Pulmonary - Bates Ch. 8 Flashcards
Landmarks for procedures:
2nd intercostal space for needle insertion for ___ ___
4th intercostal space for ___ ___ insertion
T7-8 interspace for ___
tension pneumothorax
chest tube
thoracentesis
The 11th and 12th ribs are known as what?
“floating ribs” bc they have no anterior attachments
The inferior tip of the scapula lies at the level of the ___ rib/interspace.
7th
When the neck is flexed forward, the most protruding process is usually the vertebra of ___
C7 (or T1)
Each lung is divided roughly in 1/2 by an ___ (major) fissure.
The Rt lung is further divided by the ___ (minor) fissure, and contains upper, middle, and lower lobes.
The Lt lung contains only 2 lobes, the ___ and ___.
oblique
horizontal
upper, lower
Locations for chest findings: Supraclavicular = Infraclavicular = Interscapular = Infrascapular = Bases of the lungs = Upper, middle, and lower lung fields
above the clavicles below the clavicles btwn the scapulae below the scapulae the lowermost portions
The trachea bifurcates into its mainstem bronchi at the levels of the ___ ___ anteriorly and the ___ spinous process posteriorly.
sternal angle, T4
2 pleural surfaces, or serous membranes, cover the lung:
The ___ pleura covers the outer surface.
The ___ pleura lines the inner rib cage and the upper surface of the diaphragm.
visceral
parietal
This is a type of fluid that lubricates the pleural surfaces of the lungs, allowing them to move more easily w/in the rib cage during inspiration and expiration.
Pleural
Pleural effusions may be seen in what conditions?
atelectasis, HF, nephrotic synd, pneumonia, TB, pulm embolus, pancreatitis, and malignancy
Breathing is ___, controlled by respiratory centers in the ___ that produce the neuronal drive for the muscles of respiration.
automatic, brainstem
Principal muscle of inspiration = ___
diaphragm
During inspiration, the diaphragm ___. As the thorax expands, intrathoracic pressure ___, drawing air thru the tracheobronchial tree into the ___, filling the expanding lungs.
contracts, decreases, alveoli
During expiration, the chest wall and lungs ___, and the diaphragm ___ and ___ passively. As air flows ___, the chest and abd return to their resting positions.
recoil, relaxes, rises, outward
Extra work is required to breathe during what?
exercise and certain diseases
What are some sources of chest pain and related causes?
myocardium, pericardium, aorta, trachea and large bronchi, parietal pleura, chest wall including the musculo system and skin, esophagus, extrathoracic structures including neck, GB, and stomach
A clenched fist over the sternum =
A finger pointing to a tender area on the chest wall =
A hand moving from neck to epigastrium =
angina pectoris
musculo pain
heartburn
What is the most frequent cause of CP in children?
anxiety (costochondritis is also common)
Lung tissue has ___ pain fibers.
no
What is the term for painless but uncomfortable awareness of breathing that is inappropriate to the level of exertion?
Dyspnea (aka SOB)
What is the term for sensations or tingling or “pins and needles” around the lips or in the extremities?
paresthesias
What type of lung sound is musical and occurs in partial airway obstruction from secretions and tissue inflam?
What conditions is it associated with?
wheezing
asthma or foreign body
While cough typically signals a problem in the resp tract, it may also be ___ in origin. Cough can be a symptom of what heart condition?
cardiovascular
Lt sided HF
A cough lasting < 3 wks =
A cough lasting 3-8 wks =
A cough lasting > 8 wks =
acute
subacute
chronic
Acute cough can be caused by what conditions?
Subacute?
Chronic?
Acute: Viral URI, acute bronchitis, pneumonia, LT ventricular HF, asthma, foreign body
Subacute: Postinfection cough, bacterial sinusitis, asthma
Chronic: Postnasal drip, asthma, GERD, chronic bronchitis, bronchiectasis
Translucent, white, or grey sputum =
Yellow or green sputum =
Mucoid
Purulent
What is the term for coughing up of blood from the lungs?
What condition is it typically seen in?
Hemoptysis
Cystic Fibrosis
When blood is vomited, it probably originated in the ___ tract. Blood originating in the stomach is usually ___ than blood from the resp tract.
GI, darker
Smoking increases risk of developing what conditions?
CAD, stroke, PVD, COPD, Lung CA
Smoking contributes to ___ types of CA and increases risk of what conditions?
15, infertility, preterm birth, low birth wt, SIDS
Nonsmokers exposed to smoke also have increased risk of what conditions?
Lung CA, ear and resp inf, and asthma
___ is the leading preventable cause of death.
Smoking
What is included in the 5 A’s model to assess readiness for quitting smoking?
Ask about tobacco use Advise to quit Assess willingness to make a quit attempt Assist in quit attempt Arrange F/U
Stimulation of the nicotinic cholinergic receptors in the brain increase release of what neurotransmitter? What does the neurotransmitter do for the body?
dopamine, enhances pleasure and modulates mood
Important to educate pt’s who may be trying to quit smoking on signs of withdrawal such as ?
irritability, depressed mood, poor concentration, anxiety
Annual influenza vaccination is recommended for what ages?
6 months and older
Influenza vaccine is especially important for who?
Pt’s w/chronic pulm conditions, immunocompromised, pregnant women, residents of nursing homes, American Indians and Alaska natives, health care personnel, and caregivers of children 5 yrs of age and younger and of adults 50 yrs and older w/medical conditions placing them at higher risk
What causative agent causes pneumonia and meningitis and can lead to sepsis and death?
