Lung assessment Flashcards
Left axillary lung
U and L lobe seperation, posteriorly 3rd rib anteriorly 6th
R axillary lung
RUL runs posteriorly 3rd rib to anteriorly 6th rib but RML is mid axillary ~5th rib
Broncial lung sounds
Throat, high pitch, harsh amplitude short inspiration long exp
Bronchialvesicular sounds
Moderate pitch mixed quality = insp and exp length
Vesicular
Low pitch breezy quality soft amplitude Long insp SHORT exp (peripheral lungs
Fine crackles
Short high pitched popping during insp, not cleared with cough
Pneumonia, CHF.
If EARLY in insp COPD
Air opening small deflated passages coated with exudate
Course crackles
Low-pitch bubbling moist
Early insp to early exp
Air hitting secretions in large bronchi and trachea
Pneumonia, PE, fibrosis
Pleural rub
Low pitched dry grating
Inflamed pleural surfaces rubbing
Pleuritis
Sibilant wheezes
High pitched and musical
Expiration mainly
Air through constricted passages (swelling, secretions, tumour)
Asthma or emphysema
Sonorous wheezes
Low pitched snoring or moaning mainly during expiration
Air through constricted passages
Bronchitis, single obstructions
Resonance
Part air part solid
Normal lung
Hyper resonance
Mostly air
Lung with emphysema
Tympany
Over air, puffed out cheek or gastic bubble, pneumo
Dullness
Solid tissue
Diaphragm pleural effusion, liver
Flatness
Dense tissue like muscle bone sternum
Bronchophony test
Lung consolidation
Say 99 while auscultating posterior thorax
Soft and muffled normally, louder and more easily understood over consolidation
Egophony
Eeee outloud listening to lung fields
Sound like AAAA over consolidation
Good for pneumonia and effusion
Tactile Fremitus
Ulnar surface of hands and say 99, fremitus increased over consolidation
Whispered pectoriloquy
Pt speaking clearly if over consolidation
Get pt to whisper 1-2-3
S1
First heard sound, produced by AV closing at beginning of systole.
Intensity of S1 is dependant on
Position of mitral valve at start if systole, structure of valve leaflets, how quicky pressure rises in ventricles
S1 clinical (just the) tip
Normal S1 variations heard at apex of heart.
S1 softer at base and louder at apex
Accenuated S1
Louder than S2, occurs when mitral valve is wide open and closes quickly from:
Hyperkinetic states from increased blood velocity (fever, anemia, hyperthyroidism)
or Mitral stenosis in which leaflets are mobile but increased ventricular pressure needed to close the valve
Diminshed S1
Mitral valve not fully open from
Delayed conduction from atria to ventricles (1st degree block) - mitral starts drifting closed before closing
Mitral insufficiency (extreme calcification limits mobility)
Delayed/diminished ventricular contraction from forceful atrial contraction or into a noncompliant ventricle (severe pulmonary or systemic HTN)
Split S1
L and R ventricles contract at different times
BBB
Ventricular ectopy in which impulse starts in one ventricle, contracting it first and spreading into second
Varying S1
Mitral valve is in different position when contraction occurs
A and V bating independendtly (a-fib, AV dissociation, blocks)
S2 sounds
Closure of aortic and pulmonary valves. Closure of pulmonic is delayed by inspiration, resulting in split S2
Accenuated S2
Aortic or pulmonic valves have higher closing pressure
From increased pressure in aorta (excercise, excitment, systemic HTN)
Increased pulmonary vasculature (mitral stenosis or CHF)
Calcification of semi-lunar valve (valve still mobile, pulmonic or aortic stenosis)
Diminished S2
Aortic or pulmonic valves have decreased mobility
Decreased systemic BP (weakens valves) as in shock
Aortic or pulmonic stenosis in which valves are thickened and calcified with decreased mobility
Normal S2 split
Heard over second or third intercostal
Usually best heard during inspiration (can’t during expiration)
If it doesn’t disappear during expiration that’s pathologic
Wide S2 split
Increase in usual splitting that persists throughout entire resp cycle and widens on exp. Occurs when there is delayed electrical activation of RV (RBBB)
Fixed split S2
Wide splitting does not vary with resp
From delayed closure of one valve
Atrial septal defect, RV failure
Observing JVP
R side, pt lays 30-45 supine. Torso elevated.
