Pulmonary Evaluation Flashcards
Normal breath sounds include =
Vesicular
Bronchial
Bronciovesicular
Vesicular =
SOFT, LOW PITCHED SOUNDS HEARD DURING INSPIRATION; DURING EXPIRATION THEY ARE MINIMAL AND ONLY HEARD DURING 1/3 OF EXHALATION
Inhale longer than exhale
AUSCULTATED IN THE PERIPHERAL LUNG FIELDS = below scaps & over bottom ribs
Bronchial =
TUBULAR SOUNDS, LOUD, HIGH PITCHED SOUNDS WITH EQUAL INSPIRATORY AND EXPIRATORY DURATION
AUSCULTATED OVER THE ANTERIOR CHEST AND OVER THE TRACHEAL AREA
Inhale shorter than expire
Bronciovesicular =
HEARD OVER THE JUNCTION OF THE MAINSTEM BRONCHI WITH THE SEGMENTAL BRONCHI; SOFTER VERSION OF BRONCHIAL SOUNDS; POSTERIORLY THEY ARE HEARD ONLY BETWEEN THE SCAPULAE
AUSCULTATED ANTERIORLY (1ST AND 2ND INTERCOSTAL SPACE NEAR THE STERNUM) AND POSTERIORLY OVER THE BRONCHI (BETWEEN THE SCAPULAE)
Inhale & exhale are equal
Abnormal breathing sounds
Wheezing
Crackles
DEC in sound transmission ( Emphysema)
Wheezing
S - CONTINUOUS SOUNDS WITH A CONSTANT PITCH AND VARYING DURATION
MOST FREQUENTLY HEARD ON EXHALATION AND ARE ASSOCIATED WITH AIRWAY OBSTRUCTION
WHEEZES ON INSPIRATION ARE RARE AND ARE ASSOCIATED WITH SEVERE AIRWAY OBSTRUCTION
Crackles
DISCONTINUOUS ADVENTITIOUS SOUNDS THAT SOUND LIKE BRIEF BURSTS OF POPPING BUBBLES (CAN BE FINE OR COURSE)
MORE COMMON DURING INSPIRATION AND MAY BE ASSOCIATED WITH RESTRICTIVE OR OBSTRUCTIVE RESPIRATORY DISORDERS
MAY RESULT FROM THE SUDDEN OPENING OF CLOSED AIRWAYS, OR AS A RESULT OF THE MOVEMENT OF SECRETIONS DURING INSPIRATION AND EXPIRATION
DEC IN LUNG TISSUE DENSITY (EMPHYSEMA) WILL CAUSE A DEC IN SOUND TRANSMISSION
WEAKER, SOFTER SOUNDS ARE HEARD IN THE PRESENCE OF HYPERINFLATION
STRONGER, LOUDER SOUNDS ARE HEARD IN THE PRESENCE OF CONSOLIDATIVE PATHOLOGY
THIS IS COMMON WITH PNEUMONIA
IT IS IMPORTANT TO BE AWARE OF AREAS OF CONSOLIDATION. SECRETION CLEARANCE TECHNIQUES ARE INDICATED WHEN PRESENT.
Egophany
HAVE PATIENT SAY “EE”
SHOULD BE SOFT AND MUFFLED AND SOUND LIKE “EE” AS YOU LISTEN WITH A STETHOSCOPE ACROSS THE LUNG TISSUE
IF IT SOUNDS LIKE “AY” THEN IT IS AN INDICATOR OF CONSOLIDATION
Auscultate upper (traps), middle (mid-axillary line), and lower lung (below inferior scap border) regions
Respiratory rate for adult
12-25 breaths/min
Percsussions
Loosen secretions
Cupped hands in a steady rhythm over specific area of the lung for 3-5 minutes in postural drainage position
DONT do on bare skin
Vibrations
Moves the secretions to an optimal position to be cleared
Use palmar aspect of hand and put pressure & oscillates through the end of expiration for 1-10 breaths after percussions
Pursed Lip Breathing indicated to
*DEC Dyspnea symptoms (esp w/activity )
Slows HR, slows RR, decreases pressure and reduced airway collapse during expiration
*Clinical sign of COPD
How do you perform pursed lip breathing?
Inhale through the nose for several seconds with the mouth closed and exhale over 4-6 seconds through lips in a whistle position
“Blow out the bday candles”
What mm weakness do you think is common in pulmonary pts?
Trunk/core
Back EXT’s
LE’s
