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Assessments & Fundamentals II > Lungs/Thorax > Flashcards

Lungs/Thorax Flashcards

1
Q

Hemopytysis

A

Coughing up blood

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2
Q

Orthopnea

A

Difficulty breathing when supine. State number of pillows needed to achieve comfort.

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3
Q

Paroxysmal nocturnal dyspnea

A

Awakening from sleep with SOB and needing to be upright to achieve comfort

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4
Q

Coughing continuously throughout day

A

Acute illness

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5
Q

Cough in the afternoon/evening

A

Exposure to irritants at work

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6
Q

Coughing at night

A

Post nasal drip; sinusitis

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7
Q

Early morning cough

A

Chronic bronchial inflammation of smokers

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8
Q

White or clear mucoid

A

Colds, bronchitis, viral infections

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9
Q

Yellow or green mucous

A

Bacterial infection

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10
Q

Rust colored mucous

A

TB, pneumococcal pneumonia

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11
Q

Pink, frothy mucous

A

Pulmonary edema, some sympathomimetric medications have a side effect of pink-tinged mucous

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12
Q

Decreased fremitus

A

Occurs when obstructed bronchitis, pleural effusion or thickening, pneumothorax, or emphysema. Any barrier that comes between the sound and your hand decreases fremitus.

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13
Q

Increased fremitis

A

Occurs with compression or consolidation of lung tissue. This is present only when the bronchus is patent and the consolidation extends to the lung surface.

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14
Q

Rhoncal fremitis

A

Palpable with thick bronchial secretions

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15
Q

Pleural friction fremitis

A

Palpable with inflammation of the pleura

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16
Q

Crepitis

A

A coarse, cracking sensation palpable over the skin surface. It occurs in subcutaneous emphysema when air escapes from the lung and enters the subcutaneous tissue, as after open thoracic injury or surgery.

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17
Q

Hyperossance

A

Lower-pitched, booming sound found when too much air is present such as in emphysema or pneumothorax.

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18
Q

Dull note

A

Soft, muffled thud) signals abnormal density in the lungs, as with pneumonia, pleural effusion, atelectasis, or tumor

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19
Q

Barrel chest

A

Horizontal ribs and costal angle > 90 degrees

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20
Q

When does hypertrophy of abdominal muscles occur?

A

Chronic emphysema

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21
Q

Tense, strained, tired facies and purses lips while breathing

A

COPD

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22
Q

Excessive drowsiness or anxiety, restlessness, irritability

A

Cerebral hypoxia

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23
Q

Clubbing of distal phalanx occurs with __________ because of growth of vascular connective tissue.

A

COPD

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24
Q

Noisy breathing

A

Severe asthma or chronic bronchitis

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25
Q

Unequal chest expansion

A

Pneumonia or pleurisy pain

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26
Q

Retraction of interspaces

A

Suggests obstruction of respiratory tract or atelectasis

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27
Q

Bulging of interspaces

A

Indicates trapped air as in the forced expiration associated with emphysema or asthma

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28
Q

Accessory muscles used to breath

A

Acute airway obstruction and massive atelectasis

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29
Q

Recite abdominis and internal intercostal muscles used for expiration

A

COPD

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30
Q

Abnormally wide costal angle with little inspiration variation

A

Emphysema

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31
Q

Lag in expansion

A

Atelectasis, pneumonia, and postoperative guarding

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32
Q

Palpable grating sensation with breathing

A

Pleural friction fremitus

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33
Q

inability to breathe, sharp pain on left side of chest. Cyanosis, tachypnea, tracheal deviation, to the right, decreased tactile fremitus on the left, hyperressonance on the left.

A

pneumothorax

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34
Q

70 y/o patient is being seen in the clinic for severe exacerbation of his heart failure. Which of these findings is the nurse most likely to observe?

A

A. shortness of breath, orthopnea, paroxysmal nocturnal dyspna, and ankle edema

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35
Q

The nurse is percussing over the lungs of a patient with pneumonia. The nurse knows percussion over an area with atelectasis the lungs will reveal;

A

dullness

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36
Q

____________ is a bony structure with a conical shape, which is narrower at the top

A

thoracic cage

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37
Q

___ pairs of ribs, and __ thoracic vertebrae

A

12, 12,

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38
Q

How many cervical, thoracic, and lumbar?

