Lab 8: Lungs and Thorax Flashcards
Mr. McKay is a 55 yr old client attending your Health and Wellness Clinic. You will be performing a lung/thorax assessment. What will you inquire about? What will your assessment include?
Injury:
A) Family history of illness (eg. cancer, allergies, TB)
B) Lifestyle habits (eg. smoking, occupational hazards)
C) Current conditions (eg. swellings, cough, wheezing, pain)
D) Current prescriptions
E) Client concerns
Assessment:
A) Inspection, palpation, percussion, auscultation
B) Posterior thorax (eg. palpate, percussion, auscultation)
C) Anterior thorax (eg. inspect breathing patterns, palpate, percussion, auscultation)
- What are some observations you may make when assessing an infant’s thorax and lungs?
- Thorax is rounded and cylindrical
- Diaphragm breathing
- Tracheal tug: place the hand over the infant’s thorax
- Easy to see respiratory changes
- Anterioposterior and transverse diameters are equal until the age of six (adults it should be 1:2)
What are some observations you may make when assessing a child’s thorax and lungs?
- Anteroposterior diameter has decreased in proportion to the transverse diameter with a 1:2 ratio present
- Abdominal breathing up to age of 6 years old
- Spinal curvature or scoliosis may appear
What physiological changes, if any would you expect to notice when assessing an older adult’s thorax and lungs?
- Thoracic curvature may be accentuated
- Breathing rate takes longer to return to resting rate
- Expiration may use accessory muscles
- Inspiratory muscles become less strong
- Alveolar tissue loses elasticity
- Describe normal vesicular breath sounds and identify where they are located? What does it mean if these breath sounds are found in places other than the normal?
- Soft-intensity, low-pitched, “gentle-sighing” sounds created by air moving through smaller airways (bronchioles and alveoli)
- location: over peripheral lung; best heard at base of lungs
- Characteristics: best heard on inspiration, which is approx. 2.5 times longer than the expiratory phase (5:2 ratio)
Describe normal Bronchovesicular breath sounds and identify where they are located? What does it mean if these breath sounds are found in places other than the normal?
- Moderate-intensity and moderate-pitched “blowing” sounds created by air moving through larger airways (bronchi)
- Location: between the scapulae and lateral to the sternum at the first and second intercostal spaces
- Characteristics: Equal inspiratory and expiratory phases (1:1 ratio)
Describe normal Bronchial (tubular) breath sounds and identify where they are located? What does it mean if these breath sounds are found in places other than the normal?
- High-pitched, loud, “harsh” sounds created by air moving through the trachea
- Location: anteriorly over the trachea; not normally heard over lung tissue
- Characteristics: louder than vesicular sounds; have a short inspiratory phase and long expiratory phase (1:2 ratio)
What are adventitious breath sounds and what are they caused by?
abnormal breath sounds that occur when -air passes through narrowed airways
- airways filled with fluid or mucus
- when pleural linings are inflamed
Fine crackles (rales)
- dry, high-pitched, discontinuous crackling, popping; sound can be simulated by rolling a lock of hair near the ear; predominantly heard on inspiration but can be heard on both inspiration and expiration; may not be cleared by coughing
Causes: Air passing through moisture (fluid or mucus) in sm airways that suddenly re-inflate
Location: most commonly heard in bases of lower lung lobes
Coarse crackles
-discontinuous, moist, low-pitched crackling, gurgling; predominantly heard on inspiration but can be heard on both inspiration and expiration; may be altered by coughing
Causes: air passing through moisture (fluid or mucus) in large airways that suddenly re-inflate
Location: loud sounds heard over most lung areas but predominate over trachea and bronchi
Friction rub
-superficial grating or creaking sounds heard during inspiration and expiration; not relieved by coughing
Causes: rubbing together of inflamed pleural surfaces
Location: heard most often in areas of greatest thoracic expansion (eg. lower anterior and lateral thorax)
Wheeze
-Continuous, high pitched, squeaky musical sounds. Best heard on expiration, not usually altered by coughing
Cause: air passing through constricted bronchus due to secretions, swelling, tumors
Location: Narrowed`
Sonorous wheeze (rhonchi)
-continuous, low-pitched snoring sound; best heard on expiration; may be cleared by coughing
Causes: air passing through narrowing of large airways or obstruction of bronchus
Location: heard over all lung fields
Sibilant wheeze
-continuous, high-pitched, musical sounds; best heard on expiration; not usually altered by coughing
Causes: air passing through narrowing of large airways or obstruction of the bronchus
Location: heard over all lung fields
Stridor
-continuous crowing sound, high pitched; predominantly heard on inspiration
Causes: partial obstruction of larynx or trachea
Location: louder in neck than over chest wall