Lungs Flashcards
(hint: this one is not a deformity)
Normal adult
The thorax in the normal adult is wider than it is deep. Its lateral diameter is larger than its anteroposterior diameter.
Funnel chest (pectus excavatum)
Note depression in the lower portion of the sternum. Compression of the heart and great vessels may cause murmurs.
Barrel Chest
There is an increased anteroposterior diameter. This shape is normal during infancy, and often accompanies aging and chronic obstructive pulmonary disease.
Pigeon Chest (Pectus Carinatum)
The sternum is displaced anteriorly, increasing the anteroposterior diameter. The costal cartilages adjacent to the protruding sternum are depressed.
Breath Sounds:
Transmitted voice sounds: (bronchophy, egophony, whispered pectoriloquy)
Tactile Fremitus:
Breath sounds: Predominantly vesicular
Transmitted voice sounds: Spoken words muffled and indistinct, Spoken “ee” heard as “ee”, Whispered words faint and indistinct, if heard at all
Tactile fremitus: Normal
Breath Sounds:
Transmitted voice sounds: (bronchophy, egophony, whispered pectoriloquy)
Tactile Fremitus:
Breath sounds: Bronchial or bronchovesicular over the involved area
Transmitted voice sounds: Spoken words louder, clearer (bronchophony), Spoken “ee” heard as “ay” (egophony), Whispered words louder, clearer (whispered pectoriloquy)
Tactile fremitus: Increased
Chest Disorders: Consolidation
Defn:
Percussion:
Breath sounds:
Adventitious sounds:
Tactile fremitus and transmitted voice sounds:
Alveoli fill w/ fluid or blood (pneumonia, pulmonary edema, hemorrhage)
Percussion: dull
Breath sounds: bronchial over involved area
Adventitious sounds: late crackles
Tactile fremitus and transmitted voice sounds: increased TF and yes to broncho, ego, whispered pectoriloquy
Chest Disorders: Atelectasis
Defn:
Percussion:
Breath sounds:
Adventitious sounds:
Tactile fremitus and transmitted voice sounds:
Plug in bronchus obstructs air flow, affected lung tissue collapses into airless state
Percussion: dull
Breath sounds: may be absent if bronchial plug persists
Adventitious sounds: none
Tactile fremitus and transmitted voice sounds: may be absent or increased
Chest Disorders: Pleural Effusion
Defn:
Percussion:
Tracheal deviation:
Breath sounds:
Adventitious sounds:
Tactile fremitus and transmitted voice sounds:
Fluid accumulates in pleural space, blocks transmission of sound
Percussion: dull to flat over fluid
Trachea shifted toward OPPOSITE side of effusion
Breath sounds: decreased to absent
Adventitious sounds: possible pleural rub
Tactile fremitus and transmitted voice sounds: decreased to absent, may be increased on top of large effusion
Chest Disorders: Pneumothorax
Definition:
Percussion:
Tracheal deviation:
Breath sounds:
Adventitious sounds:
Tactile fremitus and transmitted voice sounds:
air leaks into pleural space, usually unilaterally. Air blocks the transmission of sound.
Percussion: hyperresonant over pleural air
Trachea: shifted toward opposite side if much air
Breath sounds: decreased to absent
Adventitious sounds: possible pleural rub
Tactile fremitus and transmitted voice sounds: decreased/absent over air
Chest Disorders: COPD
Definition:
Percussion:
Breath sounds:
Adventitious sounds:
Tactile fremitus and transmitted voice sounds:
slowly progressive disorder, distal air spaces enlarge and lungs become hyperinflated. associated w/ chronic bronchitis, emphysema, smoking.
Percussion: hyperresonant
Breath sounds: decreased to absent
Adventitious sounds: generally none, sometimes crackles, wheezes, rhonchi of associated chronic bronchitis
Tactile fremitus and transmitted voice sounds: all decreased
Chest Disorders: Asthma
Definition:
Percussion:
Breath sounds:
Adventitious sounds:
Tactile fremitus and transmitted voice sounds:
widespead, reversable narrowing of the tracheobronchial tree diminshes air flow. During attacks, air flow decreases, lungs hyperinflate
Percussion: resonant to hyperresonant
Breath sounds: obscured by wheezes
Adventitious sounds: Wheezes, possible crackles
Tactile fremitus and transmitted voice sounds: all decreased
Where do you hear vesicular sounds?
Where do you hear bronchovesicular sounds?
Where do you hear bronchial sounds?
In order of loudest to softest and high-pitched to low-pitched, put the following in order:
Bronchial
Vesicular
Bronchovesicular
Tracheal
- vesicular
- Sounds: soft & low pitched
- Bronchovesicular
- Sounds: louder than vesicular, softer than bronchial or tracial; middle pitch
- Bronchial
- Sounds: loud and high pitched
- Tracheal
- Sounds: VERY loud, high pitched
Describe if expiration > inspiration, inspiration > expiration, or if the breath sounds are = for:
tracheal
bronchial
bronchovesicular
vesicular
Which breath sound has a pause between the two?
Bronchovesicular & Tracheal: exp = insp
Bronchial: exp > insp - this one has pause
Vesicular: insp > exp
What do you suspect if you hear BV or bronchial sounds outside of where they should be?
Fluid-filled lungs or solid lung tissue.
What should you expect in a ptn w/ decreased air flow (msk weakness, obstructive lung disease) or poor transmission (COPD, pleural effusion, pneumothorax)?
decreased breath sounds
What occurs during inspiration?
●diaphragm moves down
●intercostal msks lift sternum & ribs
●accessory neck msks used if forced/heavy
What occurs during expiration?
●usually passive (autonomic)
●Accessory abdominal msks in forced expiration if help is needed to squeeze air out.
