Lecture 4: chest Flashcards
thorax
between neck and diaphragm
bronchi
air passaged with irregularly placed plates of hyaline cartilage, interlacing networks of smooth muscle and a mucous membrane of columnar ciliated epithelium
bronchioles
tine (less than 1 mm in diameter), branching airways tat lead from the bronchi to the alveoli. they have elastic fibers and smooth muscle.
oxygen exchange begins at the…
respiratory brionchioles and continues at the alveolar ducts and alveolar sacs.
pain in the lungs
the lung tissue itself doesn’t have pain fibers, pain usually arises from inflammation o the adjacent parietal pleura.
5 A’s of tobacco cessation
Ask, Advise, Asses (pts readiness), Assist, arrange for follow-up
Who should get the strep pneumonia vaccine?
adults older then 65. Pt 2-64 with chronic illnesses. Immunocompromised, Alaskan natives
the pulmonary exam (4)
inspect, palpate, percuss, auscultate
pectus excavatum vs. pectus carinatum
sticking in vs sticking out
cheyne-stokes breathing
periods of deep breathing alternating with apnea
Boit’ breathing
unpredictable irregularity with breaths that may be shallow or deep and stop for short periods. causes include respiratory depression and brain damage
kussmaul breathing
fast, normal or slow deep breathing. Due to metabolic acidosis
barrel chest
increased AP diameter
increased fremitus in …
fluid/pus/blood is in the lung. ex. pneumonia
decreased fremitus
voice vibrations transmitted to the chest wall are blocked by a cushion of fluid outside the lung ex. pneumothorax
how many places on chest/back for fremitus?
3, 4
how many locations for chest/back for percussion?
6, 7
diaphragmatic excursion
difference in position of lower lung fields between inspiration and expiration
vesicular breath sounds
inspiratory longer than expiratory. Pitch is soft, over most of both lungs
bronchovesicular sounds
inspiratory and expiratory are the same length. Intermediate pitch.
Bronchial breath sounds
expiratory sounds last longer than inspiratory, loud pitch
tracheal breath sounds
equal sounds, very loud pitch
crackles/rales
intermittent, nonmusical and brief sounds created when air is forced through respiratory passages that are narrowed by fluids, mucus or pus. Heard on inspiration.
wheezes
a continuous, coarse, whistling sound (heard on expiration). Thought to occur due to narrowing in the respiratory tree and increased airflow velocities across the narrowed spaces.
stridor
type of high pitched wheeze that is primarily inspiration, loud over the neck than chest and indicated partial obstruction of the larynx or trachea
rhonchi
similar to wheeze though lower pitch with snoring like quality. Suggests secretions in the large airways.
bronchophony
normally sounds becomes less distinct and much softer when pt speaks. If there is consolidation then the sound is very loud and
whispered pectoriloquy
normal: sound hardly heard
if present you will be able to distinguish clearly
egophony
pt says “e” and results in “a” sound. caused by an increased resonance of voice sounds heard when auscultating the lungs due to compressed lung tissue
