Notes Ch: 31 - Assessment Pt. 3 Flashcards
Lungs
What is the order of examination when assessing the lungs?
- Inspection; visual
- Palpation; feel; light, then deep
- Auscultation; listen
What can be observed a visual sign of respiratory distress?
- Irregular breathing patterns
- Using accessory muscles to breathe
- Cyanosis at lips/muscous membranes
What position is preferred for a patient having a hard time breathing, supine or fowler?
Fowler
When assessing the posterior thoracic area of a patient, what “lines” are used?
- Left/Right scapular line
- Vertebral line
When assessing the lateral thorasic area of a patient, what “lines” are used?
- Posterior axillary line
- Midaxillary line
- Anterior axillary line
When assessing the anterior thorax of a patient, what “lines” are used?
- Midsternal line
- Midclavicular line
- Anterior axillary line
How does one test for chest excursion?
- Wrap hands around waste of patient
- Place thumbs on either side of the spine
- If there is separation of the thumbs on inhalation, there is chest excursion
Consolidation in the thorax is…
the accumulation of fluids in the pleural space
What is tactile fremitus?
How is it assessed?
- A vibration felt on the patient’s chest during low frequency vocalization.
- Transmitted through lungs to chest wall
- Assessed by placing each hand under each scalpula and have the patient saying “99”, if there is no vibration, it can be indicative of blockage
What is Egophony?
How is it assessed?
- An increased resonance of voice sounds heard when auscultating the lungs, often caused by lung consolidation and fibrosis.
- While auscultating lungs, have patient say “E”. If it sounds like “A”, it indicates egophony and positive for consolidation.
What are abnormal lung sounds called?
Adventitious
What are the four adventitious lung sounds?
- Crackles
- Rhonchi
- Wheezes
- Pleural friction rub
Describe adventitious lung “crackles” and how the are described.
- Caused by sudden reinflation of groups of alveoli or disruptive passage of air through small airways.
- Described as fine, medium, coarse
What are crackles indicitive of?
- Pneumonia
To open up airways, what kind of medication is needed?
Bronchodilator
Describe adventitious lung “Rhonchi”.
How is it cleared?
- Low-pitched, continuous sounds caused by muscular spasm, fluid, or mucus in larger airways.
- Cleared by coughing
Describe adventitious lung “wheezes”.
- high-pitched sound or squeak heard continuously during inspriation or expiration.
- Usually louder on expiration
- Often heard in asthma
Describe adventitious lung “pleural friction rub”.
- Dry rubbing or grating sound
- Caused by inflamed pleura; parietal pleura rubbing against visceral pleura
During auscultation of breath sounds, what must be indicated?
- Location
- Characteristics of sound
- Absence of breath sounds
What is the one assessment you must do on your patients everytime?
Respiratory
What do the following prefixes mean?
Supra-
Infra-
Inter-
- Supra- above
- Infra- below
- Intra- between
What are the terms used for regions of the lungs assessed?
- Upper, middle, lower lung fields
- Base of lungs; lowermost portions
What/how is generally observed during a respiratory assessment?
- Auscultate vesicular and bronchial sounds
- Observation of accessory, sterocleidomastoid, trapezius and abdominal muscles
- Palpation of muscles and skeleton
- Assessment of tactile fremitus
- Semetry comparison of right/left sides
What are the three classifications of breath sounds?
Name the location, lung region assessed and describe the sound of each.
Bronchial
- Location: supraclavicular/trachea
- Assessed: apex/upper of lungs - expiration longer than inspiration at 3:2 ratio
- Sound: loudest, high pitch w/ audible pause between inspiration and expiration
Bronchovesicular
- Location: mid-thorax/intrascapular
- Assessed: middle of lungs - larger airways
- Sounds: medium pitch
Vesicular
- Location: base of thorax/around kidneys
- Assessed: lower/base of lungs - smaller airways
- Sounds: Low pitch
