Physical Exam (2) - Pulmonary

Question 1

auscultation

Answer 1

listening to lung sounds over the chest wall

using a stethoscope

Question 2

reliability of auscultation depends on

Answer 2

quality of stethoscope

position of patient

skill of the evaluator

effective and accurate communication and documentation

Question 3

what does auscultation provide

Answer 3

important clues about the condition of lungs and pleura

Question 4

which side of stethoscope do we use with auscultation

Answer 4

diaphragm of stethoscope

Question 5

how should the pt be positioned –> auscultation

Answer 5

sitting

Question 6

how should we perform auscultation

Answer 6

superior to inferior

side to side

Question 7

how should the pt breath during auscultation

Answer 7

breath deeper than normal

w/ mouth open

Question 8

what dont we auscultate over

Answer 8

clothes

bone

breast tissue

Question 9

how are lung sounds divided

Answer 9

3 categories

Question 10

3 categories of lung sounds

Answer 10

normal breath sounds

adventitious breath sounds

voice sounds

Question 11

normal breath sounds are caused by

Answer 11

air flowing through the tracheobronchial tree

4 types

Question 12

4 types of normal breath sounds

Answer 12

tracheal

bronchial

bronchovesicular

vesicular

Question 13

tracheal lung sounds are heard where

Answer 13

only over the trachea

not normally assessed

Question 14

how does a tracheal lung sound like

Answer 14

loud and very high pitched

harsh, hollow quality

expiration is slightly long than inspiration

Question 15

bronchial lung sounds are heard where

Answer 15

over the manubrium and at either side

Question 16

how do bronchial lung sounds sound like

Answer 16

loud and high pitched

expiration is louder and longer than inspiration

pause b/w inspiration and expiration

Question 17

bronchovesicular lung sounds are heard where

Answer 17

over major bronchi

best is at the sternum at either side and posteriorly b/w the scaps

Question 18

how do bronchovesicular lung sounds sound

Answer 18

soft and lower pitched

inspiration and expiration are about equal in length

Question 19

vesicular sounds are heard where

Answer 19

over healthy lung tissue

located over the rest of the peripheral lung fields

Question 20

vesicular sounds sound like

Answer 20

soft and low pitched

inspiration is markedly longer than expiration

no pause

Question 21

what must we decide about lung sounds

Answer 21

if breath sounds are normal or abnormal

Question 22

when are abnormal lung sounds considered

Answer 22

when sounds are diminished or absent at peripheral lung fields

Question 23

adventitous breath sounds

Answer 23

extra sounds

produced by pathological processes in the airways, lungs and pleura

Question 24

what do pathological processes include

Answer 24

secretions

edema

fibrous inflammation

bronchospasm

atelectasis

tumor

pathological changes

Question 25

pathological changes –> adventitious sound

Answer 25

that cause obstruction, turbulence and friction during ventilation

Question 26

if adventitious sounds are heard

Answer 26

always abnormal

superimposed on breath sounds

Question 27

2 types of adventitious sounds

Answer 27

rales or crackles

bronchi or wheezes

Question 28

rales or crackles

Answer 28

discontinuous sounds

heard more often during inspiration

Question 29

what are rales and crackles caused by

Answer 29

disruptive passage of air through small airways in the respiratory tree

Question 30

rhonchi or wheezes

Answer 30

sounds are deeper and more rumbling

continuous

heard during expiration

Question 31

voice sounds

Answer 31

normally the spoken voice vibrates

transmitted through lung fields with relative ease

Question 32

transmitted sounds are normally –> voice

Answer 32

muffled

indistinct

Question 33

3 changes that may indicate pathology –> voice

Answer 33

bronchophony

whispered pectoriloquy

egophony

Question 34

bronchophony

Answer 34

when there is greater clarity

increased loudness of spoken words

Question 35

test for bronchopohony

Answer 35

have pt say “99” or “AEIOU”

w/ pathology this sounds clearer

Question 36

whispered pectoriloquy

Answer 36

when a whisper can be heard clearly through a stethoscope

Question 37

whispered pectoriloquy test

Answer 37

have the pt whisper “1234”

will sound like the pt is actually whispering in your ear

indicate pathology

Question 38

egophony

Answer 38

when the intensity of the spoken voice is increased and there is a nasal quality

Question 39

egophony test

Answer 39

have pt say “Eeeeeeeee”

if pathology is present
-will sound like “AAAAA”
-documented as E to A changes

Question 40

what are the abnormal voice sounds associated w/

Answer 40

consolidation

pleural effusion

atelectasis

Question 41

coughign is a

Answer 41

common and import sns of pulmonary dysfxn

Question 42

why is a cough assessment helpful

Answer 42

effectiveness helps determine the most appropriate interventions

Question 43

normal cough mechanism

Answer 43

has 3 stages

Question 44

3 stages of normal cough mechanism

Answer 44

inspiratory phase

compressive phase

expiratory phase

Question 45

inspiratory phase

Answer 45

take a deeper breath than normal

Question 46

compressive phase

Answer 46

the glottis closes

expiratory muscle contract

increase the intrathoracic pressure

Question 47

expiratory phase

Answer 47

glottis opens

air is forcefully expulsed w/ continued contraction of the expiratory and abdominal muscles

Question 48

what should an effective cough assessment concentrate on

Answer 48

determining at what phase the cough mechanism is impaired

Question 49

ex: if a person is unable the take a deep breath

Answer 49

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