Pulmonary I Flashcards
The interspace between 2 ribs is numbered by the rib ____ it.
above
Use the ____ ____ on the chest wall as a guide.
Move laterally to _____ rib then walk down interspaces.
sternal angle (Angle of Louis)
2nd rib
Inferior tip of scapula lies at the level of the ____ rib.
7th
When the neck is flexed _____ and ____ verterbrae are most prominent.
C7 and T1
Precise locations of chest wall:
- midsternal line
- midclavicular
- anterior axillary line
- midaxillary line
- posterior axillary line
The apex of each lunch rises ___ to ___ cm above the clavicle.
2cm to 4 cm
The lower border of the lung crosses the ____ rib at the _________ line and the ______ rib at the _________ line.
- 6th
- midclavicular
- 8th
- midaxillary
Posteriorly, the lower border of the lung lies at the ___ spinous process.
T10
The trachea bifurcates into its mainstem bronchi at the levels of the _____ ____ (anteriorly) and ____ (posteriorly).
sternal angle
T4
What muscles are used during exercise or in pulmonary diseases? aka accessory muscles
- scalenes
- trapezius
- pectoralis major
- SCM
- internal intercostals
- abdominals muscles
Common concerning symptoms to ask patient:
- chest pain
- dyspnea
- wheezing (musical sound)
- cough
- blood streaked sputum
Sources of chest pain:
- myocardium
- pericardium
- aorta
- trachea/large bronchi
- parietal pleura
- chest wall
- esophagus
- neck, gall bladder and stomach
Interview: Chest pain ask patient:
ask broadly then narrow down
- Do you have unpleasant feelings in your chest?
- point to location of pain
- elicit 7 attributes of pain
Lung tissue has pain fibers. True or false.
false, pain in lung arises from inflammation of parietal pleura usually
Non-painful but uncomfortable awareness of breathing that is inappropriate to the level of exertion characterizes:
determine severity based on daily activities:
dyspnea
flight of stairs, carrying groceries
- Makes musical respiratory sounds that may be audible to the patient and others
- suggests partial airway obstruction from secretions, tissue inflammation, or an airway obstruction
Examples:
wheezing
- asthma
- emphysema
a reflex response to stimuli that irritate receptors in the larynx, trachea, or large bronchi
stimuli:
cough
mucus, pus, blood, dust, extremely hot or cold air (basically anything in the throat)
coughing up of blood from the lung
confirm source of bleeding! mouth, pharynx, GI
hemoptysis
Initial survey of patient for the pulmonary exam:
- inspect pt for any signs of respiratory difficulty
- assess patient’s color for cyanosis
- listen to breathing
- inspect the nect
- observe shape of chest
During inspection of the chest:
Note:
observe the shape of the patients chest and movement of the chest wall
- deformities or asymmetry
- abnormal retraction of the lower interspaces
- impaired respiratory movement
Test ensuring that voice sounds consistent where the stethoscope is applied:
tactile fremitus
Chest percussion:
hyperextend ______ finger of non-dominant hand.
Strike pleximeter finger with _____ finger and use the wrist to strike
middle finger
middle
Normal breath sounds
- Vesicular
- Bronchovesicular
- Bronchial
soft intensity, lower pitched sighing sounds
vesicular
normal breath sound
moderate intensity and moderate pitched blowing sounds
bronchovesicular sound
normal breath sound
high pitched harsh sounds moving through the trachea
bronchial breath sound
normal breath sound
snap, crackle, pop sound
rales
aka crackles
continuous low-pitched coarse gurgling
gurgles aka rhonchi
superficial grating sounds not relieved by coughing
friction rub
continuous high pitched musical sound
wheezing
Ask the patient to whisper a sequence of words “one, two, three”, only faint sounds are heard.
However, over areas of tissue abnormalit, the whispered sounds will be clear and distinct
whispered pectoriloquy
Ask the patient to say “99” in a normal voice . Words should be indistinct
bronchophony
Ask the patient to say the vowel “e” . If the lung tissue is consolidated, the “e” sound will change to a nasal “a”
egophony
Attributes of pain, use chloride:
- Character
- Location (unilateral vs. bilateral)
- Onset (acute or chronic, sudden or gradual)
- Radiation
- Intensity
- Duration
- Exacerbating
