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Health assessment > objective 13 > Flashcards

objective 13 Flashcards

1
Q

bony structure with conical shape, defined by the sternum, 12 pairs of ribs and 12 thoracic vertebrae

A

thoracic cage

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2
Q

what are the anterior thoracic landmarks

A

sternum
sternal angle
costal angle

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3
Q

breastbone- 3 pts
manubrium, body, xiphoid process

A

sternum

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4
Q

Useful landmark - helps localize a respiratory finding horizontally

A

sternal angle

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5
Q

usually 90 degrees or less

A

coastal angle

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6
Q

what are the posterior thoracic landmarks?

A

vertebra prominens
spinous processes
inferior boarder of the scapula
twelfth rib

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7
Q

Most prominent bony protrusion – spinous process of C7
* If 2 bumps seem equally prominent – upper is C7, lower is T1

A

vertebra prominens

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8
Q

Spinous process align with ribs down to T4
* After T4 spinous processes angle downward from their vertebral bodies

A

spinous processes

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9
Q

Scapulae located symmetrically in each hemithorax
* Lower tip usually at level over 7th or 8th rib

A

inferior boarder of the scapula

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10
Q

Free tip - palpated midway between spine and the client’s side

A

twelfth rib

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11
Q

midsternal line
midclavicular line

A

anterior chest

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12
Q

vertebral line
scapular lines

A

posterior chest

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13
Q

anterior axillary line
posterior axillary line
midaxillary line

A

lateral chest

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14
Q

Middle section of the thoracic cavity
* Contains: esophagus, trachea, heart, great vessels

A

mediastinum

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15
Q

Right and left, on either side of the mediastinum
* Contains: lungs

A

pleural cavities

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16
Q

Shorter (liver)
* 3 lobes
* Stack in diagonal sloping segments that are separated by
fissures that run obliquely through the chest

A

right lung

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17
Q

Narrower (heart bulges to the left)
* 2 lobes
* Stack in diagonal sloping segments that are separated by a
fissure that runs obliquely through the chest

A

left lung

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18
Q

highest point of lung
tissue, 3-4 cm above inner
third of the clavicles

A

apex

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19
Q

lower border, rests on
the diaphragm at about the
6th rib in the midclavicular
line

A

base

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20
Q

Location of C7 – marks
the apex
*Location of T10 –
usually corresponds to
the base

A

posterior chest

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21
Q

*Lung tissue extends from apex of
the axilla to 7th or 8th rib
*RUL – apex of axilla down to the
horizontal fissure (5th rib)
*RML – level of horizontal fissure
down and forward to level of the
6th rib
*RLL – level of 5th rib to the 8th
rib midaxillary line
*LUL – level of apex of axilla down
to 5th rib midaxillary line
*LLL – 5th rib to 8th rib

A

lateral chest

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22
Q

Thin and slippery
* Visceral pleura and parietal pleura
* Form an envelope between lungs and chest wall
* Pleural cavity (envelope)

A

pleurae

23
Q

Anterior to esophagus
* Begins at the level of the cricoid cartilage in the neck
* bifurcates just below the sternal angle into the right and left
main bronchi

A

trachea

24
Q

Consists of the: bronchioles and alveoli
* Gas exchange occurs across the respiratory membrane
(alveolar duct and in the millions of alveoli)

A

acinus

25
Q

what are the developmental considerations for infants and children?

A

Fetus
* Primitive lung buds emerge during the first 5 weeks of fetal life
* At 16 weeks – conducting airways reach the same number as in the
adult
* At 32 weeks surfactant is present in adequate amounts
* By birth – lungs have 70 million primitive alveoli (ready for respiration)
Respiratory system does not function until birth
* Respiratory development continues throughout childhood
* diameter and length of airways increases
* Size and number of alveoli increases (300 million by adolescence

26
Q

what are the developmental considerations for pregnancy?

A

Enlarging uterus elevates the diaphragm
* Increase in estrogen relaxes the thoracic cage ligaments
allowing for increase in the transverse diameter of the
thoracic cage, the costal angle widens
* Diaphragm moves (with breathing) even more during
pregnancy which increases tidal volume – meets the
oxygen demand caused by the growing fetus

27
Q

what are the developmental considerations for older adults?

A

Costal cartilage becomes calcified – reduces mobility of the
thorax
* Respiratory muscle strength declines after age 50 and continues
to decrease into the 70’s
* Decrease in elastic properties within the lungs –– less distensible
and lessens their tendency to contract and recoil
* Less surface area available for gas exchange – gradual loss of
intra-alveolar septa and decrease in number of alveoli

28
Q

how do we prep for examination of the respiratory system?

A

Ask client to sit upright; leave gown open at the back
* When assessing the anterior chest, lift up gown and drape over
client’s shoulders
* Ensure room is warm and private
* Warm diaphragm of stethoscope (clean prior to use – infection control)
* Perform IPPA on the posterior and lateral thorax, then move to
anterior chest (avoids moving back to front around the client
repetitively)

29
Q

what equipment do we use for exam of the respiratory system?

A

stethoscope, small ruler, marking pen, alcohol swab

30
Q

how do we inspect the thoracic cage?