A

7, 12, 5, then sacrum, then coccyx

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39
Q

What is the breastbone?

A

Sternum

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40
Q

Angle of Louis

A

Manubriosternal angle, is at articulation of manubrium and sternum, and continuous with second rib

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41
Q

You can easily palpate down to the _______ rib

A

10th

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42
Q

Each intercostal space is numbered by ____________________.

A

The rib above it

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43
Q

Angle of Louis also marks site of tracheal ________ into right and left main bronchi;

A

bifurcation

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44
Q

Costal angle: the right and left costal margins form an angle where they meet at _________ process.

A

xiphoid process

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45
Q

Usually _____ degrees or less, this angle increases when rib cage is chronically overinflated, as in emphysema.

A

90

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46
Q

This is spinous process of C__; if two bumps seem equally prominent, upper one is C7 and lower one is T___.

A

C7, T1

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47
Q

What causes emphysema?

A

Lost elasticity in the alveoli. Impaired gas exchange.

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48
Q

Middle of the chest

A

-midclavicular line (is it on the left or right)

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49
Q

Manubriosternal angle (angle of Louis)

A

2nd intercostal space

-site of bifurcation of the trachea

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50
Q

What classification of tissue is the diaphragm? Voluntary or involuntary?

A
  • muscle

- both voluntary and involuntary

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51
Q

How many intercostal spaces do we have?

A

11

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52
Q

Where is the PMI (point of maximal impulse)?

A

Lt
5th ICS
MCL

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53
Q

The higher the injury to the spinal cord the ___________

A

greater the risk for paralysis

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54
Q

What is the medical term for the shoulder blade?

A

scapula

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55
Q

Are processes depressions or projections?

A

projections

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56
Q

On anterior chest, note _______________ line and midclavicular line.

A

midsternal

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57
Q

Posterior chest wall has _______ (or midspinal) line and scapular line, which extends through inferior angle of scapula when arms are at sides of body.

A

vertebral

58
Q

What is the anatomical landmark for the anterior axillary line

A

the axilla

59
Q

Mediastinum: _______section of thoracic cavity containing esophagus, trachea, heart, and great vessels

A

middle

60
Q

Base rests on ________ at about sixth rib in midclavicular line.

A

the diaphragm

61
Q

Posteriorly, the location of ___ marks apex of lung tissue, and ___ usually corresponds to base.

A

C7, T10

62
Q

Lobes of the lung

A
  • Lungs are paired but not precisely symmetric structures.
  • Right lung shorter than left because of underlying liver
  • Left lung narrower than right because heart bulges to left.
  • Right lung has three lobes, and left lung has two lobes.
63
Q

Expiratory wheezes are found mostly where?

A

RUL and LUL

64
Q

posterior chest is almost all _________ lobe.

A

lower

65
Q

_________ lobe does not project onto posterior chest at all.

A

right middle lobe

66
Q

Left lung only ____ lobes, upper and lower.

A

2

67
Q

Visceral pleura lines ________ of lungs.

A

outside

68
Q

It is continuous with _________ pleura lining inside of chest wall and diaphragm.

A

parietal

69
Q

Pleural cavity normally has a vacuum, or ________ pressure,

A

negative

70
Q

This is a potential space; when it abnormally fills with air or ____, it compromises lung expansion.

A

fluid

71
Q

__________bronchus is shorter, wider, and more vertical than the left main bronchus.

A

right main

72
Q

Bronchi are lined with ______ cells, which secrete mucus that entraps particles; bronchi are lined with cilia, which sweep particles upward where they can be swallowed or expelled.

A

goblet

73
Q

_______ is a functional respiratory unit that consists of bronchioles, alveolar ducts, alveolar sacs, and the alveoli.

A

Acinus (parallel to kidney’s nephron)

74
Q

_______ are clustered like grapes around each alveolar duct.

A

Alveioli

75
Q

______________ (slow, shallow breathing) causes carbon dioxide to build up in blood, and _____________ (rapid, deep breathing) causes carbon dioxide to be blown off.

