LRE

Question 1

Normal adult breathing

Answer 1

quiet and regular at respiratory rate: 14-20/min

Question 2

Hypopnea

Answer 2

· Shallow and slow breathing

Question 3

Bradypnea

Answer 3

· regular rhythm but slower than normal rate (RR< 14/min)

Question 4

Hyperpnea

Answer 4

deep and fast rate of breathing (normal in excerise)

Question 5

Tachypnea

Answer 5

· rapid breathing

Question 6

Dyspnea

Answer 6

· short of breath

Question 7

Hypoxia

Answer 7

decreased in the amount of O2, going to the tissues.

Question 8

Apnea

Answer 8

· no breathing

Question 9

Atelectasis

Answer 9

lung tissue collapses and affects alveoli from absorbing O2

Question 10

Pleximeter finger

Answer 10

· àhyperextended middle fiber of non-dominant hand in percussion

Question 11

Plexor finger

Answer 11

· “tapping” finger on dominant hand used for percussion

Question 12

Medial to lateral lines on front of body:

Answer 12

· Midsternal lineàmidclavicular lineàanterior axillary line

Question 13

Lines on back of body

Answer 13

Vertebral lineàscapular line

Question 14

· Needle thoracentesis (decompression) is performed at the where?

Answer 14

2ndintercostal space, above the 3rdrib at the midclavicular line for decompression of tension pneumothorax, followed by test tube placement.

Question 15

Chest tube insertion

Answer 15

occurs at the 4thand 5thintercostal space, anterior to the mid-axillary line. In males, the 5thintercostal space is right below the nipple and inframammary fold in females.

• Chest tube should be inserted over the superior margin of the rib to avoid the bundle because the neurovascular bundle runs inferior to each rib.

Question 16

Hypoxemia·

Answer 16

· O2 deficiency in blood

Question 17

pulse oximeter allows us to calculate what?

Answer 17

SpO2 (peripheral arterial O2 saturation)- 5th vital sign by comparing the amount the amounts of red and infrared light.

Question 18

bad waveform of spo02 is d/t what? (4)

Answer 18

improper placement,

hypoperfusion,

hypothermia,

motion artifact

Question 19

end tidal CO2 aka

Answer 19

PETCO2

normally 35-40 mmHg

PO2 normal is 35-45 mmHg

Question 20

Incentive spirometer (IS): 4 steps

Answer 20

1. Move the slider on the outside of the large column to the level you want to reach
2. Sit or stand and hold it leveled in front of you
3. Breathe out normally, then close your lips tightly around mouthpiece
4. Take a slow, deep breath. Breathe in as deeply as you can. The ball inside the large column will move up. Try to move the piston or ball as high up as you can or to the level your doctor recommended. When you can’t breathe in anymore, hold your breath for 2 to 5 seconds.

* can help with atelectasis

Question 21

Pulmonary Fx Test (PFT)

Answer 21

non-invasive test to show how well lungs are working and used to dx certain lund disorders (obstructive vs restrictive)

Spirometry- technique used to measure lung fx by measuring amount of air inhaled and exhaled

Question 22

clubbing

Answer 22

• swelling of terminal phalanx causing loss of normal angle

Question 23

shape of chest

Answer 23

thorax wider than deep,

lateral diameter > AP diameter

Question 24

(Asymmetrical expansion can indicate

Answer 24

pleural effusion

Question 25

Retraction can indicated

Answer 25

COPD severese asthma upper airway obstruction (stridor)

Question 26

Unilateral lagging of chest

Answer 26

pleural disease (asbestosis ,trauma, or phrenic nerve damage

Question 27

Retractions include

Answer 27

supraclavicular retractions, substernal retractions, intercostal retractions

Question 28

Accessory muscles

Answer 28

: scalenes, sternomastoids, intercostals, abdominal m. Used in asthma, COPD, airway obstruction, viral illness (RSV)

Question 29

Palpation **:1. Tenderness** **2. Abnormalities in the skin** **3. Respiratory expansion**: __________ **4. tactile fremitis**

Answer 29

to do so, place the thumbs at the level of the 10thrib, loosely grasping the lateral rib cage. Ask patient to deeply inhale. Watch the distance between the thumbs as they move apart during inspiration and feel for the *range* and *symmetry* of the rib cage as it expands and contracts.

