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NURS 5200 Holistic Health Assessment & Therapeutics for the Advanced Practice Nurse > Pulmonary > Flashcards

Pulmonary Flashcards

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1
Q

Inspection Elements

A 
Chest wall:  any deformities?
Symmetric expansion	
AP diameter of the chest is typically < lateral chest diameter
0.70 to 0.75 average for healthy adult
AP diameter increases with age
Kyphosis
Lordosis
Scoliosis
Barrel chest
Lips and fingernails
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2
Q

AP diameter of the chest is typically

A

lateral chest diameter

0.70 to 0.75 average for healthy adult

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3
Q

AP diameter increases

A 
with age
Kyphosis
Lordosis
Scoliosis
Barrel chest
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4
Q

Resp Rate Elements

A 
Respiratory effort
Any retraction of muscles
Do you hear any sounds?  
Stridor
Wheeze
Dyspnea
Tachypnea
Bradypnea
Orthopnea
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5
Q

Cough

A 
Onset
Sputum production or dry cough
characteristics
Frequency
Severity
Associated symptoms
What have they tried
Sputum
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6
Q

SOB

A 
Onset
Pattern
Severity 
Associated symptoms
What have they tried
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7
Q

Chest pain

A

Onset and duration
Associated symptoms
What have they tried

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8
Q

Palpate thoracic muscles

A 
Tenderness
Depressions
Masses
Bulges
Crepitus
Crackly sensation
Air in subcutaneous tissue
Palpated and heard
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9
Q

Thoracic Expansion place thumbs along the

A

thumbs along the spinal processes at the level of the 10th rib

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10
Q

Tactile fremitus

A

Palpable vibration
Heard best at the level of bifurcation of the bronchi
Ask patient to recite “99” or “Mickey Mouse”
Compare sides-do both sides feel similar?
Increased fremitus with fluid or a mass
Decreased fremitus with decreased lung tissue density
COPD
Asthma

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11
Q

Percussion two techniques

A

direct and indirect

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12
Q

Percussion - Resonance is

A

normal

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13
Q

Percussion - Hyper resoance indictes

A

hyper inflation

COPD

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14
Q

Percussion - Dullness noted with decreased air exchanges indicates

A

Pneumonia
Atelectasis
pleural effusion

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15
Q

Measuring Diaphragmatic Excursion

A

Typically 3 to 5 cm
May be decreased in pulmonary or abdominal diseases
Percuss along the scapular line

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16
Q

Auscultation

A 
Patient in upright position
Compare right lung to left lung
Start at Apex then proceed to base
Listen for 
Intensity
Pitch
Quality
Duration
Use diaphragm of stethoscope
High pitched sounds
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17
Q

Vesicular

A

Heard over most lung fields

Low pitched, low intensity

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18
Q

Bronchovesicular

A

Heard over the bronchi

Moderate pitch, moderate intensity

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19
Q

Bronchial

A

Heard over the trachea

High pitched

20
Q

Crackles

A

Heard more often during inspiration

Does not clear with a cough

21
Q

Rhonchi

A

Loud, low, coarse sound caused by thick secretions, muscular spasm, tumor, external pressure
May clear with a cough

22
Q

Wheeze

A

High pitched musical sound heard during inspiration or expiration

23
Q

Pleural effusion rub

A

Grating sound caused by inflammation of pleural spaces

24
Q

Pleural friction rub

A

Inflammation of the pleural spaces
Heard on inspiration and expiration
Disappears while holding your breath

25
Q

Pericardial friction rub

A

Inflammation of the pericardium
Louder on inspiration
Does not disappear while holding your breath

26
Q

Bronchophony

A

Recite numbers, names, words
99 or Mickey Mouse
Increased clarity and loudness of spoken words
Occurs with solid mass or lung consolidation with pneumonia

27
Q

Egophony

A

“E” changes to “Aaay”
Occurs with lung consolidation
Pneumonia
Fibrosis

28
Q

Respiratory Abnormalities

A 
Atelectasis
Bronchitis
Pleural effusion
Asthma
Pneumonia
Pleurisy
29
Q

Infant A/P diameter

A

approximately the same as lateral diameter

RR 40-60/min

30
Q 
School aged (6-12 years)
RR
A

RR 18-30/min

31
Q

Pregnant Patients

A

Dyspnea is common
Breathing is deeper but not more frequent

Asthma could be affected during pregnancy

32
Q

Elderly Patients

A 
Chest expansion may be decreased
Calcification of ribs
Patients may be less able to use respiratory muscles due to 
muscle weakness
 general physical disability 
sedentary lifestyle
Bony prominences are marked	
Less subcutaneous tissue
Kyphosis
Doral curve of the thoracic spine
33
Q

RML heard best between

A

the right midaxillary line to the right axillary line on the anterior portion of the chest

34
Q

Right bronchus is

A

wider, shorter, and more vertically placed than left bronchus
More susceptible to aspiration of foreign objects

35
Q

Diaphragm on the right chest may be

A

higher than the left chest due to the size and position of the liver
Always compare right to left

36
Q

ROS

A

Denies cough, sputum production, shortness of breath

37
Q

PE

A

Respiratory rate regular with ease of chest expansion. Breath sounds clear to auscultation bilaterally without wheezes, rhonchi or crackles. AP diameter less than lateral diameter. Lung percussion resonant in all lung fields bilaterally. Thoracic expansion symmetric. Diaphragmatic excursion 3 cm bilaterally. RR documented under VS

38
Q

Kyphosis

A

Outward curvature of the back. Elderly women

39
Q

Lordosis

A

Sway back. Inward arch

40
Q

Scoliosis

A

Sideward curve

41
Q

Barrel Chest

A

round bulging chest

42
Q

Decreased fremitus could indicate

A

air or fluid in the pleural space or COPD or asthma

43
Q

Dullness to percussion indicates

A

denser tissue
Consolidation with pneumonia
solid mass tumor
pleural effusion

44
Q

Most common lung condition found in surgery

A

atelectasis

45
Q

pleurisy

A

inflmaiton of pleural spaces

NURS 5200 Holistic Health Assessment & Therapeutics for the Advanced Practice Nurse (12 decks)

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