lungs

Question 1

what is involved in respiratory health hx

Answer 1

acute or chronic symptoms, hx of chest pain, sob, difficulty breath on inspiration, exhalation or both, hx of asthma, smoking (pack hx), occupational exposure to toxins or fibers, hx of chronic respiratory infections in self or family (TB), hx of cardiac problems or genetic pulmonar dz in family (cystic fibrosis), coughing (productive/nonprod, color of sputum), fever, chills, weightloss (poss TB)

Question 2

what are the important landmarks of chest

Answer 2

suprasternal notch, manubrium of sternum, xyphoid process

Question 3

what are the planes of the anterior chest wall

Answer 3

midsternal line, midclavicular line, anterior axillary line)

Question 4

what is the most important plane in ant chest wall & why

Answer 4

midclavicular line, especially for CPR

Question 5

what are the tools for assessing the chest and thorax

Answer 5

chest wall diameter lateral>ant-post diameter, movement of chest with respirations, observe use of acessory muscles for breathing, skin color, mucous membrane color, inspect chest from ant/post views, pt’s desired position for breathing

Question 6

T/F It is normal for adults to use their abdomen when breathing

Answer 6

FALSE! It is only normal for neonates to use their abdomen for breathing. It is an abnormal finding to see neck muscles, intercostal muscles, and abdomen used in breathing.

Question 7

breath sounds in trachea_

Answer 7

have a different quality than breath sounds over the lungs.

Question 8

use of accessory muscles can indicate

Answer 8

COPD, or chronic asthma

Question 9

neck muscles are considered_

Answer 9

accessory muscles

Question 10

normal chest wall shape is

Answer 10

lateral diameter>ant/post diameter, this is a NORMAL finding

Question 11

barrel chest is_

Answer 11

ant/post diameter=lateral diameters, this is ONLY NORMAL in infants

Question 12

barrel chest could indicate

Answer 12

CPOD, occupational exposure (asbestos or cotton fibers), persistant bronchitis

Question 13

pectus carinatum is

Answer 13

anteriorly displaced sternum and depressed costal cartilages; not necessarily genetic mostly familial

Question 14

pectus excavatum is aka

Answer 14

funnel chest, consists of a depressed sternum, important to assess especially in infants

Question 15

scoliosis includes

Answer 15

spinal convexity to the right (while pt is bending forward), ribs widely separated on rt side, ribs close together on lt side, if detected early braces can be used to correct curvature

Question 16

what is flail chest

Answer 16

abnormal finding, typically caused by acute trauma, chest wall gets sucked in upon inpiration and pushed back out during exhalation, needs to be addressed immediately and can be corrected c surgical intervention

Question 17

what are the tools in assessing the respiratory system

Answer 17

palpation and percussion

Question 18

what is percussion

Answer 18

examination technique that helps the examiner determine if underlying tissues are fluid filled, air-filled, or solid, done by placing middle finger in intercostal space and striking the finger with the opposite hand

Question 19

percussion is used to assess_

Answer 19

pneumonia

Question 20

what are the notes associated with percussion

Answer 20

flat, dull, resonant, hyper-resonant, tympanitic

Question 21

T/F A hyper-resonant note is normal in percussion

Answer 21

FALSE! This is an ABNORMAL finding and is associated with COPD or severe asthma, makes more of a ringing sound

Question 22

a resonant note in percussion is

Answer 22

a NORMAL finding and is more of a vibration

Question 23

a flat percussion note is associated with_

Answer 23

bone

Question 24

a dull percussion note is associated with_

Answer 24

abnormal lung tissue

Question 25

a tympanic note is associated when_

Answer 25

percussing the abdomen

Question 26

percussion is always

Answer 26

from side to side (1:1, 2:2, 3:3, etc) and sounds should be compared

Question 27

ascultation is used to assess the_

Answer 27

chest and throax; is the most inportant examination technique for assessing air flow through the tracheobronchial tree

Question 28

auscultation involves_

Answer 28

listening to the sounds generated by breathing, listening for adventitious sounds, and abnormalities in sounds of the pt’s spoken or whispered voice

Question 29

ant/post ascultation is always

Answer 29

side to side and should be compared

Question 30

special considerations for ascultation include

Answer 30

women, pregnant women(not going to get a good assess in lower lobes b/c they have become displaced by growth of fetus), neonates(should be able to hear in all lobes of lungs & places of assess), infants(make sure to ascultate FIRST! Have parent hold child, or allow them to play with steth, frail elderly/immobile pts(have them move to side with use of pillow)

Question 31

T/F You don’t need to ascultate immobile pts of any age

Answer 31

FALSE! You always want to listen to the lungs even if pt is on a ventilator; pts who are immobile are at increased risk of pneumonia no matter what their age is; pts on ventilators can also contract ventilator-associated pneumonia

Question 32

what is chain stokes

Answer 32

an abnormal respiratory pattern; normal in neonates ONLY!

Question 33

adventitious or abnormal sounds are_

Answer 33

crackles, wheezes, rhonchi, stridor, pleural rubs

Question 34

crackles are_

Answer 34

air bubbles flowing through secretions or snapping open of airways closed by secretions; caused by asthma, acute upper respiratory infection, chronic bronchitis

Question 35

wheezes are_

Answer 35

air flow through narrowed airways; heard in pts with asthma, COPD or acute URI

Question 36

rhonchi are_

Answer 36

lower pitched than wheezes and are secretions in larger airways; they are common in different types of respiratory infections

Question 37

stridor is_

Answer 37

wheezing on inspiration only; is an emergent situation

Question 38

pleural rubs are_

Answer 38

rubbing or creaking sounds usually on expiration from inflammed pleura rubbing together