Lungs and Breasts Flashcards
What subjective data can you ask for lung assessment?
HPI, Lifestyle & Health Practices, PMH, Medications; Family Hx
Name the anterior reference lines
midclavicular line, medial line,
Which lung has 3 lobes?
right
Pt is dehydrated - what sounds might you hear when you auscultate their lungs?
sounds like a grating sounds (rubbing)
–> Pleural rub
Pt has pneumonia - pt complains of pain when breathing, what is that called?
Pleuritis
What is Dyspnea?
difficulty breathing
What is Orthopnea?
difficulty breathing when laying down
What is Paroxysmal Nocturnal Dyspnea?
while sleeping, breathing stops for a small period and you wake up gasping for air
What is Sleep apnea?
snore - sometimes have to gasp for breathe when sleeping
Pt has hx of respiratory issues & is healthy. The nurse is auscultating lung sounds and hears some adventitious breath sounds. What should the nurse tell the pt?
tell the pt to cough to see if that clears the adventitious sound
What is the order of the lung assessment?
- Inspection
- Palpation
- Percussion
- Auscultation
Inspection: What would you observe related to assessment of the lungs?
- Physical appearance: Does the pt have a barrel chest?
- Color (cyanosis?)
- Chest expansion
- Accessory muscles
- Nails (cyanosis? clubbing?)
- Behavior (is the pt irritable?)
- Respiration (rate and depth)
What is Pectus Excavatum?
Funnel chest: the chest dips in
Why are we palpating? What are we palpating for?
crepitus; pain and tenderness; edema; masses; look for symmetry in chest expansion
While palpating, you feel a crackling sensation. What could this be?
Crepitus: air trapped under the skin
What are the general techniques of
- Examine the posterior thorax and lungs while pt is sitting (same for anterior)
- Compare one side to the other side
What is tactile fremitus?
vibrations
You are assessing your pt for tactile fremitus. You place your hands on the pt’s pt and ask them say “99” - Why do you do that?
to feel for symmetry in vibrations
What would unequal fremitus mean?
fluid or air in the lungs (low)
consolidation (high)
What are you looking for during percussion of the lungs?
- Tone: sound, is it equal?
- Hyper-resonance: sounds more hollow (loud drum-like sound)
- Dullness: over solid (consolidation)
- Resonance: specific type of tone (low pitch sound over healthy tissue)
- Diaphragm excursion: measuring movement of the diaphragm
What is emphysema?
Alveoli lose their elasticity and air gets trapped
What type of sound will you hear with a pt with emphysema?
Hyper- resonance: loud drum-like sound
Which side of the body is there only Bronchial sounds?
anterior
Which side of the body is vesicular sounds?
where the lungs are
Which side of the body is bronchial vesicular sounds?
sternum area - anterior and posterior
You ask your pt to say “99” while you auscultate - What test is this?
Bronchophony
You noticed that you can hear “99” very easy during auscultation, should you be concerned?
Yes - pneumonia
You ask the pt to repeat “E” - What test is this?
Egophony
The “E” sounds like “A” - should you be concerned?
Yes - abnormal
You ask the pt to whisper “123” - What test is this?
Whisper Pectorolquoy
You hear a muffled sound when the pt is saying “123” - Should you be concerned?
No - normal
You auscultate a high pitch sound during inspiration - how would you document this sound?
stridor
What is asthma?
Inflammation causing constriction
What is the most prominent adventitious sound for asthma?
wheezing
What causes wheezing?
inflammation and bronchospasms
The pt has been admitted to ICU with TBI. Their respiration are sometimes deep, sometimes. shallow with occasional apnea - How will you document this?
Biot
Pt’s breathing is deep and rapid, followed by periods of apnea - how would you document this?
Cheyne Stokes Breathing
How would you document hyperventilation?
Kussamaul
Common variations in Older Adults
- Increased anterior posterior chest diameter
- Increase in dorsal spinal curve (kyphosis)
- Decrease thoracic expansion
- Use of accessory muscles to exhale
- Risk for fractures (osteoporosis)
- Experiencing dyspnea with aging lungs
- Decreased ability to cough (weakened muscles & increased thoracic wall rigidity –> cold could easily turn into pneumonia)
Can Kyphosis affect breathing?
yes
Kussamaul is associated with __________. (condition)
Diabetic Ketoacidosis
Where is the tail of spence?
axillary area
Why would you inspect the tail of spence?
made up of breast tissue (do not overlook); lymph nodes
What are the three types of breast tissue? What are their functions?
- Glandular: milk production
- Fibrous: provides support for glandular tissue
- Fatty: provide substance of breast and determines size and shape of breast
What are the methods of breast palpation?
- Vertical
- Circular
- Radial
What is Gynecomastia?
enlargement of the breasts in males
What is Mastitis?
breast infection - bacteria gets into the breast
Your pt has a right side mastectomy. While assessing pt’s lymph nodes, you notice the right arm circumference is larger than the left, you notes some non-pitting edema. Should you be concerned?
Yes - Lymphedema
Common Variations of Older Adults: Breast
- Decrease in size and firmness of breasts
- May have more pendulous saggy breasts
- May have smaller, flatter nipples
- Breasts may have less glandular texture
What are the symptoms of pulmonary edema?
dyspnea, pink frothy sputum, restlessness, cyanosis
What is the first rib?
it is difficult to palpate the apices of the lungs
What is Lymphadenopathy?
enlargement of a lymph node that exceeds 1cm
What is pleural rub?
sounds like walking on snow
What is Menarche?
first occurrence of menstruation
What is Plueriitis
inflammation and pain during respiration
What is a Supernumerary nipple?
an extra nipple
