Physical Exam (2) - Pulmonary Flashcards
auscultation
listening to lung sounds over the chest wall
using a stethoscope
reliability of auscultation depends on
quality of stethoscope
position of patient
skill of the evaluator
effective and accurate communication and documentation
what does auscultation provide
important clues about the condition of lungs and pleura
which side of stethoscope do we use with auscultation
diaphragm of stethoscope
how should the pt be positioned –> auscultation
sitting
how should we perform auscultation
superior to inferior
side to side
how should the pt breath during auscultation
breath deeper than normal
w/ mouth open
what dont we auscultate over
clothes
bone
breast tissue
how are lung sounds divided
3 categories
3 categories of lung sounds
normal breath sounds
adventitious breath sounds
voice sounds
normal breath sounds are caused by
air flowing through the tracheobronchial tree
4 types
4 types of normal breath sounds
tracheal
bronchial
bronchovesicular
vesicular
tracheal lung sounds are heard where
only over the trachea
not normally assessed
how does a tracheal lung sound like
loud and very high pitched
harsh, hollow quality
expiration is slightly long than inspiration
bronchial lung sounds are heard where
over the manubrium and at either side
how do bronchial lung sounds sound like
loud and high pitched
expiration is louder and longer than inspiration
pause b/w inspiration and expiration
bronchovesicular lung sounds are heard where
over major bronchi
best is at the sternum at either side and posteriorly b/w the scaps
how do bronchovesicular lung sounds sound
soft and lower pitched
inspiration and expiration are about equal in length
vesicular sounds are heard where
over healthy lung tissue
located over the rest of the peripheral lung fields
vesicular sounds sound like
soft and low pitched
inspiration is markedly longer than expiration
no pause
what must we decide about lung sounds
if breath sounds are normal or abnormal
when are abnormal lung sounds considered
when sounds are diminished or absent at peripheral lung fields
adventitous breath sounds
extra sounds
produced by pathological processes in the airways, lungs and pleura
what do pathological processes include
secretions
edema
fibrous inflammation
bronchospasm
atelectasis
tumor
pathological changes
pathological changes –> adventitious sound
that cause obstruction, turbulence and friction during ventilation
if adventitious sounds are heard
always abnormal
superimposed on breath sounds
2 types of adventitious sounds
rales or crackles
bronchi or wheezes
rales or crackles
discontinuous sounds
heard more often during inspiration
what are rales and crackles caused by
disruptive passage of air through small airways in the respiratory tree
rhonchi or wheezes
sounds are deeper and more rumbling
continuous
heard during expiration
voice sounds
normally the spoken voice vibrates
transmitted through lung fields with relative ease
transmitted sounds are normally –> voice
muffled
indistinct
3 changes that may indicate pathology –> voice
bronchophony
whispered pectoriloquy
egophony
bronchophony
when there is greater clarity
increased loudness of spoken words
test for bronchopohony
have pt say “99” or “AEIOU”
w/ pathology this sounds clearer
whispered pectoriloquy
when a whisper can be heard clearly through a stethoscope
whispered pectoriloquy test
have the pt whisper “1234”
will sound like the pt is actually whispering in your ear
indicate pathology
egophony
when the intensity of the spoken voice is increased and there is a nasal quality
egophony test
have pt say “Eeeeeeeee”
if pathology is present
-will sound like “AAAAA”
-documented as E to A changes
what are the abnormal voice sounds associated w/
consolidation
pleural effusion
atelectasis
coughign is a
common and import sns of pulmonary dysfxn
why is a cough assessment helpful
effectiveness helps determine the most appropriate interventions
normal cough mechanism
has 3 stages
3 stages of normal cough mechanism
inspiratory phase
compressive phase
expiratory phase
inspiratory phase
take a deeper breath than normal
compressive phase
the glottis closes
expiratory muscle contract
increase the intrathoracic pressure
expiratory phase
glottis opens
air is forcefully expulsed w/ continued contraction of the expiratory and abdominal muscles
what should an effective cough assessment concentrate on
determining at what phase the cough mechanism is impaired
ex: if a person is unable the take a deep breath
the inspiratory phase will be insufficient
or
the pt has impairment of the expiration phase –> may be d/t pain of recent surgery or trauma
