Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Advanced Health Assessment > Quiz 2- Respiratory > Flashcards

Quiz 2- Respiratory Flashcards

1
Q

right lung anatomy

A

3 lobes

shorter b/c of liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

left lung anatomy

A

2 lobes, more narrow because of heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

mediastinum anatomy

A

esophagus, trachea, heart, and great vessels between the lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

anterior thoracic landmarks

A

suprasternal notch (depression between clavicles)

sternum

manubriosternal angle (angle of louis; below suprasternal notch, level of 2nd rib)

costal angle

midsternal line (midline)

midclavicular line (halfway across clavicle)

midaxillary line (transverse midline)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

apex of the lung

A

highest point, top of the lungs, 3-4 cm above inner third of clavicles (C7 posteriorly is the apex level)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

base of the lung

A

lowest border, rests on diaphragm, at the 6th rib/MCL (T10 posteriorly; drops to T12 with deep inspiration in normal lung)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

important to listen posteriorly

A

you will always hear adventitious sounds better from the posterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

infant anatomy of the lung

A

thorax is more rounded

chest wall is thin and hard to auscultate because can hear every other sound/all of the lobes at the same time (even harder if they’re crying)

little musculature; bone/cartilage ribcage is very soft/pliant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

purpose of respiration

A

maintain acid-base of arterial blood, supply oxygen to the blood, and eliminate CO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

mechanics dependent on anatomy

A

intact musculature and innervation

can have healthy lungs but if these aren’t intact then will not breathe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

inspiration

A

ACTIVE process

diaphragm descends and chest cavity expands then negative pressure builds

leads to pressure difference between alveoli and atmosphere

air moves into lung (from high to low pressure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

expiration

A

PASSIVE process

diaphragm rises then chest cavity contracts and air is forced back out as pressure rises

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

resting phase of respiration

A

occurs at the end of expiration

no pressure differences, no airflow occurs

negative intrapleural pressure that keeps alveoli open/prevents lungs from collapsing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

external respiration

A

GAS EXCHANGE in the lungs

necessary components: 
lung compliance
lung volume
adequate perfusion
adequate diffusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

lung compliance

A

pliability of tissues

decreased with COPD (stiff lungs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

lung volume

A

space available for gas exchange to occur

decreased with lobectomy, pneumonia, pneumothorax, etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

adequate perfusion

A

blood supply

decreased with CHF, anemia, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

adequate diffusion

A

movement of gasses at the cellular/molecular level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

internal respiration

A

occurs at the CELLULAR LEVEL

O2 diffuses through capillary bed and attaches to and carried by Hgb to body

Hgb drops off O2 in tissues and picks up CO2

returns to lungs to drop off CO2 (exhaled) and pick up more O2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

health history cues for respiration

A

orthopnea

dyspnea on exertion

fatigue/lethargy

sputum

smoker

obese

cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

orthopnea

A

SOB with laying down (# of pillows/what do you sleep on?)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

dyspnea on exertion

A

SOB with walking (long or short distances? stairs?)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

sputum

A

if yes, ask about color/smell/amount/consistency/thickness/how often

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

smoker

A

if yes, quantity (how long, ppd, when quit, etc.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

obese

A

more O2 demand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

cough

A

quality

precipitating factors

associated factors

timing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

quality of cough

A

moist/rattly (infectious), dry (ACE inhibitors, allergies, HIV), brassy (tumor, croup), pitch (high=airway constriction, low=secretions or inflammation), sputum (blood tinged=pneumonia/TB/lung CA; greenish= production of neutrophils/infection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

precipitating factors of cough

A

exercise (asthma), posture (cough with lying down=sinus drainage/post nasal drip/GERD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

associated factors of cough

A

SOB, fever, chest pain/tightness, congestion, noisy respirations, hoarseness (worrying if out of nowhere), coryza (runny nose), gagging, choking, stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

timing of cough

A

when does it happen? spastic/intermittent/constant?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

respiratory cues in infants/children

A

pattern of breathing (tachypnea, irregular, periods of apnea)

stopping play to breathe

retractions/nasal flaring

grunting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

respiratory testing

A

TB test?

CXR?

immunizations?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

general appearance

A

what the patient looks like to you

OBJECTIVE information (age, LOC, signs of distress, vital signs, height/weight, etc)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

shape and configuration of cage

A

**normal=AP diameter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

barrel chest

A

ribs are horizontal d/t air trapping, AP>transverse diameter, can be normal with aging; chronic asthma, emphysema, COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

pectus excavatum chest

A

sunken sternum, funnel chest (congenital, asypmtomatic)

if severe enough can have issues with cardiac output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

pectus carinatum

A

protrusion of the sternum, pigeon breast

congenital, asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

scoliosis

A

lateral S curve in thoracic and lumbar spine

can be problematic (decreased lung volume) if significant enough (>45 degrees)

39
Q

kyphosis

A

exaggerated posterior curve of thoracic spine (humpback)

can impair cardiac output if severe

40
Q

lordosis

A

exaggerated curvature of the lumbar spine

often r/t lower back pain

41
Q

dahl’s sign (thinker’s sign)

