Lab 8: Lungs and Thorax

Question 1

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?

Answer 1

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)

Question 2

2. What are some observations you may make when assessing an infant’s thorax and lungs?

Answer 2

1. Thorax is rounded and cylindrical
2. Diaphragm breathing
3. Tracheal tug: place the hand over the infant’s thorax
4. Easy to see respiratory changes
5. Anterioposterior and transverse diameters are equal until the age of six (adults it should be 1:2)

Question 3

What are some observations you may make when assessing a child’s thorax and lungs?

Answer 3

1. Anteroposterior diameter has decreased in proportion to the transverse diameter with a 1:2 ratio present
2. Abdominal breathing up to age of 6 years old
3. Spinal curvature or scoliosis may appear

Question 4

What physiological changes, if any would you expect to notice when assessing an older adult’s thorax and lungs?

Answer 4

1. Thoracic curvature may be accentuated
2. Breathing rate takes longer to return to resting rate
3. Expiration may use accessory muscles
4. Inspiratory muscles become less strong
5. Alveolar tissue loses elasticity

Question 5

3. 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?

Answer 5

1. Soft-intensity, low-pitched, “gentle-sighing” sounds created by air moving through smaller airways (bronchioles and alveoli)
2. location: over peripheral lung; best heard at base of lungs
3. Characteristics: best heard on inspiration, which is approx. 2.5 times longer than the expiratory phase (5:2 ratio)

Question 6

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?

Answer 6

1. Moderate-intensity and moderate-pitched “blowing” sounds created by air moving through larger airways (bronchi)
2. Location: between the scapulae and lateral to the sternum at the first and second intercostal spaces
3. Characteristics: Equal inspiratory and expiratory phases (1:1 ratio)

Question 7

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?

Answer 7

1. High-pitched, loud, “harsh” sounds created by air moving through the trachea
2. Location: anteriorly over the trachea; not normally heard over lung tissue
3. Characteristics: louder than vesicular sounds; have a short inspiratory phase and long expiratory phase (1:2 ratio)

Question 8

What are adventitious breath sounds and what are they caused by?

Answer 8

abnormal breath sounds that occur when -air passes through narrowed airways

• airways filled with fluid or mucus
• when pleural linings are inflamed

Question 9

Fine crackles (rales)

Answer 9

• 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

Question 10

Coarse crackles

Answer 10

-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

Question 11

Friction rub

Answer 11

-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)

Question 12

Wheeze

Answer 12

-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`

Question 13

Sonorous wheeze (rhonchi)

Answer 13

-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

Question 14

Sibilant wheeze

Answer 14

-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

Question 15

Stridor

Answer 15

-continuous crowing sound, high pitched; predominantly heard on inspiration
Causes: partial obstruction of larynx or trachea
Location: louder in neck than over chest wall

Question 16

a. Tachypnea

Answer 16

• abnormally fast respirations, usually more than 24 respirations per minute; marked by quick, shallow breaths

Question 17

Bradypnea

Answer 17

• abnormally slow respiration rate, usually fewer than 10 respirations per minute

Question 18

Apnea

Answer 18

• a complete absence of respirations

Question 19

Hyperventilation

Answer 19

• very deep, rapid respirations

- An increase in the amount of air in the lungs, characterized by increased rate and depth of breaths

Question 20

Hypoventilation

Answer 20

• very shallow respirations

- A reduction in the amount of air in the lungs, characterized by shallow respirations

Question 21

Cheyne-Stokes

Answer 21

• rhythmic waxing and waning of respirations from very deep breathing to very shallow breathing with periods of temporary apnea, often associated with cardiac failure, increased intracranial pressure, or brain damage

Question 22

Dyspnea

Answer 22

• the subjective sensations of difficult or laboured breathing

Question 23

Orthopnea

Answer 23

• the ability to breathe only when in an upright position (sitting or standing)

Question 24

Intercostal

Answer 24

• the space between the ribs

Question 25

Substernal

Answer 25

• situated or perceive behind or below the sternum

Question 26

Suprasternal

Answer 26

• situated above or measured from the top of the sternum

Question 27

Hemoptysis

Answer 27

• the presence of blood in the sputum

Question 28

Productive Cough

Answer 28

• a cough accompanied by expectorated secretions

Question 29

Non Productive Cough

Answer 29

• a dry, harsh cough without secretions

Question 30

Fremitus

Answer 30

• the faintly perceptible vibration of the vocal chords felt through the chest wall when the client speaks

Question 31

Pectus Carinatum

Answer 31

• pigeon chest, a permanent deformity; can be caused by rickets (a softening of bones due to deficiency or impaired metabolism of vitamin D, magnesium, phosphorus, or calcium)
• A narrow transverse diameter, an increased anteroposterior diameter, and a protruding sternum characterize pigeon chest

Question 32

Pectus Excavatum

Answer 32

• funnel chest, a congenital defect; the opposite of pigeon chest
• sternum is depressed, narrowing the anteroposterior diameter
• Because the sternum points posteriorly in clients with a funnel chest, abnormal pressure of the heart can result in altered function

Question 33

Scoliosis

Answer 33

• a lateral curvature / deviation of the spine
• Assess by having the client stand up. Have the client bend at the hips, if the shoulders and hips aren’t in one line then we suspect scoliosis

Question 34

Kyphosis

Answer 34

• excessive convex curvature of the thoracic spine

Question 35

Barrel Chest

Answer 35

• enlarged chest with a rounded cross section and fixed horizontal position of the ribs that occurs in chronic pulmonary emphysema

Question 36

When assessing respirations, what will you assess for?

Answer 36

Depth, rate, rhythm and character

Question 37

Emphysema

Answer 37

• a chronic pulmonary condition in which the air sacs, or alveoli, are dilated and distended

Question 38

Pulmonary embolus

Answer 38

• a blockage of an artery in the lungs by fat, air, tumour tissue, or a blood clot