Module 5 Flashcards
listening to sounds from the heart, lungs, and other organs
auscultation
tapping the person’s skin with short sharp strokes to assess underlying structures
percussion
percussion notes
mediate/indirect
tenderness
immediate/direct
loudest, drum like
gastric bubble
tympany
boom like
emphysematous lungs
hyperresonance
hollow
normal lungs
resonance
thud like
organs
dull
quietest, dull
muscles and bones
flat
what are the functions of respiratory
ventilation, diffusion and perfusion, and control of breathing
movement of air into or out of the lungs
ventilation
gas exchange across alveolar-pulmonary membrane
diffusion and perfusion
stimulus for breathing (increased CO2)
neural and chemical factors
control of breathing
slow shallow breathing
CO2 build up in blood
acidosis
hypoventilation
rapid deep breathing
CO2 is blown off
alkalosis
hyperventilation
Primary muscles of respiration
Diaphragm – divides chest from abdomen
External intercostal muscles
Accessory muscles
what is the function of the upper airway
Conduct air to lower airway
Filter to protect lower airway
Warm and humidify inspired air
what are the parts of the upper airway
Nose, pharynx, larynx, intrathoracic trachea
what is the function of the lower airway
Conduct air to alveoli
Clear mucociliary structures
what are the parts of the lower airway
Trachea, bronchi, bronchioles
what is the function of alveoli
Gas exchange
Production of surfactant
what is asked in past health history during respiratory
Lung disease or breathing problems Frequent severe colds, asthma, emphysema, bronchitis, pneumonia, tuberculosis Last PPD and/or chest x-ray Allergies Medication use
what is checked during general inspection
Appearance
Posturing
Breathing effort
Trachea position
what should the anterior posterior diameter be
½ the transverse diameter
what should the costal angle be
90 degrees or less
where do you check for oxygenation/cyanosis
Nails
Skin
Lips
what do you palpate the trachea for
for position
what do you palpate the chest wall for
for symmetry
how do you check for thoracic expansion
Place both thumbs at about 7th rib posteriorly along the spinal process
Normal will be bilateral, symmetric expansion
how do you check for tactile/vocal fremitus
Systematically position hands over both sides of posterior chest
Have person repeat “1 – 2 – 3” or “99” as you move from the apices to the bases
Normal: bilaterally symmetrical vibrations
how should you auscultate
systematic manner
Compare one side to the other
Listen one full respiration at each spot
where should you place your stethoscope
on BARE skin
what sound is high, loud, blowing/hollow, I
bronchial
what sound is moderate pitch and intensity, I=E, and located between scapulae
bronchiovesicular
what sound is low, soft, gentle/breezy, I>E, and located in peripheral lungs
vesicular
Soft (fine)/ High and Loud (coarse)/ Low pitch, inspiration, possibly cough, and Discontinuous, nonmusical, brief quality
crackles
high pitch, expiration, Continuous musical sounds,
possibly cough
wheeze
low pitch, expiration, Continuous snoring sounds, possibly cough
rhonchi
Continuous or discontinuous creaking or brushing sounds
never cough
pleural friction rub
Continuous, crowing
never cough
stridor
what are developmental variations in neonates
Obligate nose breathers
Periodic breathing is common
what are signs of compromise in neonates
Stridor (“crowing”)
Grunting
Central cyanosis
Flaring nares
developmental variations in infants and young kids
Roundness of the chest persist for first 2 years
Chest walls are thinner than the adult’s
Breath sounds may sound louder, and more bronchial than the adult
variation in pregnancy
Costal angle increases to about 105 degrees in the third trimester
Dyspnea and orthopnea are common
Breathes more deeply
variation in older adult
Chest expansion is often decreased
Bony prominences are marked
AP diameter is increased with respect to transverse (but not 1:1)
