Lower Respiratory Flashcards
What are the 4 steps of a lower respiratory exam?
inspection, palpation, percussion, and auscultation
What is the sternal angle? What is another name for it?
angle of Louis -> where the 2nd ribs join the sternum
Where would you perform a needle thoracentesis (decompression)?
2nd intercostal space, midclavicular line
Where would you insert a chest tube?
4th and 5th intercostal space just anterior to mid-axillary line
Should chest tubes and needles be placed over or under ribs?
along superior margin (over) ribs; neuromuscular bundle runs along inferior margin of each rib
What is atelectasis? What can help prevent it?
loss of lung volume due to collapse of lung tissue (alveoli); seen post-surgery; Incentive spirometer (IS) can help prevent it
What is accessory muscle use? What muscles are used in accessory muscle use?
sign of respiratory distress;
Scalenes, SCM, and supraclavicular retrations
What is cyanosis?
blue skin (either in nail bed or perioral); sign of hypoxia
What may cause tracheal deviation?
pneumothorax, pleural effusion, atelectasis, or mass
What are some of the causes of clubbing?
congenital heart disease, interstitial lung disease, pulmonary fibrosis, cystic fibrosis, lung abscess, lung acne, or inflammatory bowel disease (IBD)
Describe pectus excavatum
funnel chest; depression in lower portion of sternum; can compress heart and great vessels causing murmurs
Describe pectus carinatum
pigeon chest; sternum anteriorly displaced w/ adjacent costal cartilages depressed
Describe barrel chest
increased AP diameter resembling a barrel; seen in COPD
Describe a blue bloater
chronic bronchitis (daily productive cough for 3 months or more for 2 consecutive years); overweight/cyanotic, peripheral edema, rhonchi and wheezing
Describe a pink puffer
emphysema; older/thin w/ severe dyspnea; X-ray will show hyperinflation w/ flattened diaphragm
Describe a flail chest
multiple rib fx may result in paradoxical movement of thorax
How do you examine thoracic expansion?
place thumbs at 10th ribs posteriorly w/ fingers loosely grasping rib cage; ask pt to inhale deeply and feel for symmetry of rib cage
What is tactile fremitus? What causes increased/decreased fremitus?
palpable vibrations on pt’s back as they speak
Increased: consolidation (pneumonia)
Decreased: COPD or pleural changes
Name 5 percussion sounds and their normal locations?
flat - thigh dull - liver resonant - healthy lung hyperresonant - none tympanitic - gastric air bubble or puffed-out cheek
Causes of dullness when percussing lungs
fluid or solid tissue replaces air-containing lung
Causes of hyper resonance when percussing lungs
heard over hyper inflated lungs (COPD; emphysema; asthma)
What does unilateral hyper resonance suggest when percussing lungs?
pneumothorax or large air-filled bulla in lung (COPD/emphysema)
What is suggested by asymmetrical diaphragmatic excursion?
pleural effusion or high diaphragm secondary to atelectasis or phrenic nerve paralysis
How may spots should you listen to when auscultating lungs? How should the pt breathe?
2 on the front; 4 on the back; pt should breath through an open mouth
What is stridor? Common causes?
high pitched inspiratory wheeze due to narrowing of upper airway; caused by croup, epilottitis, upper airway FB, or anaphylaxis
What is wheezing? Common causes?
generally expiratory sound (continuous musical sound) due to rapid airflow through narrowed bronchial airway; caused by RAD, asthma, and COPD
What is crackles (rales)?
inspiratory sound that sounds like “velcro”; discontinuous, intermittent and nonmusical; caused by pneumonia, CHF, atelectasis, COPD, and asthma
Describe bronchophony
pt’s spoken words get louder when listening through stethoscope
Describe whispered pectoriliquy
whispered words are louder and clear during ascultation
Describe egophony
when pt says “ee” it sounds like “A”
What does positive bronchophony, egophony, or whispered pectoriliquy usually mean?
lung consolidation (tumor, pneumonia, effusions)
What does the following mnemonic for interpreting chest X-rays mean: AABCDEFFGGHI
Assessment of quality Airway Bones Cardiac size Diaphragms Effusions Fields and fishes Foreign body Great vessels Gastric bubble Hilar masses Impression
What is the lower margin of an endotracheal tube on an Xray?
T4
What is the landmark for a thoracentesis?
7th intercostal space
Describe vesicular breath sounds
heard over most of lungs -> soft and low pitched (inspiration and 1/3 expiration)
Describe bronchovesicular breath sounds
heard best in 1st and 2nd interspaces anteriorly between scapula; intermediate in intensity and pitch (equal in inspiration and expiration)
Describe bronchial breath sounds
heard best over manubrium; loud and high pitched (expiratory longer than inspiratory)
Describe tracheal breath sounds
best heard over trachea in neck; very loud and high pitched (equal during inspiration and expiration)
Describe rhonchi
relatively low-pitched snoring sound that suggests secretions in airway
Describe pleural friction rub
inflamed pleural surfaces grate against each other; sounds like “creaking” during expiration (can also occur during inspiration)