Question 30

-Tactile fremitis

Answer 30

palpable vibrations transmitted through the bronchopulmonary tree--\>chest wall as the patient speaks. Use the balls of hand or ulnar surface on both sides to compare them at the same time. Do this on the anterior or posterior chest wall. Say 99 or 1-1-1. - Decreased or absent--\> **COPD**, **changes in pleura** (effusion, fibrosis or air), **tumor.** - Incr**ea**sed--\> **pneumonia**

Question 31

percussion

Answer 31

helps to determine if the underlying structures are air-filled, fluid or solid. Penetrates 5-7 cm, so cant detect deep lesions. Technique

Question 32

peruccsion technique

Answer 32

1. Hyperextend the middle finger of non-dom hand and firmly touch the skin (do not let another part of hand touch bc it will dampen out vibration)àpleximeter finger 2. Tell pt to cross hands in front of them to pull scapula laterally, away from where you are percussing. 3. **Strike the DIP** with a quick, sharp BUT RELAXED wrist motion of the dominant middle finger \> plexor finger 4. Start superiorly and percuss both sides of the chest, going to the base in a **ladder** like pattern. Can be done on anterior or posterior chest

Question 33

5 percussion sounds

Answer 33

1. flat 2. dull (effusion or emphysema) 3. resonant (normal lungs are resonant; loud intensity, low pitch and long duration) 4. hyperresonant (pneumothorax) 5. tympanic (abdominal)

Question 34

Auscultation The most important techniques in assessing airflow is to:

Answer 34

* -Listen to the sounds made when breathing * -Listen for adventitious (added) sounds * -If an abnormality is detected--\> listen for **vocal resonance.** * -Difficulties: clothes, gowns, chest hair can sound like adventitious sounds. **Thus, listen on bare skin.**

Question 35

Lateral displacement of trachea can occur w (4)

Answer 35

**pneumothorax** **pleural effusion** **atelectasis** **mass**

Question 36

lower margin of the endotracheal tube on a CXR

Answer 36

t4

Question 37

· _______ intercostal space is the landmark for thoracentesis (not depression)

Answer 37

7th

Question 38

**Barrel chest (seen in COPD)**

Answer 38

increased AP diameter, resembling a barrel. AP diameter increases with aging, but can be normal in infancer

Question 39

Traumatic fail chest

Answer 39

flail chest can be d/t multiple rib fractures when you breathe in, the injured area caves in. when you breathe out, it moves out (opposite of what should happen

Question 40

diaphragmatic excursion

Answer 40

1. Get patient to exhale completely and hold it 2. Percuss to find the diaphragm, which is the spot where the lung tissue and dullness of structures below the lung meet 3. Mark with a pen 4. Tell patient to breathe normally 5. Inhale completely and hold it 6. find the diaphragm using the same technique 7. Distance between the two is the diaphragmatic excursion. Normal= 3- 5.5 cm. If dullness is higher than expected--\> **pleural effusion** or a **high diaphragm d/t atelectasis or phrenic nerve paralysis.**

Question 41

If dullness is higher than expected--\>

Answer 41

**pleural effusion** or a **high diaphragm** d/t *atelectasis* or *phrenic nerve paralysis.*

Question 42

normal breath sounds

Answer 42

1. vesicular 2. bronchovesicular 3. bronchial 4. tracheal

Question 43

Adventitial breath sounds

Answer 43

1. **crackles (rales**)- discontinous crackles, high pitched. Suggest pneumonia or bronchitis 2. **wheezing**- continous and prolonged and high ptiched, sounds like music. Suggests asthma and bronchiti 3. **rhonchi**- low pitched and snoring. Suggest secretions in airways 4. **stridor**- high pitched wheeze during inspiration. Indicates and obstruction of the larynx and needs immediate ATN! 5. p**leural friction ru**b- inflamed pleura. sounds like creaking when you breathe out.

Question 44

Bronchophony

Answer 44

words become louder and clearer normally; muffled and indistinct when auscultating

Question 45

Egophony

Answer 45

ee sounds like an A normall; sounds like an E

Question 46

Whispered pectoriloquy

Answer 46

whisper is louder and clearer during auscultation normally, faint and not distinct

Question 47

13. Identify the mnemonic for reading a chest x-ray

Answer 47

· A- adequate-assessment of quality [PIER] and airway 1. Position, **inspiration** (should see 10-11 ribs), exposure and rotation · B- bones and soft tissue · C- cardiac size, valves 1. Normal should be less than 50% of chest diameter of PA films and \< 60% on AP · D-diaphragms · E (4) -effusions/endotracheal tube/EKG leads/wires **· F- Fields and fissures & foreign body** **· G- great vessels/gastric bubble** · H- hilar masses **· I- impression**

Question 48

clubbing is d/t

Answer 48

1. CHF 2. Interstitial lung dz 3. IBD 4. Bronchiectasis **5. fibrosis** 6. cancer