Patient assessment

Question 1

What things cause the trachea to move away from the affected side? Pushing effect

Answer 1

• Neck tumor
• Mediastinal mass
• tension pneumo
• massive pleural effusion

Problems outside the lung push the trachea away

Question 2

What things cause the trachea to towards the affected side? Pulling effect

Answer 2

• Atelectasis
• Unilateral pulmonary fibrosis
• Pneumonectomy
• Paralyzed hemidiaphragm

Problems inside the lung pull the trachea towards the affected side

Question 3

What is edema? What are some causes?

Answer 3

soft tissue swelling from fluid overload

Causes

• Heart failure
• Kidney disease
• Liver disease
• obstruction of venous or lymphatic drainage
• allergic response

Question 4

What is tactile fremitus?

What causes increased fremitus? Decreased?

Answer 4

• feeling the vocal cord vibration on the chest wall during speech. The patient instructed to say ninety-nine
• Increased fremitus (vibration) from increased density of the lung. Commonly caused by consolidation which is the replacement of air in the healthy lung with another substance
  
  • Pneumonia
  • Atelectasis
• Decreased fremitus (vibration) from the decreased density of the lung - From hyperinflation of the lung or increased distance from lung to the chest wall (ex. air or fluid collects in pleural space)
  
  • air trapping
  • pneumothorax
  • pleural effusion

Question 5

What is vocal fremitus?

Answer 5

Auscultation of voice sounds

Question 6

What causes increased vocal resonance (louder)?

Answer 6

• Pneumonia
• compressed lung
• atelectasis
• lung tumor
• lung mass
• pulm fibrosis

Less air (more consolidation) in lung increased sound transmission

consolidation = “solidifcation” of lung due to the accumulation of fluid or liquids

Question 7

What causes decreased vocal resonance (quieter)?

Answer 7

• Pleural effusion
• plural tumor
• pneumothorax
• emphysema
• pneumonectomy

More air in lung or plural consolidation (shit in the plural space) decreases sound transmission

Question 8

What are the percussion sounds heard over the chest wall and what do they mean?

Answer 8

• Hyperresonance
  
  • loud, low pitched sound- heard in an area with more air than tissue
  • Emphysema, pneumothroax
• Resonance
  
  • low pitched sound
  • normal
• dullness
  
  • medium intensity and pitch
  • atelectasis, consolidation, pleural effusion
• Flatness
  
  • low amplitude and pitch
  • massive pleural effusion, atelectasis
• Tympany
  
  • drum-like sound
  • tension pneumothorax