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Health Assessment > Health assessment-test 2-thorax and lungs > Flashcards

Health assessment-test 2-thorax and lungs Flashcards

1
Q

intercostal space

A

space between each of the ribs

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2
Q

sternum

A

aka breastbone

three parts: manubrium, the body and the xiphoid process

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3
Q

Angle of Louis

A

aka sternal angle

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

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4
Q

costal margin

A

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

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5
Q

xiphoid process

A

point on the bottom of the breast bone

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6
Q

assessment skills of the lung include:

A 
general inspection
chest expansion
tactile fremitus
chest percussion
lung auscultation
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7
Q

COPD can cause what type of chest?

A

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

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8
Q

pectus excavatum

A

caved in sternum

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9
Q

pectus carinatum

A

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

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10
Q

scoliosis

A

lateral curvature of the spine

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11
Q

kyphosis

A

hunch back from old age or osteoporosis

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12
Q

normal chest ratio from anterior to posterior

A

1:2 (reach this by age 6)

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13
Q

hyperventilation

A

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

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14
Q

Cheyne-Stokes respirations

A

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

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15
Q

Biot respirations

A 
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
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16
Q

signs of respiratory distress:

  1. accessory muscles
  2. grunting
  3. head bobbing
  4. nasal flaring
  5. retractions
  6. tachpnea
  7. tripod position
A
  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)
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17
Q

test for chest expansion

A

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

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18
Q

tactile fremitus

A

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

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19
Q

chest percussion

A 
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
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20
Q

lung auscultation

A

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

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21
Q

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

A

500 Hz

1000-1500 Hz

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22
Q

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

A

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

23
Q

vesicular breath sounds

A

sounds filtered by the alveoli (air filled vesicles)

24
Q

frequency of vesicular breath sounds?

phases?

A

lower frequency
expiratory phase short (inspiratory longer)
no pause

25
Q

bronchial breath sounds are only normal if heard over the _____

A

neck

26
Q

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

A

collapsed

filled with fluid (blood, pus or pulmonary edema

27
Q

crackles

A

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

28
Q

if present, when do you hear crackles?

A

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

29
Q

early crackles
mechanism?
possible meaning?

A

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

30
Q

mid inspiratory crackles

A

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)

31
Q

late inspiratory crackles

A

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

32
Q

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

A

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

33
Q

Wheezes

A

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)

34
Q

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

A

narrowing of the airway

speed of air

35
Q

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

A

the speed of air (not the narrowing)

“beware of the silent asthmatic”

36
Q

Normal clients may wheeze while you auscultate their lungs if…

A

you have them expire with too much force

37
Q

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

A

wheezes
asthma
asthma

38
Q

Wheezes will be either ___ and ___ or ___.

A

inspiratory and expiratory

expiratory

39
Q

Wheezes are never just ___

A

inspiratory

40
Q

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

A

stridor

41
Q

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

A

adduction

vocal cords

42
Q

Stridor is a ___ ___

A

medical emergency

43
Q

Rhonchi are similar to ___ but they are ___

They also have a ___ quality

A

wheezes
longer
musical

44
Q

Rhonchi are ___ pitched and have a ___ quality to them

A

lower

snoring (sonorous)

45
Q

Rhonchi are tricky to identify because…

A

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

46
Q

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

A

thick secretions

narrow

47
Q

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

A

diffuse

localized

48
Q

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

A

neoplasm
dislodge
growth

49
Q

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

A

get worn out

50
Q

Apgar scoring

A

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

51
Q

tachypnea

A

rapid shallow breathing; increased rate >24 per min

52
Q

hyperventilation

A

increase in both rate and depth

53
Q

bradypnea

A

slow breathing; decreased but regular rate

54
Q

hypoventilation

A

irregular shallow pattern caused by overdose of narcotics or anesthetics

Health Assessment (10 decks)

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