Health assessment-test 2-thorax and lungs

Question 1

intercostal space

Answer 1

space between each of the ribs

Question 2

sternum

Answer 2

aka breastbone

three parts: manubrium, the body and the xiphoid process

Question 3

Angle of Louis

Answer 3

aka sternal angle

articulation of the manubrium an body of the sternum and is continuous with the 2nd rib

Question 4

costal margin

Answer 4

located at the bottom of the rib cage; margin where the cartilage meets ribs

Question 5

xiphoid process

Answer 5

point on the bottom of the breast bone

Question 6

assessment skills of the lung include:

Answer 6

general inspection
chest expansion
tactile fremitus
chest percussion
lung auscultation

Question 7

COPD can cause what type of chest?

Answer 7

barrel chest; chest appears as if help in continuous inspiration; occurs due to hyperinflation of the lungs (toddlers have this normally)

Question 8

pectus excavatum

Answer 8

caved in sternum

Question 9

pectus carinatum

Answer 9

(front of a ship is called carinatum); forward pertrusion of the sternum

Question 10

scoliosis

Answer 10

lateral curvature of the spine

Question 11

kyphosis

Answer 11

hunch back from old age or osteoporosis

Question 12

normal chest ratio from anterior to posterior

Answer 12

1:2 (reach this by age 6)

Question 13

hyperventilation

Answer 13

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

Question 14

Cheyne-Stokes respirations

Answer 14

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

Question 15

Biot respirations

Answer 15

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

Question 16

signs of respiratory distress:

1. accessory muscles
2. grunting
3. head bobbing
4. nasal flaring
5. retractions
6. tachpnea
7. tripod position

Answer 16

1. use if trouble breathing
2. when breathing out
3. head wiggle with breath; children
6. breath fast
7. hands on knees for diaphragm to move better (COPD)

Question 17

test for chest expansion

Answer 17

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

Question 18

tactile fremitus

Answer 18

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

Question 19

chest percussion

Answer 19

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

Question 20

lung auscultation

Answer 20

directly on skin
pt. breathes through the mouth
listen to one full inspiration/expiration before moving to next site
use side-to-side pattern

Question 21

normal lung sounds are ____ where normal frequency we hear best is ____ - ____

Answer 21

500 Hz

1000-1500 Hz

Question 22

bronchial breath sounds
pitch?
which phase is longer?
explain phase…

Answer 22

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

Question 23

vesicular breath sounds

Answer 23

sounds filtered by the alveoli (air filled vesicles)

Question 24

frequency of vesicular breath sounds?

phases?

Answer 24

lower frequency
expiratory phase short (inspiratory longer)
no pause

Question 25

bronchial breath sounds are only normal if heard over the _____

Answer 25

neck

Question 26

if you hear bronchial breath sounds over the lung fields, the alveoli have either ____ or ___ with ____

Answer 26

collapsed | filled with fluid (blood, pus or pulmonary edema

Question 27

crackles

Answer 27

important; presence always significant discontinuous sounds; short in duration; can't have musical characteristics; taken together though, they can have a long duration

Question 28

if present, when do you hear crackles?

Answer 28

inspiration (if you pay attention, you may can tell if they occur in early, middle, or late inspiration

Question 29

early crackles mechanism? possible meaning?

Answer 29

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

Question 30

mid inspiratory crackles

Answer 30

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)

Question 31

late inspiratory crackles

Answer 31

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

Question 32

*** how would you tell if late inspiratory crackles would be the result of fibrosis or fluid***

Answer 32

fluid would cause the underlying sound to be bronchial instead of vesicular

Question 33

Wheezes

Answer 33

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)

Question 34

in wheezing, it's not necessarily the ___ of the ___ that causes wheezing; it is the ___ of air

Answer 34

narrowing of the airway | speed of air

Question 35

Asthmatics on the brink of respiratory failure may not wheeze. What is this due to? What is the saying?

Answer 35

the speed of air (not the narrowing) | "beware of the silent asthmatic"

Question 36

Normal clients may wheeze while you auscultate their lungs if...

Answer 36

you have them expire with too much force

Question 37

so not everyone who ___ has ___ and not everyone who has ___ wheezes.

Answer 37

wheezes asthma asthma

Question 38

Wheezes will be either ___ and ___ or ___.

Answer 38

inspiratory and expiratory | expiratory

Question 39

Wheezes are never just ___

Answer 39

inspiratory

Question 40

If you think you hear a wheeze only on inspiration, it is actually a ___

Answer 40

stridor

Question 41

Stridor is the result of closing (___) of the ___ ___

Answer 41

adduction | vocal cords

Question 42

Stridor is a ___ ___

Answer 42

medical emergency

Question 43

Rhonchi are similar to ___ but they are ___ | They also have a ___ quality

Answer 43

wheezes longer musical

Question 44

Rhonchi are ___ pitched and have a ___ quality to them

Answer 44

lower | snoring (sonorous)

Question 45

Rhonchi are tricky to identify because...

Answer 45

they can all sound quite different (don't all sound the same)

Question 46

Rhonchi are often caused by ___ ___ that ___ the airway.

Answer 46

thick secretions | narrow

Question 47

Rhonchi can be ___ (heard over several places of the lung) but are often ___

Answer 47

diffuse | localized

Question 48

A persistent rhonchus localized to a specific area can be a sign of ___. Sometimes if patient coughs, they can ___ if it is not a ___.

Answer 48

neoplasm dislodge growth

Question 49

When auscultating an older patient, start on lower lobes as they can ...

Answer 49

get worn out

Question 50

Apgar scoring

Answer 50

1st respiratory assessment of newborn; measured at 1 and 5 minutes of life; a 1 minute score of 7-10 is good

Question 51

tachypnea

Answer 51

rapid shallow breathing; increased rate >24 per min

Question 52

hyperventilation

Answer 52

increase in both rate and depth

Question 53

bradypnea

Answer 53

slow breathing; decreased but regular rate

Question 54

hypoventilation

Answer 54

irregular shallow pattern caused by overdose of narcotics or anesthetics