Module 5 Flashcards
How long and how wide is the trachea
10-11 cm; 2 cm in diamter
Trachea divides into right and left main stem at the level of _____________
T4 and T5
Other name for the manubriosternal joint
Sternal angle or angle of louis
Arteries that branch from the anterior thoracic aorta and the intercostal arteries
bronchial arteries
The bronchial vein is formed at the __________ of the lung, but most of the blood supplied by the bronchial arteries is returned by the ____________ veins
hilum; pulmonary
A visible and palpable angulation of the sternum and the point at which the second rib articulates with the sternum
The manubriosternal junction (angle of Louis)
A depression, easily palpable and most often visible at the base of the ventral aspect of the neck, just superior to the manubriosternal junction
The Suprasternal notch
The angle formed by the costal margins at the sternum. It is usually no more than 90 degrees, with the ribs inserted at approximately 45-degree angles
Costal angle
Name for the spinous process of C7. It can be more readily seen and felt with the patient’s head bent forward.
Vertebra prominens
When inspecting the chest of an infant: note that the anteroposterior diameter is approximately __________ as the lateral diameter.
The same
The number of alveoli increases at a rapid rate in the first ____ years of life. This slows down by age ____ years.
2: 8
When does an infants lungs fill with air for the first time
During the infants initial gasp and cry
Most often leads to closure of the heart’s foramen ovale within minutes after birth, and the increased oxygen tension in the arterial blood usually stimulates contraction and closure of the ductus arteriosus
Cutting the umbilical cord
The chest of the newborn is generally what shape
Round
The failure for the foremen ovales and ductus arteriosus to close is more common in
Premature infants born before 30 weeks
can lead to left ventricular overload and heart failure in a newborn
Patent ductus arteriosus
The costal angle progressively increases from about 68.5 degrees to approximately _______ degrees in later months of pregnancy
103.5
In pregnancy, the diaphragm at rest rises as much as _____ cm above its usual resting position
4
What usually increases in pregnancy: minute volume or respiratory rate
Minute ventilation due to increase tidal volume
_________ in an older adult is often caused by loss of muscle strength in the thorax and diaphragm, coupled with loss of lung resiliency
Barrel chest
Moist or productive cough, accompanied by fever, may be caused by
infection
A regular, paroxysmal cough that produces an inspiration whoop, is heard in
Pertussis
Commonly observed with pulmonary or cardiac compromise
Dyspnea
shortness of breath that begins or increases when the patient lies down; ask whether the patient needs to sleep on more than one pillow and whether that helps
Orthopnea
a sudden onset of shortness of breath after a period of sleep; sitting upright is helpful
Paroxysmal nocturnal dyspnea
dyspnea increases in the upright posture
Platypnea
can cause tachycardia, hypertension, coronary arterial spasm (with infarction), and pneumothorax (lung collapse), with severe acute chest pain being the common result
Cocaine use
T or F: the AP diameter of the chest is generally > the lateral diameter
F: it is less than
results from compromised respiration as in, for example, chronic asthma, emphysema, or cystic fibrosis.
Barrel chest
Location: vertically down the midline of the sternum
Midsternal line
Location: parallel to the midsternal line, beginning at midclavicle; the
inferior borders of the lungs generally cross the sixth rib at the midclavicular line
Right and left midclavicular lines
Location: parallel to the midsternal line, beginning at the anterior axillary fold
Right and left anterior axillary lines
Location: parallel to the midsternal line, beginning at the midaxilla
Right and left midaxillary lines
Location: parallel to the midsternal line, beginning at the posterior axillary folds
Right and left posterior axillarty lines
Location: vertically down the spinal process
Vertebral line
Location: parallel to the vertebral line, through the inferior angle of the scapula when the patient is erect
Right and left scapular lines
The spine may be deviated either posteriorly (_called:________) or laterally (called: _________)
kyphosis; scoliosis
a prominent sternal protrusion
Pigeon Chest or pectus carinatum
an indentation of the lower sternum above the xiphoid process
Funnel chest (pectus excavatum)
The sequence of steps in examination of the chest and lungs is:
- Inspection
- Palpation
- Percussion
- Auscultation
In a pleural effusion and Lobar pneumonia, the percussion sound is
Dullness
In pleural effusions, breath sounds are
Absent
In lobar pneumonia, breath sounds are
Bronchial
On palpation, tactile fremitus is __________ in a pleural effusion while it is ____________with lobar pneumonia
Absent; increased
Normal RR for adults
12-16 breath per minute
Ratio of RR to HR is
1:4
is a persistent respiratory rate above 16 respirations per minute in an adult
Tachypnea
________________, a rate slower than 12 respirations per minute, may indicate neurologic or electrolyte disturbance, infection, or a conscious response to protect against the pain of pleurisy or other irritative phenomena.