A person has been smoking 10 cigarettes a day for 20 years. How do you calculate his/her pack years?
1 pack = 20 cigs
1/2 * 20 = 10 pack years
What is bloody sputum called?
Hemoptysis
If mixed w/ night sweats & weight loss, suspect TB: ask about travel outside US and last TB screen.
What is it called when a person has difficulty breathing, so much that it awakens the person from their slumber?
Paroxysmal Nocturnal Dyspnea
What respiration pattern would you suspect in a ptn with restrictive lung disease, pleuritic chest pain, elevated diaphragm?
Rapid, shallow breathing
What respiration pattern would you suspect in a ptn w/ asthma, pneumonia, pulmonary edema, shock, metabolic alkalosis, panic/anxiety attack?
slow, shallow breathing
What respiration pattern would you suspect in a ptn with asthma, chronic bronchitis, COPD?
obstructive breathing
(prolonged expiration)
What respiration pattern would you see in a ptn who has just exercised vigorously, or someone w/ anxiety or experiencing metabolic acidosis?
In ptns w/ DKA, renail failure, breathing may be deep, labored, gasping.
Rapid deep breathing (hyperpnea, hyperventilation)
Kussmaul
What respiration pattern would you see in someone w/ respiratory depression or brain damage?
NOT regular, unpredictable
- may be shallow, deep, stop for pds
Ataxic breathing
What respiration pattern do you see in ptns w/ heart failure, uremia, drug induced respiratory depression, brain damage?
May also be normal in young children…
- pds of deep breathing alternate with apnea
Cheyne-stokes
Where do you put your hands when doing respiratory excursion? What are you measuring?
Put hands near 10th rib.
distance btw thumbs w/ expiration
Where do you see decreased tactile fremitus?
when anything obstructs transmission of vibrations (e.g., obstructed bronchus, pleural effusion, pneumothorax, or emphysema)
Where do you see increased tactile fremitus?
occurs with compression or consolidation of lung tissue (e.g., lobar pneumonia, tumor, Atelectesis, Pulmonary Fibrosis)
In percussion, which hand is the pleximeter hand? Which is the plexor hand?
Your non-dominant hand, or hand that is directly touching the ptn is called the PLEXIMETER finger. Your dominant hand, or striking hand, is called the PLEXOR finger. Aim for the DIP of your pleximeter finger, and strike w/ the TIP of your plexor finger.
What does percussion demonstrate in the lungs?
quality of air space below chest wall (air/fluid/solid)
What would you expect to hear when percussing lungs of a person w/ COPD or pneumothorax?
A mass on the lungs or a pleural effusion or lobar pneumonia?
hyperresonance
dullness
What would you hear in lungs where air flow is decreased, there is fluid or tissue obstruct air passage, or the ptn has emphysema r/t lost elasticity and hyperventilation?
faint, absent breath sounds
What kind of breath sounds would you hear if the ptn has expiratory wheezes, consolidation, or compression?
louder (abnormally) breath sounds
When would you hear louder/clearer bronchophony? (what disease processes)
over airless tissue (pleural effusions, thickening, areas of consolidation)
Where would “ee” sounds sound like “ay”? (what disease process)
pneumonia, areas of consolidation
Where would whispered words sound clearer? (what disease process)
consolidation
Your ptn has a massively hairy chest. What can you do to your stethoscope so that you can hear better?
Press harder… or wet the hair. Ew.
What are the 5 A’s when assessing the readiness to quit smoking?
- Ask about tobacco use.
- Advise to quit through clear, personalized messages.
- Assess willingness to quit.
- Assist to quit.
- Arrange follow-up and support.
Describe stridor.
What does it sound like?
When is it heard (insp/exp)?
What are some causes?
Where in the lungs do you hear this? (trachea, bronchi, bronchioles, alveoli)
- high pitched, musical - blockage in throat/voice box. Heard on inspiration mostly.
- sounds like whales mating
- some causes: croup, epiglottitis, secretions, swollen tonsils/adenoids
- trachea
Describe rhonchi.
What does it sound like?
What pitch?
Does it clear w/ a cough?
Is it intermittent or continuous?
Where in the lungs do you hear it? (trachea, bronchi, bronchioles, alveoli)
- gook/obstruction in the big airways; like snoring or clearing mucus
- Usually clears with cough; low pitch gurgling (submarine)
- Low-pitched
- CONTINUOUS
- bronchi
Describe wheezes.
What is happening to the lungs?
Is it louder than or quieter than crackles?
Is it heard on inspiration, expiration, or both?
In what disease processes do you hear wheezes?
What is the pitch?
Is it intermittent or continuous?
Where in the lungs do you hear this? (trachea, bronchi, bronchioles, alveoli)
- lungs are clamping down
- moisture or debris in larger airway;
- louder than crackles; inspiratory: Reactive Airway Disease, Asthma
- High pitched
- CONTINUOUS
- bronchioles
Describe crackles / rales.
What is it caused by?
Does it clear w/ a cough?
When would you hear it (insp/exp)?
In what disease processes would you hear crackles?
What does it sound like?
Is it intermittent or continuous?
Where in the lungs do you hear this? (trachea, bronchi, bronchioles, alveoli)
- fluid in small area
- small airway moisture; does not clear with cough;
- at end of inspiration; moist, dry, fine, and coarse: pneumonia or CHF, bronchitis
- rubbing hair between your fingers
- DISCONTINUOUS, intermittent, brief
- alveoli
Describe a pleural friction rub.
What does it sound like?
Does a cough clear it?
Is it on inspiration or expiration?
What disease process?
low grating noise in peripheral and lateral chest;
cough does not clear
noticed on inspiration/expiration
Pleurisy