A

Note the shape and configuration of the chest wall
* Neck and trapezius muscles should have developed
normally for age and occupation
* Position client takes to breathe – should be relaxed
posture, ability to support own weight, arms
comfortably at sides or in lap
* Assess skin colour and condition

31
Q

how do we palpate the posterior chest?

A

Place warmed hands on posterolateral chest wall with
thumbs at level of T9-T10
* Slide hands medially to pinch up a small fold of skin
between the thumbs
* Ask client to take a deep breath

32
Q

what are the normal and abnormal findings for palpation of the posterior chest?

A

Normal: As client inhales deeply, thumbs should move apart
symmetrically
* Abnormal: Unequal chest expansion

33
Q

how do we look for tactile fremitus?

A

Use palmar base of the fingers or the ulnar edge of one hand
* Touch the client’s chest as the client says the words “ninety-
nine” or “blue moon” repeatedly
* Start over lung apices and palpate from one side to the other
* Although fremitus intensity varies among persons, symmetry
should be noted

34
Q

what are the normal and abnormal findings when looking for tactile fremitus

A

Normal: Vibrations should be the same in the corresponding area on
each side
* Exception: just between the scapula fremitus may feel stronger on
the right side because it is closer to the bronchial bifurcation

35
Q

how do we percuss the posterior chest?

A

Percuss to determine the predominant note
* Start at apices and percuss the band of normally resonant
tissue across the tops of both shoulders
* Percuss in the interspaces making a side-to-side
comparison all down the lung region
* Percuss at 5 cm intervals, avoiding the scapulae and ribs
(dampening effect)

36
Q

low-pitched, clear hollow sound that predominates in healthy lung tissue

A

resonancel

37
Q

lower-pitched, booming sound that occurs when too much air is present

A

hyperresonance

38
Q

soft, muffled thud, signals abnormal density in the lungs

A

dull note

39
Q

how do we auscultate the posterior chest?

A

Evaluate the presence and quality of breath sounds
* Client should be sitting, leaning forward slightly, arms resting comfortably
across the lap
* Instruct the client to breathe through the mouth a little deeper than usual
* Instruct the client to stop if the client becomes dizzy
* Allow times throughout the examination for the client to breathe normally
* Hold diaphragm flat against client’s skin and hold it firmly to the chest
wall
* Listen to at least one full respiration in each location
* Side-to-side comparison is essential
* Careful not to confuse background noise with the lung sounds

40
Q

what is the procedure for auscultating the posterior chest?

A

1.Stand behind the client
2.Listen to following lung areas:
1.Posterior from apices at C7 to the bases around T10
2.Laterally from the axilla down to the 7th or 8th rib
3.Follow the sequence shown in the picture, p. 474
4.Visualize the approximate location of the lobes of each
lung (correlate findings to anatomical location)

40
Q

what are the normal and abnormal findings when palpating the anterior chest?

A

Normal: As client inhales deeply, thumbs move apart
symmetrically
* Abnormal: unequal chest expansion

41
Q

how do we inspect the anterior chest?

A

Note shape and configuration
* Facial expression
* Assess level of consciousness
* Note skin colour and condition, nail beds, assess profile
sign
* Assess respirations

41
Q

how do we palpate the anterior chest?

A

Symmetrical Chest Expansion
* Place hands on anterolateral chest wall with thumbs
along the costal margins and pointing toward the
xiphoid process
* Ask client to take a deep breath

42
Q

how do we test for tactile fremitus in the anterior chest?

A

Use palmar base of the fingers
* Touch the client’s chest as the client says “ninety-nine”
* Start over the lung apices in the supraclavicular areas
* Compare one side to the other

43
Q

how do we percuss the anterior chest?

A

Percuss to determine the predominant note
* Start at apices in the supraclavicular area
* Percuss in the interspaces making a side-to-side comparison all down
the lung region

44
Q

how do we auscultate the anterior chest?

A

Auscultate from the apices in the supraclavicular areas
down to the 6th rib
* Move from side-to-side as go downward
* Listen to one full respiration in each location
* Use the proper sequence
* Do not place stethoscope directly over female breast
tissue
* Note normal, abnormal, and adventitious breath sounds

45
Q

Harsh, hollow, tubular sound
* Normal location: trachea and larynx

A

bronchial (tracheal)

46
Q

Mixed quality
* Normal location: over major bronchi where fewer alveoli are located

A

bronchovesicular

47
Q

Rustling sound
* Normal location: over peripheral lung fields where air flows through
smaller bronchioles and alveoli

A

vesicular

48
Q

Obstruction of the bronchial tree
* Emphysema
* Obstruction of the transmission of sound

A

decreased breath sounds

49
Q

No air is moving in or out

A

absent breath sounds

50
Q

Sounds are louder than they should be

A

increased breath sounds

51
Q

Fine crackles
* Coarse crackles
* Atelectatic crackles
* Pleural friction rub

A

discontinuous sounds

52
Q

Wheeze (high-
pitched)
* Wheeze (low-
pitched)
* Stridor

A

continuous sounds

Health assessment (11 decks)

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