A

hypoventilation, hyperventilation

76
Q

Four major functions of the respiratory system

A
  1. supply oxygen to the body
  2. removing carbon dioxide as a waste product
  3. maintaining homeostasis (acid-base balance) of arterial blood
  4. Maintaining heat exchange
77
Q

Normal stimulus to breathe for most of us is an increase of carbon dioxide in blood, or _____________.

A

hypercapnia

78
Q

Normal value for pH

A

7.35-7.45

79
Q

Normal value for HCO3

A

2.2-2.6

80
Q

Normal value for PCO2

A

35-45

81
Q

Normal percent Oxygen

A

98-100%

82
Q

Normal stimulus to breathe for most of us is an increase of carbon dioxide in blood, or _____________.

A

hypercapnia

83
Q

Decrease of oxygen in blood (____________) also increases respirations but is less effective .

A

hypoxemia

84
Q

During the first ______ week s of fetal life, primative lung bud emerges

A

5

85
Q

When does an infant’s respiratory system function?

A

all body systems develop in utero, but the respiratory system alone does not function until birth

86
Q

What conditions are associated with environmental tobacco smoke

A
  • sudden infant death syndrome

- negative behavioral and cognitive functioning, and increased rates of adolescent smoking

87
Q

How much does the uterus elevate the diaphragm during pregnancy

A

4cm

88
Q

Although the diahrpagm is elevated, it is not _________

A

fixed

  • It moves with breathing even more during pregnancy, which results in an increase in tidal volume
  • growing fetus increases oxygen demand on mother’s body
89
Q

Aging lung is more ______ structure that is, harder to inflate.

A

rigid

90
Q

With aging, less surface area is available for ___ exchange.

A

gas

91
Q

signs and symptoms of active TB incldue

A

coughing that lasts three or more weeks
coughing up blood
chest pain, pain with breathing or coughing

92
Q

signs and symptoms of active TB incldue

A

coughing that lasts three or more weeks
coughing up blood
chest pain, pain with breathing or coughing

93
Q

Prevalence of asthma in the US in 2011 was ___

A

8.4%

94
Q

What is the most common chronic disease in childhood?

A

asthma

95
Q

Who experiences the most asthma-related problems?

A

-blacks, hispanics, and american indians more so than Whites or Asians

96
Q

Questions to ask when patient has shortness of breath

A

What brings it on? How severe is it? How long does it last?
Is it affected by position, such as lying down?
Occur at any specific time of day or night?
Shortness of breath episodes associated with night sweats?
Or cough, chest pain, or bluish color around lips or nails? Wheezing sound?Do episodes seem to be related to food, pollen, dust, animals, season, or emotion?
What do you do in a hard-breathing attack? Take a special position, or use pursed-lip breathing? Do you use any oxygen, inhalers, or medications?
How does the shortness of breath affect your work or home activities? Is it getting better or worse or staying about the same?

97
Q

Additional History for Aging Adult

A

Tell me about your usual amount of physical activity.
(For those with a history of chronic obstructive pulmonary disease, lung cancer, or tuberculosis): How are you getting along each day? Any weight change in last 3 months? How much?
How is your energy level? Do you tire more easily? How does your illness affect you at home and at work?
Do you have any chest pain with breathing?
Do you have any chest pain after a bout of coughing or after a fall?

98
Q

______________ diameter should be less than transverse diameter.

A

Anteroposterior

99
Q

Instruct person to breathe through ______, a little bit deeper than usual.

A

mouth

100
Q

Use flat ________ endpiece of stethoscope and hold it firmly on person’s chest wall; listen to at least one full respiration in each location.

A

diaphragm

101
Q

Side-to-side ____________ is most important.

A

comparison

102
Q

Normal ratio of AP (anterior posterior) to transverse for adult

A

transverse side is greater than twice of the AP (anterior posterior) 1:2

103
Q

Normal ratio of AP (anterior posterior) to transverse for child

A

more round abdomen - about 1:1

104
Q

If a patient is stabbed, should you remove the object?

A

No

105
Q

When does blood pool in the posterior side?