A

redness/calluses above the knees from being in the tripod position/leaning forearms on knees; seen with severe COPD

42
Q

bradypnea

A

<10 breaths per minutes

hypothyroid, drug induced depression of the medulla, IICP, diabetic coma

43
Q

tachypnea

A

rapid, shallow, >24 breaths/minute

fever, fear, anxiety, insufficiency, cardiac dysrhythmias

44
Q

biot’s

A

irregular pattern of 3-4 breaths, followed by regular periods of apnea

cycle lasts 10 seconds-1 minutes

head trauma, brain abscess, heat stroke

45
Q

cheyne-stokes

A

regular patterns of increases and decreases in respirations with periods of apnea

breaths 20-30 sec then 20 sec apnea; severs CHF, renal failure, meningitis, drug OD

normal aging and infants with sleep

46
Q

hyperventilation

A

increased depth/rate

extreme fear, exertion, DKA, ASA overdose, hepatic coma, midbrain lesion, increased CO2

47
Q

infant inability to feed or smile

A

obligate nose breathers

RR/nasal flaring evident during these activities

48
Q

purpose of palpation

A

identify TENDER AREAS: may be seen in the IC areas (Tietze syndrome, IC chondritis- inflamed areas of cartilage); important with atypical chest pain; if you can reproduce pain with palpation, probably muscular not ischemic heart pain

ID areas of CREPITATION (subcutaneous emphysema)

ID large LYMPH NODES, assess supraclavicular/axillary fossae

49
Q

assessment of symmetric expansion

A

place hands onto chest wall with thumbs almost touching at T9/T10 level, grab a little bit of skin between thumbs and have patient take a deep breath

PNA in RLL- L hand would slide away but R would not

COPD- thumbs won’t move d/t air trapping

atelectasis, PNA, thoracic trauma; accompanied with pain is pleuritic

50
Q

tactile fremitus

A

palpable vibration from chest wall- symmetrical on either side

patient repeats “99”

using the ulna side of hand, move down chest wall; should feel the same throughout

infant you can use fingertips

normal=positive tactile fremitus

51
Q

abnormal tactile fremitus

A

INCREASED- compression or consolidation of lung tissue (PNA- sound is conducted better through solid)

DECREASED- with obstruction, air trapping, or abnormal air movement (pleural effusion, pneumothorax, epmhysema)

if abnormal, state whether INCREASED or DECREASED and in WHICH AREAS

52
Q

purpose of percussion

A

to set the chest wall underlying tissue into motion

produces audible sounds

determine if underlying tissue is air-filled, fluid-filled, or solid

in INFANTS- hyperresonance throughout; percussion not overly helpful

53
Q

method of percussion

A

place distal joint of middle finger over intercostal space, then stroke sharply with tip of other hand

start at apices and move down, comparing side to side at 5 cm intervals

54
Q

normal percussion

A

resonance throughout all lung fields with loud intensity, low pitch, hollow

indicates an air filled space

55
Q

dullness with percussion

A

medium intensity, medium-high pitch, thud like:

heard over solid organs (liver, spleen)

sign of PNA (consolidation), atelectasis, or tumor

56
Q

flatness with percussion

A

soft intensity, high pitch, dull like

heard over scapula/ribs, indicates large pleural effusion

57
Q

hyperresonance with percussion

A

very loud intensity, lower pitch, booming:

classic sound of over-inflation

indicates air trapping, epmhysema, COPD, asthma

58
Q

tympany with percussion

A

loud intensity, high pitch, drum like

gastric air bubble/air filled bowel (shouldn’t hear in the lungs)

59
Q

diaphragmatic excursion

A

measures distance diaphragm travels during inspiration and expiration

diaphragm should drop down when taking a deep breath

have patient exhale completing, then hold breath then percuss down the scapula line on each side to the point where resonance turns to dullness and mark the spot

have the patient take a deep breath in and hold it then percuss again and mark spot.

measure the difference between the two marks

hold your breath the same amount of time you tell patient to

60
Q

normal diaphragmatic excursion

A

3-5 cm

7-8cm in well conditioned

61
Q

abnormal diaphragmatic excursion

A

DIFFERENT MEASUREMENT on each side or absence of movement

higher level of dullness-effusion/atelectasis

absence of excursion-effusion/atelectasis

PNA won’t have excursion on affected side

failure of diaphragm to contract is from paralysis or muscle flattening (COPD)

62
Q

anterior auscultation

A

side to side, starting from apices/supraclavicular area to the 6th rib

only upper airway breath sounds

least important

listen to this area last

63
Q

posterior auscultation

A

most important, listen to this area first

side to side, starting at apices/C7 level to the bases/T10 level

also listen LATERALLY from axilla to 7th or 8th rib

64
Q

tracheal sounds

A

heard over trachea

loud, high pitched, tubular

I+E

65
Q

bronchial sounds

A

heard over manubrium

loud, high pitched, E>1

abnormal when heard over vesicular areas, as with consolidation (alveolar collapse, fluid-filled, fibrosis)