Bradypnea
Word for breathing deeply
Hyperpnea
always deep and most often rapid, is the eponym applied to the respiratory effort associated with metabolic acidosis
Kussmaul breathing
refers to abnormally shallow respirations
Hypopnea
A regular periodic pattern of breathing with intervals of apnea followed by a crescendo/decresendo sequence of respiration
Cheyne stokes
is the result of a prolonged but inefficient expiratory effort; can also result from increased resistance (i.e., chronic bronchitis), decreased elastic recoil of the lung (i.e., emphysema) or a drop in the critical closing pressure of the airway (i.e., asthma)
Air trapping
consists of irregular respirations varying in depth and interrupted by intervals of apnea but lacking the repetitive pattern of periodic respiration
Biot or ataxic respiration
usually is associated with severe and persistent increased intracranial pressure, respiratory compromise resulting from drug poisoning, or brain damage at the level of the medulla and generally indicates a poor prognosis
Biot respiration
Common contributors include seizures, central nervous system trauma or hypoperfusion, a variety of infections of the respiratory passageway, drug ingestions, and obstructive sleep disorders
Apnea
A self-limited condition, and not uncommon after a blow to the head. It is especially noted immediately after the birth of a newborn, who will breathe spontaneously when sufficient carbon dioxide accumulates in the circulation
Primary apnea
Breathing stops and will not begin spontaneously unless resuscitative measures are immediately instituted. Any event that severely limits the absorption of oxygen into the bloodstream will lead to secondary apnea.
Secondary apnea
When irritating and nausea-provoking vapors or gases are inhaled, there can be an involuntary, temporary halt to respiration.
Reflex apnea
characterized by periods of an absence of breathing and oxygenation during sleep. Due to blockage of the airway when the soft tissue in the back of the throat collapses during sleep, airflow is not maintained through the nose and mouth.
Sleep apnea
Characterized by a long inspiration and what amounts to expiration apnea. The neural center for control is in the breathing pons and medulla. When it is affected, breathing can become gasping because inspirations are prolonged and expiration constrained
Apneustic breathing
A normal condition characterized by an irregular pattern of rapid breathing interspersed with brief periods of apnea that one usually associated with rapid eye movement sleep
Periodic apnea of the newborn
Inspiratory stridor (with an I/E ratio of more than 2:1); A hoarse cough or cry; Flaring of the alae nasi; Retraction at the suprasternal notch
All may indicate
Upper airway obstruction
Stridor is inspiratory and expiratory; Cough has a barking character; Retractions also involve the subcostal and intercostal spaces; Cyanosis is obvious even with supplemental oxygen
May indicate
Severe upper airway obstruction
Stridor tends to be quieter; The voice is muffled; Swallowing is more difficult; cough is not a factor; The head and neck may be awkwardly positioned to preserve the airway (e.g., extended with retropharyngeal abscess; head to the affected side with peritonsillar abscess
May indicate what type of obstruction
Above the glottis
Stridor tends to be louder, more rasping; The voice is hoarse; Swallowing is not affected; Cough is harsh, barking; Positioning of the head is not a factor
May indicate what type of obstruction
Below the glottis
causes unilateral retractions, but they are not seen in the suprasternal notch
Foreign body in the bronchus
Retraction of the lower chest occurs with
asthma and bronchiolitis
Flaring of the alae nasi during inspiration is a sign of
air hunger
T or F: Crepitus always results from an underlying pathological process
T
A palpable, coarse, grating vibration, usually on inspiration, suggests a
Pleural friction rub
Where is fremitus best felt
Posteriorly and laterally at the level of the bifurcation of the bronchi
T or F: the scapulae may obscure fremitus
T
dullness to percussion and decreased tactile fremitus are the most useful findings for
Pleural effusion
Hyperresonance associated with hyperinflation may indicate
emphysema, pneumothorax, or asthma
Dullness or flatness on percussion suggests
pneumonia, atelectasis, pleural effusion, or asthma
the movement of the thoracic diaphragm that occurs with inhalation and exhalation
Diaphragmatic excursion
Why is the diaphragm usually higher on the right than the left
Sits over the liver
___________ breath sounds are low-pitched, low-intensity sounds heard over healthy lung tissue
Vesicular
_________________ sounds are heard over the major bronchi and are typically moderate in pitch and intensity.
Bronchovesicular
The sounds highest in pitch and intensity are the __________ breath sounds, which are ordinarily heard only over the trachea
Bronchial
T or F: Both bronchovesicular and bronchial breath sounds are normal if they are heard over the peripheral lung tissue.