Pt turns head to left, use light to see, use light to inspect
Internal jugular veins first
Reasons for JVP increased
Cardiac tamponade Tricuspid stenosis Tricuspid regurg RV failure Pulmonary htn PE
Internal jugular collects
Brain, superficial face and neck
External jugular collects
External cranium, deep parts of the face, occipital
Jugular vein should not be
distended bulging or protruding at greater than 45
Evaluating JVP
Position bed 30,45,60,90. Turn head and mark what degree pt was at with elevation.
Auscultation & palp of carotid
ask pt to hold breath for 30 seconds use bell end
Bruit- blowing or swishing caused by turbulent blood flow from narrowed arteries
Check pulses are equal with normal rate
Palpation should reveal elastic arteries - otherwise arterioslcerosis
Inspection of heart sounds
Pt 30-45 degrees
Pulsations other than apical are abnormal
If apical (normal) is visible it will be at mitral area
Pulsations may mean enlarged ventricle or weakened vessel
Palpation of apical pulse
Two fingers palpate mitral area (lie on L to increase)
should feel like gentle tapping
Difficult pulse to find from emphysema, fatty fat fat fat, tig ol bitties
Check for pulses in other areas
Palpate radials and apical to see if there are differences (a fib PVCs heart block)
Auscultate heart sounds
Study guide says diaphragm for S1 S2, and S3 S4 then bell for S3 S4
Ask pt to breath normally
S1 heard everywhere but best at 5th spot
S2 heard everywhere, loudest at erbs
Note location and timing of extra sounds.
Benign S3
Children, young adults, rare after 40
Benign S4
End of diastole in well conditioned athletes and those over 40
Ejection or clicks
Mitral valve prolapse
Pathologic S3
Ventricular gallop, possibly ischemic heart disease
Pathologic S4
Atrial gallop, L side of precordium heard with CAD, cardiomyopathy, aortic stenosis
Murmur
Listen for swishing sounds in the 5 areas. Variations include
Patholigc, midsystolic, pansystolic, diastolic
Heart sounds other positions
L lateral. Use bell. S1 S2 normally present. S3 or S4 mitral stenosis that was not detected may be revealed
Sit up, lean forward, exhale use diaphragm. Aortic regurg heard when pt sits upright mebbe
Normal breath sounds
Bronchial over throat, BV near sternum, vesicular peripherally
Tachypnea
24 minute+. Fever anxiety exercise, hypoxia, alkalosis, pneumonia, pleurisy
Bradypnea
Less than 10, neuro damage, drugs, diabetic coma
Hyperventilation
Increased rate and dpeth
Kussmaul
Rapid, deep, laboured
Hypovent
Decreased depth, irregular pattern
Cheyne-Stokes
Reg pattern with deep rapid and periods of apnea
Biots resps
Irregular, varying depth and rate with periods of apnea
Ataxic
Significant disorganization with irregular and varying depths of resps
Air trapping
Difficulty getting breath out
Percussion locations posterior
123, 456 posterior traps
8-18 ~2nd intercostal back and forth, getting wider 16-17 wider again 17-18 then 19-20 and 21-22 are more lateral
Anterior percussion
1st intercostal L to R each intercostal, 5th spot is more lateral
Resonant
Low pitched hollow normal lungs
Dull or thud
heart liver or fluid in lung tissues like pneumonia pleural effusion or tumors
Hyperresonant
Loud, lowwer pitched. Children or skinny adults
COPD, asthma attack, or pneumothorax
Tympanic
High, drum like, normally over stomach but maybe a pneumo
Inspect lungs for
Nasal flaring, pursed lip, skin colour, nails, even chest rise, scapulae not protruding, downward rib slope
Lower ribs posteriorly
8th-9th rib
Same insp and exp
BV
High pitched musical constricted airway passages
Sibilant wheeze
