Pulmonary Eval pt 2

Question 1

eupnea

Answer 1

normal rate, normal depth, regular rhythm

Question 2

bradypnea

Answer 2

-Slow rate, shallow or normal depth, regular rhythm
-Volumes stay normal

Question 3

tachypnea

Answer 3

fast rate, shallow depth

Question 4

T/F: tachypnea is hyperventilatory

Answer 4

false!!

Question 5

hyperpnea

Answer 5

normal rate, inc depth, regular rhythm

Question 6

hyperventilation

Answer 6

-Fast rate, inc depth, regular rhythm
-Often misdiagnosed

Question 7

hyperventilation results in ____ arterial CO2

Answer 7

-Decreased
-Ex. metabolic acidosis (hyperventilate to get rid of CO2 and become less acidic)

Question 8

what is dyspnea of phonation?

Answer 8

when speech is interrupted for a breath

Question 9

T/F: inc lung tissue density = inc sound transmission

Answer 9

true!!

Question 10

why does an emphysema lung have dec sound transmission and diminished breath sounds?

Answer 10

dec lung tissue density d/t inc alveoli

Question 11

wheeze

Answer 11

-Continuous but high pitched
-More pronounced expiration
-Sound like whales talking
-Inflamed, bronchospastic lung (ex. asthma)

Question 12

rhonchi

Answer 12

-Subtype of wheeze
-Low pitched like a snore
-Implies obstruction of larger airway

Question 13

crackles

Answer 13

-Discontinuous (during inspiration) adventitious breath sounds that sound like brief bursts of popping bubbles
-Ex. atelectasis
-Sound like rice krispies

Question 14

pleural rub

Answer 14

-Sounds like 2 pieces of leather or sandpaper rubbing together
-Occurs with both inspiration and expiration
-Ex. pleurisy or inflammation in pleural space
-Constant noise

Question 15

what does white and frothy mucus tell you?

Answer 15

pulmonary edema

Question 16

if someone has thick sputum what should you tell them to do?

Answer 16

drink more water

Question 17

the darker the sputum, the ___ the infection

Answer 17

worse

Question 18

productive cough is associated with

Answer 18

lung infection

Question 19

non-productive cough could mean

Answer 19

lung neoplasm

Question 20

if non-productive cough becomes chronic what should you do?

Answer 20

refer out!

Question 21

what is paradoxical breathing?

Answer 21

-Chest moves inward instead of outward during inhalation
-Excessive and rapid abdominal rise and upper chest collapses
-Inefficient but sufficient

Question 22

what are some causes of paradoxical breathing?

Answer 22

-Usually neurological in nature
-Strong contraction of diaphragm with no support from intercostals or abdominals
-Presence of an airway obstruction
-Mechanical disruption of chest wall (trauma)
-Phrenic nerve injury
-Flail chest: broken ribs

Question 23

paradoxical breathing = inc risk of

Answer 23

lung collapse

Question 24

what is paradoxical movement?

Answer 24

-Opposite of pardoxical breathing
-Weak diaphragm but strong accessory muscles
-Abdomen drawn inward during inspiration
-Chest rises and abdomen falls

Question 25

what does it mean if the trachea is deviated?

Answer 25

1 lung is more inflated than the other

Question 26

hallmark sign of crepitus (aka subcutaneous emphysema)

Answer 26

increasing edema chest > scapula > neck to face with rice crispy feeling and crackling when skin is palpated

Question 27

what causes crepitus (aka subcutaneous emphysema)?

Answer 27

-Air in subcutaneous tissue
-Air leaks out of the lungs → follows fascial planes and enters subcutaneous layer of the skin

Question 28

tactile fremitus will be decreased or absent over areas of ____ or ____

Answer 28

pleural effusion, pneumothorax

Question 29

what is atelectasis?

Answer 29

-Complete or partial collapse of lung or lobe of a lung (alveolar collapse)
-Lung still intact but there’s a dimple in it

Question 30

what can cause atelectasis?

Answer 30

blockage or laying down too long and secretions set in and cause suction

Question 31

atelectasis = inc risk of ____

Answer 31

-Pneumonia
-Reason to get post-op pts OOB and an incentive spirometer

Question 32

with atelectasis, does the trachea deviate toward or away from the collapsed side?

Answer 32

toward

Question 33

what is pneumothorax?

Answer 33

-Abnormal collection of air or gas in the pleural space that causes uncoupling of the lung from the chest wall
-Air leaks into the space bw one’s lungs and chest wall and creates restrictive lung citation
-Lung tissue itself collapsed
-ER referral

Question 34

with pneumothorax, does the trachea deviate toward or away from the collapsed side?

Answer 34

away

Question 35

S/S of pneumothorax (“DDATA”)

Answer 35

Distant or absent breath sounds
Dec tactile fremitus
Asymmetric lung expansion
Tachypnea
Adventitious breath sounds (ipsi crackles, wheezes)

Question 36

normal chest expansion (children)

Answer 36

2 cm

Question 37

normal chest expansion (fit young man)

Answer 37

5-8 cm

Question 38

severe emphysema chest expansion

Answer 38

< 1 cm