Nose Sinuses, Thorax And Lungs Flashcards
Bronchophony
Auscultate posterior chest. 99 should be soft and muffled, if loud and clear, consider lung consolidation.
Egophony
Evaluates intensity of spoken voice. Have pt. say eee, should hear soft, muffled eee, if aaa heard, consider lung consolidation
Whispered Pectoriloquy
Performed when a +) bronchophony is auscultated. Have pt. whisper 1,2,3. Sound should be faint and muffled. Clear with lung consolidation.
Normal breathing
The respiratory rate is about 14-20 per min in normal adults and up to 44 per min in infants.
Slow Breathing (Bradypnea)
Slow breathing may be secondary to diabetic coma, drop-induced respiratory depression, and increased intracranial pressure.
Sighing Respiration
Breathing punctuated by frequent sighs should alert you to the possibility of hyperventilation syndrome-a common cause of dysprea and dizziness. Occasional sighs are normal.
Rapid Shallow Breathing (Tachypnea)
Rapid shallow breathing has a number of causes, including restrictive lung discase, pluritic chest pain, and an elevated diaphragm.
Cheyne-Stokes Breathing
Periods of deep breathing alternate with periods of apnea (no breathing). Chidren and aging people normally may show this pattern in sleep. Other causes include heart failure, uremia, drug induced respiratory depression, and brain damage (typically on both sides of the cerebral hemispheres or diencephalon).
Obstructive Breathing
In obstructive lung disease, expiration is
prolonged because narrowed airways increase the resistance to air flow. Causes include asthana, chronse bronchstis, and COPD.
Rapid Deep Breathing (Hyperpnea, Hyperventilation)
Rapid deep breathing has several causes, induding exercise, anxicty, and metabolic acidosis. In the comatose patient, consider infarction, hypoxia, or hypoglycemia affecting the midbrain ce pons. Kussmaul breathing is deep breathing due to metabolic acidosis. It may be fast, normal in rate, or slow.
Ataxic Breathing (Biot’s Breathing)
Ataxic breathing, is characterized by unpredictable irregularity. Breaths may be shallow or deep, and stop for short periods. Causes include respiratory depression and brain damage, typically at the medullary levels
Flat percussion
sounds are a high-pitched sound with a soft quality. This sound is heard over dense tissue where there is no air.
Resonance
sounds are heard over normal lungs. These sounds usually have a low pitch.
Hyperresonance
sounds are also low-pitched. However, these sounds are lower than resonance sounds. You will hear hyperresonance sounds over hyper-inflated lungs.
Nose
External nose
Nasal cavity
Septum
Turbinates
Developmental care for infants and chidren
Salivation
Teeth
Nose
Developmental care for aging adult
Diminished smell and taste
Atrophic tissues
Dental changes
Developmental care for pregnant female
Nasal stuffiness
Epistaxis - nose bleed
Hyperemic gums - inflamed red gums
Subjective Data—
Health History Questions
DFSTEAA
Nose
Discharge
Frequent colds
Sinus pain
Trauma
Epistaxis
Allergies
Altered smell
Choanal atresia
narrowed and blocked
Epistaxis
Bleeding nose
Sinuses (FEMS)
Frontal - above eyes
Maxillary - upper jaw
Ethmoidal and Sphenoidal - smaller, located deeper in the skull
Abnormal findings on the nose
Abnormal findings:
- Allergies – swollen, pale, bluish gray.
- Upper respiratory infection – red, swollen
mucosa
- Purulent – contains pus.
Kiesselbach area
Epitaxis / nosebleed
C7; can be easily felt with the
client’s neck flexed.
Vertebra Prominens
True Ribs
False Ribs
Floating Ribs
1-7
8-12
11-12
3 vertical reference lines
Midsternal line
Right midclavicular line
Left midclavicular line
Lined by pleural membranes
Consists of mediastinum and the lungs
Thoracic cavity
Central area in thoracic cavity that contains trachea, bronchi, esophagus, heart and great vessels
Mediastinum
Humps on left
Levoscoliosis
Humps on right
Dextroscoliosis
Chest deformities
A. Pigeon - Pectus carinatum
B. Funnel - Pectus excavatum
C. Barrel - COPD, emphysema (pink puffer) Chronic bronchitis (blue bloater)
D. Kyphosis - thoracic and lumbar
E. Scoliosis
How many lobes are in right and left lung
Right - 3
Left - 2
Thin double layered serous membrane
Pleura
Parietal - lines chest
Visceral - covers external surface
Types of external respiration
Vertical - contract diaphragm
Horizontal - elevate ribs
strongest stimulus to breath; increase
in carbon dioxide level in the blood.
Hypercapnia
decrease in oxygen which increases respiration but is less effective.
Hypocapnia
1 lung up 1 lung down
Chest lagging
Accumulation of air in pleural cavity
Pneumothorax
Accumulation of blood in pleural cavity
Hemothorax
Accumulation of water in pleural cavity
Hydrothorax
Accumulation of pus
Pyothorax - emphyema
Altered smell
Anosmia
When you overuse nasal sprays eg. white flower
Rhinitis medicamentosa
Abnormal findings for inspection
Alar flaring – nares expanding and enlarging to assist in labored breathing.
Pursed lip – helps patient to slow down their breathing.
Cyanosis – bluish discoloration of skin due to decreased oxygen.
Clubbing of nails – hypoxia
How to palpate lungs
Ulnar edge of hand; say 99 and assess
How to percuss thorax (to see if there is liquid air or solid)
Percuss in ICS about 5 cm in systematic sequence
Types of percussion sounds in lung
Flat percussion sounds - a high-pitched sound with a soft quality. This sound is heard over dense tissue where there is no air.
Dullness - usually has a medium pitch. You will hear the dullness when there is a combination of a solid and a fluid-filled area.
Resonance sounds - heard over normal lungs. These sounds usually have a low pitch.
Hyperresonance sounds - also low-pitched. However, these sounds are lower than resonance sounds. You will hear hyperresonance sounds over hyper-inflated lungs.
Tympany sounds - drum-like sounds. A gas-filled area can cause tympanic breath sounds. Also, a pneumothorax can cause tympanic breath sounds.
99 sounds while palpating
Vocal tactile fremitus
Percussion notes
Lungs - resonance
Flatness - ribs
How to percuss thorax
Deep breath and percuss along scapular line until dullness is produced at level the diaphragm
Client breathes and percuss
What is excursion of percussion
Women - 3 to 5 cm bilaterally
Men - 5 to 6
Auscultation of thorax
Zig zag percuss and ask client to take deep breaths from mouth
Percussion notes at anterior thorax
Resonance at 6th rib
Flat over bone or muscle
Dull over heart and liver
Tympanic - stomach
Auscultation normal breathing sounds type, location and characteristics
Vesicular - base of lung - longer inspiration
Bronco-vesicular - 1st and 2nd ICS - equal inspiratory and expiratory
Bronchial - over trachea - longer expiration
Abnormal breathing sounds (adventitia) name and cause
Crackles - fluid and mucus
Gurgles (rhonchi) - narrowing
Friction rub - rubbing
Wheeze - constricted bronchus
Hyperresonance
Emphysema
Dyspnea
Aging changes of lungs
Normal breathing
Eupnea
Slow breathing below 12 rr
Bradypnea
More than 20 rr
Tachypna
Allergies
Hay fever