Streptococcus pneumonia
For adults, use the ___-valent inactivated pneumococcal vaccine. For children, use the ___-valent conjugate inactivated vaccine.
23, 7
Pneumococcal vaccine is especially recommended for who ?
adults > 65 yrs, children and adults w/chronic illnesses specifically assoc w/increased risk of pneumococcal inf (sickle cell anemia, cardio/pulm dis, diabetes, cirrhosis, leaks of cerebrospinal fluid), smokers age 19-64, anyone w/a cochlear implant, immunocompromised
Examine the posterior thorax and lungs while the pt is ___, and the anterior thorax and lungs while the pt is ___.
sitting, supine
Resp rate should be btwn ___-___.
14-20
Assess the pt’s color for ___, which indicates what?
cyanosis, hypoxia
Clubbing of the nails occurs in what conditions?
bronchiectasis, CHD, pulm fibrosis, cystic fibrosis, lung abscess, and malignancy
Audible ___ is a high-pitched wheeze that indicates upper airway obstruction in the larynx or trachea.
stridor
Lateral displacement of the trachea occurs in what conditions?
pneumothorax, pleural effusion, atelectasis
The anteroposterior (AP) diameter increased w/___, which is normal. It also increases w/what condition?
aging, COPD
There is typically intercostal tenderness over inflamed ___.
pleura
Unilateral decrease or delay in chest expansion occurs in what conditions?
chronic fibrosis, pleural effusion, lobar pneum, and unilateral bronchial obstruction
What is it called when you ask the pt to inhale deeply while you watch the distance btwn your thumbs as they move apart during inspiration?
lung excursion
What is the term that refers to the palpable vibrations transmitter thru the bronchopulmonary tree to the chest wall as the pt is speaking? It is felt best by having the pt say “99” or “1-1-1”.
tactile fremitus
Fremitus is typically more prominent in the ___ area than in the ___ lung fields, and is more prominent on the ___ side than on the ___. It disappears below the ___.
interscapular, lower
right, left
diaphragm
When percussing lung sounds, avoid surface contact w/any other part of the hand bc it ___ out vibrations.
dampens
Healthy lungs should sound ___.
resonant
Dullness replaces resonance when what occurs? Examples include?
When fluid or solid tissue replaces air
lobar pneum, pleural effusion, hemothorax, empyema (pus), fibrous tissue, tumor
Hyperresonance may be heard in hyperinflated lungs like what conditions?
Unilateral hyperresonance suggests what?
COPD, asthma
large pneumothorax
Estimate the extent of diaphragmatic excursion by determining the distance btwn the level of dullness on full ___ and the level of dullness on full ___, normally about ___-___ cm.
expiration, inspiration, 3-5.5cm
This type of breath sound is soft and low pitched, heard thru inspiration, continue w/out pause thru expiration, and then fade away about 1/3 of the way thru expiration.
Vesicular
This type of breath sound is where inspiratory and expiratory sounds are about equal in length, and sometimes separated by a silent interval. Detecting differences in pitch is often easier during expiration.
Bronchovesicular
This type of breath sound is louder, harsher, and higher in pitch, w/a short silence btwn inspiratory and expiratory sounds. Expiratory sounds last longer than inspiratory sounds.
Bronchial
Breath sounds may be decreased w/what conditions?
when air flow is decreased as in obstructive lung dis
Clearing of crackles, wheezes, or rhonchi after coughing or position change suggest what conditions?
bronchitis or atelectasis
This type of adventitious breath sound is discontinuous, intermittent, nonmusical, and brief.
Crackles (rales)
This type of adventitious breath sound is continuous, musical, and prolonged.
Wheezes and rhonchi
Adventitious breath sounds:
Sounds like dots in time =
Sounds like dashes in time =
Crackles (rales)
Wheezes and rhonchi
___ crackles are soft, high-pitched and very brief. ___ crackles are somehwat louder, lower in pitch, and brief.
Fine
Coarse
___ are relatively high-pitched w/hissing or shrill quality. ___ are relatively low-pitched w/snoring quality.
Wheezes
Rhonchi
Findings that are predictive for what condition include wheezing, hx of smoking, age, and decreased breath sounds. Dx requires ___.
COPD
spirometry
Sound the voice makes when listening over large airways. Words are louder and clearer when there is consolidation.
bronchophony
If “ee” sounds like “aa”, this is known as ? This typically presents in what condition?
egophony
lobar pneumonia
Presence of bronchial breath sounds and egophany more than triples the likelihood for what condition?
pneumonia
Pt’s w/what condition present w/leaning forward, lips pursed during exhalation and arms supported on their knees or table?
COPD
Abnormal retraction occurs in what conditions?
severe asthma, COPD, upper airway obstr.
Tender pectoral muscles or costal cartilages typically suggest that CP is what?
musculoskeletal in origin
A lung affected by COPD often displaces the upper border of the liver ___ and ___ the level of diaphragmatic dullness posteriorly.
downward, lowers
___ tests are practical, simple ways to assess cardiopulmonary function.
Walk
What type of test is used when you ask the pt to take a deep breath in and then breathe out as quickly and completely as possible w/mouth open?
Forced expiratory time
Pt’s older than 60 yrs w/a forced expiratory time of 6-9 seconds are twice as likely to have what condition?
COPD
What are you testing for if you place one hand on the sternum and the other on the thoracic spine and squeeze the chest?
Fx rib