F: they are abnormal
sounding as if coming from a cavern, is commonly heard over a pulmonary cavity in which the wall is rigid
Cavernous breathing
T or F: Breath sounds are easier to hear when the lungs are consolidated
T
Are crackles continuous or discontinuous
Discontinuous
Are ronchi and wheezes continuous or discontinuous
Continuous
Is an abnormal respiratory sound heard more often during inspiration and characterized by discrete discontinuous sounds, each lasting just a few milliseconds
Crackles
may be fine, high-pitched, and relatively short in duration or coarse, low-pitched, and relatively longer in duration. They are caused by the disruptive passage of air through the small airways in the respiratory tree
Crackles
High-pitched crackles are described as_____________; the more low-pitched crackles are termed _____________
sibilant; sonorous
are deeper, more rumbling, more pronounced during expiration, more likely to be prolonged and continuous, and less discrete than crackles.
Rhonchi
They are caused by the passage of air through an airway obstructed by thick secretions, muscular spasm, tumor, or external pressure
Rhonchi
High-pitched, discrete, discontinuous crackling sounds heard during the end of inspiration; not cleared by a cough
Fine crackles
lower, more moist sound heard during the midstage of inspiration; not cleared by a cough
Medium crackles
loud, bubbly noise heard during inspiration; not cleared by a cough
Coarse crackles
loud, low, coarse sounds like a snore most often heard continuously during inspiration or expiration; coughing may clear sound (usually means mucus accumulation in trachea or large bronchi)
Rhonchi (sonorous wheezes)
musical noise most often heard continuously during inspiration or expiration; usually louder during expiration
Wheeze (Sibilant wheeze)
dry, rubbing, or grating sound, usually caused by inflammation of pleural surfaces; heard during inspiration or expiration; loudest over lower lateral anterior surface
Pleural friction rub
Do rhonchi or crackles tend to disappear with coughing
Rhonchi
If a wheeze is heard bilaterally, it may be caused by
bronchospasm of asthma (reactive airway disease) or acute or chronic bronchitis.
Adventitious breath sound that occurs outside the respiratory tree
Friction rub
How to tell if a rub is respiratory or cardiac related
Ask pt to hold breath; if sound stops while breath is health it is not respiratory related
is found with mediastinal emphysema
Mediastinal crunch (Hamman sign)
Greater clarity and increased loudness of spoken sounds are defined as
bronchophony
When the intensity of the spoken voice is increased and there is a nasal quality (e.g., “e” becomes a stuffy, broad “a”), the auditory quality is called
Egophany
Normal RR of infant
40-60 up to 80
Do C section or vaginally delivered babies tend to have higher RR at birth
C section
Highest score on a APGAR scoring system
10
In which age group is paradoxical breathing normal
Newborn/infant
Why are crackle and rhonchi normal after birth in newborn
Fetal fluid has not yet been completely cleared
What should you expect if gastrointestinal gurgling sound is persistently heard in the chest of a newborn in respiratory distress
Diaphragmatic hernia
T or F: hyperresonance is common in the young child.
T
How does a parturiant typically change respiration to achieve optimum o2 intake
Breath deeper (higher TV)
Small airway obstruction due to inflammation within the airways; Acute episodes triggered by allergens, anxiety, cold air, exercise, upper respiratory infections, cigarette smoke, or other allergens
Asthma
Incomplete expansion of the lung at birth or the collapse of the lung at any age
Atelectasis
Inflammation of the bronchial tubes leads to increased mucus secretions; Acutely due to a viral infection, whereas chronic is usually due to irritant exposure, most commonly smoking.
Bronchitis
Respiratory failure with low blood oxygen levels resulting from the inhalation of aerosols (vapors) produced from heating solutions containing nicotine or other substances
E-Cigarette or Vaping-Associated Acute Lung Injury
Inflammatory process involving the visceral and parietal pleura; often the result of PE, infection, or connective tissue disease; sometimes associated with asbestos or neoplasms
Pleurisy
Excessive nonpurulent fluid in the pleural space; Sources of fluid vary and include infection, heart failure, renal insufficiency, connective tissue disease, neoplasm, and trauma.
Pleural Effusion
