Lower Respiratory Tract Flashcards
Needle thoracentesis (decompression)
2nd intercostal space, midclavicular line
Chest tube insertion
4th or 5th intercostal space, just anterior to midaxillary line
Neurovascular bundle
Runs along the inferior margins of each rib. Chest tubes & needles need to be placed over the superior margin of the rib to avoid the bundle
pulse oximetry
measures peripheral arterial oxygen saturation, known as “fifth vital sign”
bad waveform–improper placement, hypoperfusion, hypothermia, motion artifact
End tidal CO2
The concentration of CO2 in exhaled air at the end of respiration
Normal PaCO2– 35-40 mmHg
Incentive Spirometer
used to keep lungs healthy after surgery or after a respiratory illness
Training to take slow, deep breaths.
As you breath in with mouth around the mouthpiece, the ball inside the large column will move up. Try to move it as high as you can, or to the level recommended by Dr.
Atelectasis
The loss of lung volume due to collapse of lung tissue (alveoli)
- -can be seen post-surgery
- -Incentive spirometer can help
Pulmonary Function Test
Non-invasive, diagnose certain lung disorders (obstructive vs restrictive)
Spirometry
measures lung function
amount & speed of air inhaled/exhaled
asymmetrical expansion of the chest wall
pleural effusion
retraction of chest wall
severe asthma, COPD, or upper airway obstruction
Tracheal deviation
can be seen in pneumothorax, pleural effusion, atelectasis, & mass
Causes of clubbing
congenital heart disease, interstitial lung diseases, bronchiectasis, pulmonary fibrosis, cystic fibrosis, lung abscess, malignancy (lung cancer), inflammatory bowel disease
Pectus excavatum
“funnel chest”
depression in lower portion of the sternum. Can compress heart & great vessels & cause murmurs
Pectus Carinatum
“pigeon chest”
Sternum displaced anteriorly (increased AP diameter), adj costal cartilages are depressed
Barrel Chest
Increased AP diameter resembling a barrel, seen in COPD
Chronic bronchitis
clinical diagnosis: daily productive cough for 3 months or more, in at least 2 consecutive yrs, elevated hemoglobin, peripheral edema, rhonchi & wheezing, overweight & cyanotic
Emphysema
Pathologic diagnosis: permanent enlargement & destruction of airspaces distal to the terminal bronchiole, older & thin, severe dyspnea, quiet chest, hyperinflation with flattened diaphragms on XR
Traumatic flail chest
multiple rib fractures may result in paradoxical movements of the thorax–area caves inward on inspiration & outward on expiration
Thoracic expansion
place thumbs @ level of 10th ribs, fingers loosely grasping lateral rib cage
ask pt to inhale deeply & watch distance between your thumbs to look for symmetry
Decreased or absent tactile fremitus
COPD, pleural effusion, pleural fibrosis, infiltrating tumor, pneumothorax
increased tactile fremitus
pneumonia (consolidation)
Percussion tones
Flat over heavy muscles or bones, cardiac dullness, liver dullness
resonance over lungs
Dullness replaces resonance upon percussion
fluid or solid tissue replaces air-containing lung
lobar pneumonia (alveoli filled w fluid or blood cells)
pleural accumulations–effusion, hemothorax, empyema (pus)
