar to ___ but they are ___
They also have a ___ quality
wheezes
longer
musical
Rhonchi are ___ pitched and have a ___ quality to them
lower
snoring (sonorous)
Rhonchi are tricky to identify because…
they can all sound quite different (don’t all sound the same)
Rhonchi are often caused by ___ ___ that ___ the airway.
thick secretions
narrow
Rhonchi can be ___ (heard over several places of the lung) but are often ___
diffuse
localized
A persistent rhonchus localized to a specific area can be a sign of ___.
Sometimes if patient coughs, they can ___ if it is not a ___.
neoplasm
dislodge
growth
When auscultating an older patient, start on lower lobes as they can …
get worn out
Apgar scoring
1st respiratory assessment of newborn; measured at 1 and 5 minutes of life; a 1 minute score of 7-10 is good
tachypnea
rapid shallow breathing; increased rate >24 per min
hyperventilation
increase in both rate and depth
bradypnea
slow breathing; decreased but regular rate
hypoventilation
irregular shallow pattern caused by overdose of narcotics or anesthetics
