Lecture One (thorax+lungs)- Exam 2 Flashcards
What are the different anatomic descriptors of the chest? (6) 🌟
- Supracalvicular: above the clavicles
- Infraclavicular: below the clavicles
- Interscapular: between the scapulae
- Infrascapular: below the scapulae
- Bases of the lungs: the lowermost portions
- Upper, middle and lower lung fields
What are the different components of the health history for throax? (7)
- Common or concerning symptoms
- Chest pain
- Shortness of breath (dyspnea)
- Wheezing
- Cough
- Blood-streaked sputum (hemoptysis)
- Daytime sleepiness or snoring and disordered sleep
Complaints of CP or chest discomfort raise concerns about what?
the heart but often arise from other structures in the thorax and lungs
How do you assess the symptom of CP or chest discomfort?
To assess this symptom, you must pursue a dual investigation of both thoracic and cardiac causes.
What are different sources of CP and causes? ⭐️
- The myocardium Angina pectoris, myocardial infarction, myocarditis
- The pericardium Pericarditis
- The aorta Aortic dissection (tearing pain to back)
- The trachea and large bronchi Bronchitis
- The parietal pleura Pericarditis, pneumonia, pneumothorax, pleural effusion, pulmonary embolus
- The chest wall, including the musculoskeletal and neurologic systems
- Costochondritis (infection between ribs), herpes zoster (along dermatome)
- The esophagus Gastroesophageal reflux disease, esophageal spasm, esophageal tear
- Extrathoracic structures such as the neck, gallbladder, and stomach Cervical arthritis, biliary colic (gallbladder pain can radiate to scapula), gastritis
What should you ask the patient about their chest?
to point to the location of the pain in the chest
- What does a clenched fist over the sternum suggest?
- What does a finger pointing to a tender spot on the chest wall suggest?
- What does a a hand moving from the neck to the epigastrium suggest?
- A clenched fist over the sternum suggests angina pectoris
- a finger pointing to a tender spot on the chest wall suggests musculoskeletal pain
- a hand moving from the neck to the epigastrium suggests heartburn.
What should you make every effort to determine SOB and wheezing
Determine its severity based on the patient’s daily activities
What are questions you can ask the patient to determine the severity of SOB/wheezing based on daily activities? (3)
What should you carefully elicit?
- How many steps or flights of stairs can the patient climb before pausing for breath?
- What about carrying bags of groceries, vacuuming, or making the bed?
- Has shortness of breath altered the patient’s lifestyle and daily activities? How?
- Carefully elicit the timing and setting, any associated symptoms, and relieving or aggravating factors
What is the most common cause of acute cough? ⭐️
Viral UR infection
What are other causes of acute cough?
Also consider acute bronchitis, pneumonia, left-sided heart failure, asthma, foreign body, smoking, and ace-inhibitor therapy
FLAP AAS
What can cause subacute cough?
Post infectious cough, pertussis, acid reflux, bacterial sinusitis, and asthma
AAPP B-
Where can chronic cough be seen in?
in postnasal drip, asthma, gastroesophageal reflux, chronic bronchitis, and bronchiectasis (in children)
What should you ask about the coughing to your patient?
- Productive? (dry, sputm)
- Volume of sputum, color, odor and consistencty
* Purulent?
* Hemoptysis?
* Mudcoid (translucent, white or gray)
* Foul-smelling? (abscess or bacterial infection)
* Large volume of purulent sputum (bronchiectasis and lung abscess
What are important topics for health promotion and counseling?
- Tobacco cessation (are you interested in stopping? education?)
- Lung cancer (when to do screening)
- Immunization: covid, influenza, pneumonia vaccines
What is the initial survey of the chest?
- Observe the rate, rhythm, depth, and effort of breathing
A healthy resting adult breathes quietly and regularly about _ times a minute.
20 (range of 16-20)
What are the signs of respiratory distress (overview)?
What signals hypoxia?
Cyanosis of lips, tongue, and oral muscosa
What are you listening for with audible sounds of breathing?
- High-pitched inspiratory whistling, or stridor, is an ominous sign of upper airway obstruction.
- Wheezing is either expiratory or continuous
What do you do for inspection of the neck?
- During inspiration, contraction of the accessory muscles (SCM and scalene) (COPD)
- Supraclavicular retraction?
- During expiration, contraction of the intercostal or abdominal oblique muscles
- Trachea midline (pneumothorax, pleural effusion, atelectasis)
- When is pneumothorax common?
- Why do we care that the trachea is midline?
- Collaspe of lung common in tall males
- Trachea dev. towards the pneumothorax
What is bradynea and some causes (4)?
Rate < 12/min: Bradypnea
* Metabolic alkalosis: volume depletion, vomiting
* Narcotics
* Raised intracranial pressure
* Extreme Obesity
What is tachypnea and some causes of it (5)?
Rate > 20-25/min: Tachypnea
* Metabolic acidosis: DKA
* Hypoxemia
* Stimulants
* Anxiety
* Pain
What are signs of respiratory distress?
.
What is the tri-pod position?
In cases of real distress, pts may lean forward, resting their hands on their knees. In emphysema will purse their lips
Common in COPD and lung cancer pts
What do we inspect of the chest?
- Observe shape of the chest
- Ratio of the anteroposterior (AP) diameter to lateral chest diameter is 0.7 up to 0.9 and increases with aging
- > 0.9 in COPD, producing barrel-chest appearance
What should the anteroposterior diameter be? What is it in COPD?
- Ratio of the anteroposterior (AP) diameter to lateral chest
diameter is 0.7 up to 0.9 and increases with aging - > 0.9 in COPD, producing barrel-chest appearance
What is funnel chest (pectus excavatum)? What can it cause?
- Note depression in the lower portion of the sternum.
- Compression of the heart and great vessels may cause murmurs
What is this?
Pectus excavatum
What is barrel chest? Common in who?
- There is an increased AP diameter.
- This shape is normal during infancy, and often accompanies aging and chronic obstructive pulmonary disease.