Lower Respiratory Exam Lab

Question 1

Steps for lower respiratory exam

Answer 1

Inspect pt
Palpate (anterior & posterior chest, tactile fremitus)
Percussion (ant & post chest & diaphragmatic excursion)
Auscultate (2 ant, 4 post & 1 R lateral)

Question 2

Where is a needle thoracentesis placed?

Answer 2

2nd intercostal space just superior to 3rd rib margin @ mid-clavicular line

used for emergent decompression of tension from pneumothorax

Question 3

Where is a chest tube inserted?

Answer 3

4th intercostal space @ mid or anterior axillary line just superior to margin of 5th rib

Question 4

Where should you look for an endotracheal tube?

Answer 4

@ level of T4 vertebra on chest X ray

Question 5

What do you evaluate during pt respiration?

Answer 5

rate, rhythm, depth & effort

Question 6

What is a normal respiration rate?

Answer 6

14-20 breaths per minute

Question 7

What may asymmetrical movement of chest during respiration indicate?

Answer 7

pleural effusion

Question 8

What may intercostal retractions during respiration indicate?

Answer 8

severe asthma, COPD, upper airway obstruction

Question 9

What is pursed lip breathing assoc w/?

Answer 9

COPD or obstructive lung disease

Question 10

What is tripoding?

Answer 10

pt w/ obstructive lung disorders tend to sit & lean forward w/ shoulders elevated

Question 11

What should you inspect on the neck during respiration?

Answer 11

contraction of accessory muscles
tracheal position (should be midline)

Question 12

When does lateral displacement of trachea occur?

Answer 12

tension pneumothorax

Question 13

What do you inspect the fingernails for?

Answer 13

signs of clubbing

loss of normal angle btwn nail & proximal nail fold (>180 degrees)

Question 14

What does palpation of chest include?

Answer 14

areas of tenderness
rib motion (inhalation v exhalation dysfunction)
thoracic expansion
tactile fremitus

Question 15

How do you assess for thoracic expansion?

Answer 15

place thumbs @ level of 10th ribs & grab parallel to lateral rib cage

have pt inhale deeply & watch distance between thumbs as move apart, feel for range & symmetry of rib cage as expands & contracts

Question 16

What is tactile fremitus?

Answer 16

palpate vibrations transmitted thru bronchopulmonary tree to chest wall as pt speaks (says 99)

perform on ant & post chest & use ULNAR sides of hand

Question 17

When would increased tactile fremitus occur?

Answer 17

pneumonia (increased transmission thru consolidated tissue)

Question 18

When would decreased tactile fremitus occur?

Answer 18

COPD, pleural effusions, fibrosis, pneumothorax, thick chest wall, infiltrating tumor

Question 19

What is important in technique for percussion of chest?

Answer 19

strike extended middle finger @ DIP w/ quick & sharp motion

Question 20

Flat percussion characteristics

Answer 20

soft intensity
high pitch
short duration

Question 21

Dull percussion characteristics

Answer 21

medium intensity
medium pitch
medium duration

Question 22

Resonant percussion characteristics

Answer 22

loud intensity
low pitch
long in duration

healthy lung

Question 23

Hyper-resonant percussion characteristics

Answer 23

very loud
lower pitch
longer duration

Question 24

Tympanitic percussion characteristics

Answer 24

loud
high pitch
longer

gastric air bubble

Question 25

When does dullness occur?

Answer 25

fluid or solid tissue replaces air-containing lung ``` lobar pneumonia (b/c alveoli filled w/ fluid & RBCs) pleural accumulations (effusion, hemothorax, empyema, fibrosis or tumor) ```

Question 26

When does hyper-resonance occur?

Answer 26

hyper-inflated lungs COPD/emphysema asthma

Question 27

When does unilateral hyper-resonance occur?

Answer 27

large pneumothorax | large air-filled bulla in lung

Question 28

What is normal diaphragmatic excursion?

Answer 28

3 to 5.5 cm (distance btwn 2 levels of diaphragm-during inhalation & expiration)

Question 29

What does dullness @ higher level in diaphragmatic excursion indicate?

Answer 29

suggests pleural effusion or high diaphragm (due to atelectasis or phrenic N paralysis)

Question 30

How do you auscultate lungs?

Answer 30

have pt breathe deeply in & out thru OPEN mouth

Question 31

Crackles in breath sounds

Answer 31

discontinuous, intermittent, nonmusical & brief fine crackles sound like velcro & coarse crackles are louder & lower in pitch

Question 32

Wheezes in breath sounds

Answer 32

continuous, musical quality & prolonged (not always during entire respiratory cycle) suggests narrowed airways

Question 33

Rhonchi breath sound

Answer 33

relatively low-pitched w/ snoring quality suggests secretions in large airways

Question 34

Stridor in breath sound

Answer 34

high pitched wheeze that is usually only during INSPIRATION louder in neck & indicates partial obstruction of larynx or trachea

Question 35

Which breath sound indicates a medical emergency?

Answer 35

stridor

Question 36

Pleural friction rub

Answer 36

sounds like cracking, usually during expiration & in small area on chest wall rough pleural surfaces rubbing against each other

Question 37

Bronchophony

Answer 37

pt says "99" while listen abnormal: spoken words become louder & clearer (indicates consolidation)

Question 38

Egophony

Answer 38

pt says "ee" abnormal: "ee" sounds like "A" (usually indicates pneumonia if pt has fever & cough)

Question 39

Whispered pectoriloquy

Answer 39

pt whispers "99" or "1, 2 3" abnormal: whispers are heard louder & clearer during auscultation