A

-If dead because gravity

106
Q

Fremitis is a ______ vibration

A

palable

107
Q

Why do you ask the patient to say 99 or blue moon when assessing for tactile fremitis?

A

It will illicit vibrations; CHECK for symmetry

108
Q

Which condition increases vibrations

A

the most solid consolidation/thickness, the more vibrations (ex pneumonia)

109
Q

How to assess tactile fremitis

A

start over lung apices and palpate from one side to the other

110
Q

Factors that affect the normal intensity of tactile fremitis

A
  • relative location of the bronchi to the chest wall
  • decreases as you progress down because more and more tissue impedes
  • using fingers, gently palpate the entire chest wall
  • enables noting any areas of tenderness, skin temperature and moisture, detecting any superficial lumps or masses, and exploring any skin lesions noted on inspection
111
Q

a lot of sound upon percussion

A

hyperresonance

112
Q

What sound should you hear in abdomen

A

tympany

113
Q

What shound should you hear in the lungs

A

resonance

114
Q

What sound should you hear in the liver

A

dullness

115
Q

What sound should you hear in the bone

A

flat

116
Q

What covers the lungs?

A

visceral pleura

117
Q

What is the wall the cages the lungs

A

parietal pleura

118
Q

Fluid around lungs

A

pleural fluid

119
Q

Diaphragmatic Excursion

A
  1. First, ask the person to “exhale and hold it” briefly while you percuss down scapular line until sound changes from resonant to dull on each side.
  2. This estimates level of diaphragm separating lungs from abdominal viscera; it may be somewhat higher on right side because of presence of liver.
  3. Mark the spot.
120
Q

Where do you assess for symmetry on the back during breathing?

A

On the 9th or 10th spinal process

121
Q

When assessing breath sounds, ask the patient to breath through the ______, a little bit deeper than usual

A

mouth

122
Q

Going from superior to inferior, what breath sounds will you hear?

A
  • bronchial sounds
  • bronchovesicular sounds
  • vesicular sounds
123
Q

Is there bronchial sound in the posterior thorax?

A

No

124
Q

Use flat ________ endpiece of stethoscope and hold it firmly on person’s chest wall; listen to at least one full respiration in each location

A

diaphragm

125
Q

The nurse knows that the proper technique for assessing lungs in an adult patient is auscultation is performed __________________.

A

In a Z pattern

126
Q

What are adventitious breath sounds?

A

Added sounds that are not normally heard in the lungs

127
Q

What is the term for crackles?

A

rales

128
Q

What is the term for wheezing?

A

rhonchi

129
Q

What are voice sounds? How do you assess?

A
  1. broncophany
  2. Egonphany
  3. Whispered pecteriliery
130
Q
  1. broncophany
A

Ask patient to say 99. Normally what you hear is muffled. If you can hear clearly, that is an area that is abnormal, suspicion of adventitious breath sound.

131
Q
  1. egonphany
A

If you hear “a” when patient says “e” then abnormal

132
Q
  1. Whispered pecteriloly
A

If you can hear the whisper clearly, then that is abnormal

133
Q

TB is ___________ bacteria. Where does the TB bacteria want to be in the lungs?

A

aerobic; apex of lungs

134
Q

Assess tactile (_____) fremitus

A

vocal

135
Q

Normal respiration rate for infatns

A

25 to 40 breaths per minutes, count for 1 full minute

136
Q

Why is sound more amplified in infants?

A

Their skin is very thin

137
Q

Kyphosis

A

hunchback

138
Q

The nurse is assessing a patient with tactile fremitis the nurse suspects the patient has

A
  1. a mild case of pneumonia
139
Q

Prenatal exposure to smoke causes __________

A

chronic hypoxia

140
Q

Prenatal and postnasal exposure to secondhand tobacco smoke increases risk for ___________

A

sudden infant death syndrome, lower respiratory illnesses, acute and chronic otitis media, breathlessness, asthma, and adverse lung function throughout childhood

141
Q

prenatal exposure to nicotine increases risk for ________________

A

ADHD and depression in children and adolescents

Assessments & Fundamentals II (5 decks)

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