66
Q

bronchovesicular sounds

A

transitional, heard over main bronchus area

moderate volume, moderate pitch, I=E

67
Q

vesicular sounds

A

heard over lung fields

soft, low pitch, rustling, I>E

68
Q

infant upper airway expected sounds

A

louder, harsher, closer to sound, symmetrical throughout chest, loudest as you move up to neck, almost always inspiratory

69
Q

infant lower airway expected sounds

A

loudest over site of pathology (if louder on one side, abnormality on that side) asymmetric, occur during expiration

70
Q

crackles (discontinuous)

A

intermittent, non-musical, sound or air passing through moisture, not cleared with cough

71
Q

fine crackles

A

soft, high pitched, very brief, , heard at end of inspiration (early CHF, PNA, fibrosis, bronchitis)

72
Q

course crackles

A

louder, lower pitched, lasts longer, heard in lung base during inspiration (pulmonary edema, fibrosis, PNA)

73
Q

wheezing (continuous)

A

air being forced through a narrow pathway heard during both inspiration and expiration

74
Q

high pitched (sibilant) wheezing

A

musical, squeaking, continuous but predominant in expiration (acute asthma, chronic emphysema)

75
Q

low pitched wheezing (rhonchi)

A

low-pitched, musical snoring, continuous but predominant in expiration

larger airway, may clear with cough (bronchitis, obstruction from airway tumor)

76
Q

stridor

A

high pitch, crowing, originates in larynx/trachea, upper airway obstruction (croup, acute epiglotitis, foreign body)

77
Q

pleural friction rub

A

rubbing or grating, during inspiration or expiration (louder in E)

loudest over lower, lateral anterior surface

caused by inflammation of pleural surfaces (pleurisy); accompanied by pleuritic pain

78
Q

absence of sound

A

no air being moved in or out of area (effusion, atelectasis, consolidation, PNA, tumor)

79
Q

adventitious sounds in infants

A

same as adults but more difficult to distinguish because multiple sounds often occur together

wheezes more common b/c of smaller airways

crackles can be heard with pneumonia and bronchitis

80
Q

transmitted voice sounds

A

performed when you hear abnormally located bronchovesicular or bronchial sounds

81
Q

bronchophony

A

pt says “99” upon auscultation

NORMAL= muffled/indistinct sound

ABNORMaL= clear voice sound seen in lung consolidation (+bronchophony)

82
Q

egophony

A

pt says “E” upon auscultation

NORMA:= muffled sound

ABNORMAL= “E” sounds like “A”

indicates lung consolidation (+egophony with E to A change)

83
Q

whispered pectoriloquy

A

pt whispers “1 2 3” upon auscultation

NORMAL= faint, indistinct, or no sound at all

ABNORMAL= loud and clear

indicates lung consolidation (+whispered pectoriloquy)

84
Q

findings for lobular pneumonia

A

CRACKLES, find to medium

+bronchophony/egophony/whispered pectoiloquy (in area of consolidation_

dull to percussion over affected lobe

increased respiratory rate with guarding/leg on affected side

decreased chest expansion/diaphragm excursion on affected side

85
Q

findings for bronchitis

A

hacking, rasping cough with thick mucoid sputum

WHEEZES d/t inflammation of bronchi, CRACKLES over deflated areas of alveoli

common in SMOKERS

NO CONSOLIDATION- +tactile fremitus, resonant percussion, normal voice sounds

86
Q

emphysema findings

A

increased AP chest diameter)-barrel chest

increased use of accessory muscles, DOE, prolonged expiration

AIR TRAPPING- decreased tactile femitus, decreased chest expansion/diaphragm excursion, hyperresonance to percussion

decreased breath sounds, may hear a WHEEZE

80-90% to SMOKING

87
Q

asthma (if pt is having exacerbation) findings

A

increased airway resistance

increased RR, SOB, accessory muscle use, cyanosis, anxiety, apprehension

decreased tactile fremitus, resonant or hyperresonance to percussion

decreased breath sounds with prolonged expiration, expiratory wheezes, voice sounds decreased

88
Q

obesity hyperinflation syndrome (pickwickian syndrome)

A

BMI>30 (obesity)

awake alveolar hypoventilation (PaCO2>45 mmHg)

alternative cause of hypoventilation cannot be identified

places an excessive load on the pulmonary system

SYMPTOMS: excessive daytime sleepiness, SOB d/t elevated PaCO2, disturbed sleep at nigh, flushed face (somtetimes bluish tint to skin), high BP, enlarged liver, abnormally high RBC count (body compensating, trying to get more O2 to tissues)

89
Q

a positive clinical sign on the physical exam indicating pneumonia is:

A

dullness on percussion

90
Q

which physical finding is most suggestive of bronchitis?

A

scattered wheezing or rhonchi

91
Q

what type of sound would you expect to hear with percussion for pneumonia?

A

dull

92
Q

while auscultating the lungs of an obese patient, you would expect the breath sounds to be what?

A

softer and more distant

93
Q

expected examination findings in the healthy adult lung include:

A

muffed voice sounds and symmetric tactile fremitus

94
Q

a mucous plug over a mainstem bronchus would produce:

A

absent breath sounds

Advanced Health Assessment (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions