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Health Assessment Exam #2 > Oxingination- Thorax and the Lungs > Flashcards

Oxingination- Thorax and the Lungs Flashcards

1
Q

Anterior Thorax

A

12 pairs of ribs

Sternum

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2
Q

Posterior Thorax

A

12 thoracic vertebrae

Spinal column

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3
Q

Ribs

A

1-7 articulate with sternum
8-10 articulate with costal cartilage
11-12 do not articulate= free floating
All articulate with vertebrae

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4
Q

Right Lung

A

Three lobes: Upper, Middle, Lower

Shorter than left lung

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5
Q

Left lung

A

two lobes- upper and lower

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6
Q

Lung apex

A

Top of lung
Anterior - 2.5-4 cm above clavicles
Posterior at level of T1

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7
Q

Lung base

A

Bottom of lung
Anterior- 6th rib at MCL
Posterior- T10 on expiration and T12 on inspiration
Lateral 8th rib at MAL

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8
Q

Mediastinum

A

Extends from sternum to spine

Trachea and pulmonary vessels

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9
Q

Bronchi

A

Trachea bifurcates at sternal angle and level of 4th and 5th vertebrae
Right= shorter, more vertical

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10
Q

External intercostal muscles

A

elevates ribs and increase size of thoracic cavity on inspiration

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11
Q

internal intercostal muscles

A

draw ribs together during expiration

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12
Q

Accessory Muscles

A

Used when there is increased demand for oxygen

Scalene, sternocleidomastoid, trapezius, abdominal

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13
Q

Inferior angle of scapula

A

Level of 7th rib

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14
Q

Anterior landmark lines

A

Anterior axillary line
Midclavicular line
Midsternal (vertebral) line

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15
Q

Axillary landmark lines

A

Anterior axillary line
Midaxillary line
Posterior axillary line

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16
Q

Posterior Landmark lines

A

Posterior axillary line
Scapular line
Midspinal or vertebral line

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17
Q

Inspiration

A

active, Muscle contraction, Negative intra-pulmonic pressure

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18
Q

Expiration

A

Passive, Muscles relax, Positive intra-pulmonic pressure

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19
Q

Common chief complainst

A

Dyspnea, Cough, Sputum, chest pain

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20
Q

Generalized thorax approach

A

Compare right vs. left
systematic approach
Ask patient to displace breast tissue to palpate, auscultate, and percuss anterior thorax
Proceed from lung apices to the bases

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21
Q

Shape of thorax

A

Transverse diameter

Anteroposterior (AP) diameter- AP to transverse ratio 1:2 twice as wide as thick

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22
Q

Barrel chest

A

1:1 ratio–round chest

COPD–air trapped in alveoli

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23
Q

Pectus carinatum

A

Protrusion of sternum

Congenital, Rickets

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24
Q

Pectus excavatum

A

Depression of sternum= Can compress heart and lungs

Congenital

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25
Posterior shape of thorax variations
Kyphosis-hunch back or scoliosis
26
Symmetry of Anterior chest wall
Note any differences between the two sides, shoulder height should be the same, Masses
27
Symmetry of posterior chest wall
Note any differences between the two sides, position of scapula and shoulder height- should be the same, Masses
28
Presence of superficial veins
Dilated veins should not be seen | Note pattern and symmetry, if present
29
Costal angle
Angle formed by ribs and bottom of sternum= Normal is 90 | Angle is less during expiration and rest
30
Angle of ribs
Articulate with sternum at 45 degree angle
31
Intercostal spaces inspection
Observe through respiratory cycle There should be no bulging or retraction Abnormal: bulging during expiration/ retraction during inspiration
32
7 Inspections of Respirations
Rate, Pattern, Depth, Symmetry, Audibility, Patient position, Mode
33
Respiration Rate
full minute, do it slyly, in/out=1 cycle. Normal btw 12-20 breaths per min
34
Eupnea
12-20 breaths per minute (normal)
35
Tachypnea
> 20 breaths per minute (stress, respiratory illness)
36
Bradypnea
< 12 breaths per minute (increased intracranial pressure, drug overdose)
37
Apnea
No respiration for 10 or more seconds (brain injury, sleep apnea)
38
Respiration rhythm
Note rhythm or pattern of breathing- regularity or irregularity Normal respirations should be regular and even
39
Cheyne-Stokes
Pattern of Regularly irregular with gradual increase in depth then gradual decrease and a period of apnea (brain injury, coma)
40
Agonal
Irregularly irregular with varying depths and patterns (impending death)
41
Respiratory Depth
Observe at inspiration | Inspiration should be nonexaggerated and effortless
42
Shallow depth
Minimal movement of chest (pain, lung problems)
43
Hyperpnea
Greater volume but rate and pattern is even (warm-up for exercise, emotions, high altitude)
44
Kussmaul’s
Increased rate and depth (diabetic acidosis)
45
Respiratory Symmetry
How chest rises and falls during respiratory cycle | R/L thorax should move in unison
46
Abnormal respiratory symmetry
``` Unilateral expansion (absent or collapsed lung) Paradoxical movement (fractured ribs) ```
47
Respiratory Audibility
Listen for audibility of respiration | Normally audible a few cms from nose or mouth
48
Abnormal Respiratory Audibility
Audible breaths when a few feet away (upper airway sounds)
49
Orthopnea
difficulty breathing when lying down (COPD, congestive heart failure)
50
Tripod position
easier to use accessory muscles (COPD)
51
Mode of breathing
nose, mouth, or both to breathe Note which part of respiratory cycle each is used Should be able to inhale and exhale through nose
52
Abnormal mode of breathing
Continuous mouth breathing (nasal or sinus blockage) | Pursed-lip breath–used to prolong expiration (COPD)
53
Sputum inspection
color, consistency, amount, and odor
54
Normal sputum findings
small amount clear or light yellow, odorless sputum, can be thick or thin depending on hydration
55
Palpation of Anterior Thorax
apex to base. Above clavicles to bottom of ribs- ribs and intercostal spaces
56
Palpation of Posterior Thorax
apex to base= Level of T1 to bottom of ribs | Palpate thoracic vertebrae, ribs, ICS
57
Palpate lateral thorax
Have patient lift arms- apex to base= Axilla to bottom of ribs Palpate ribs, ICS
58
Pulsations
No pulsations should be present | Pulsation may indicate thoracic aortic aneurysm
59
Masses
no masses should be present
60
Palpation
Palpate Posterior, Anterior, and Lateral areas for all
61
Thoracic Tenderness
No tenderness should be present- may be due to fractured ribs, chest trauma
62
Crepitus
Beads of air are trapped in subcutaneous tissue= Crackling sensation when palpated (rice krispies
63
Causes of Crepitus
pneumothorax, chest trauma or surgery
64
Thoracic expansion
Assess extent and symmetry via thumbs at costal margins (A) and 10th vertebrae (P)
65
Normal thoracic expansion
3-5 cm symmetrically
66
Tactile fremitus definition
Palpable vibration of chest wall produced by spoken word, felt as buzzing
67
Assessing tactile fremitus
Use ulnar aspect of closed fist, patient says "99," | Down either side of sternum/vertebrae, out to sides- Note increase or decrease fremitus
68
Lateral assessment of tactile fremitus
midaxillary, nipple level, xiphoid process level
69
Normal tactile fremitus findings
More fremitus near major bronchi = 2nd ICS anteriorly, T1 and T2 posteriorly Less fremitus in periphery of lungs
70
Abnormal tactile fremitus findings
Increased= consolidation, decreased= increased air in lungs/thorax
71
Tracheal position
Place finger pad on the trachea in the suprasternal notch | Move laterally to right and left of trachea
72
Tracheal position Normal findings
midline in suprasternal notch
73
Tracheal position abnormal findings
deviation may be due to pressure in thorax or enlarged thyroid
74
General approach to percussion
indirect percussion, side-to-side/ top to bottom, compare sounds bilaterally, should be resonant
75
Percussion of Anterior thorax
clavicles down to 6th ribs, in ICS, zig-zag motion
76
Percussion of Posterior thorax
head bent forward, arms crossed | level of T1 to down to 10th rib btw scapula and vertebrae
77
Percussion of Left Lateral thorax
axilla to 8th rib- mid axilla, nipple level, xiphooid process level, 8th rib= curved L
78
Percussion of left lateral thorax
axilla to 8th rib- backwards z= axillary, posterior axillary line, anterior axillary line (nipply level), 8th rib
79
General approach to auscultation
use diaphram of stethoscope to hear breath sounds. take deep breath through mouth.compare side to side w/ same pattern as percussion
80
Bronchial breath sounds
I
81
Bronchovesicular breath sounds
I=E | Heard at 1st and 2nd ICS adjacent to sternum and between the scapulae
82
Vesicular
I>E | Heard in peripheral lung tissue
83
Fine Crackle
Mostly heard on late inspiration- High-pitched crackle or popping Due to moisture in small airways as they reinflate
84
coarse Crackle
Heard on inspiration- Low-pitched crackle or gurgling | Due to moisture in large airways as they reinflate
85
Adventitious Breath sounds
crackle, wheeze, pleural friction rub, stridor
86
Sonorous wheeze
Mostly heard on expiration- Low-pitched snoring sound | Due to narrowing of large airways or obstruction
87
Sibilant Wheeze
Heard on expiration- High-pitched musical sound | Due to narrowing of large airways or obstruction
88
Pleural Friction Rub
Heard on both inspiration and expiration- Creaking or grating sound Due to inflammation of pleural membranes
89
Stridor
Heard on inspiration- Crowing sound | Due to partial obstruction of larynx or trachea
90
Bronchophony
“99”when stethoscope is moved side-to-side for comparison Sound should be muffled Abnormal if sound is clear and louder= consolidation
91
Egophony
“e” when stethoscope is moved side-to-side for comparison Sound should be muffled Abnormal if sounds like “ay”= consolidation
92
Whispered pectoriloquy
“99” when stethoscope is moved side-to-side for comparison Sound should be muffled Abnormal if sound is clear and louder= consolidation

Health Assessment Exam #2 (4 decks)

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