Quiz 2- Respiratory Flashcards
1
Q
right lung anatomy
A
3 lobes
shorter b/c of liver
2
Q
left lung anatomy
A
2 lobes, more narrow because of heart
3
Q
mediastinum anatomy
A
esophagus, trachea, heart, and great vessels between the lungs
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)
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)
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)
7
Q
important to listen posteriorly
A
you will always hear adventitious sounds better from the posterior
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
9
Q
purpose of respiration
A
maintain acid-base of arterial blood, supply oxygen to the blood, and eliminate CO2
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
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)
12
Q
expiration
A
PASSIVE process
diaphragm rises then chest cavity contracts and air is forced back out as pressure rises
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
14
Q
external respiration
A
GAS EXCHANGE in the lungs
necessary components: lung compliance lung volume adequate perfusion adequate diffusion
15
Q
lung compliance
A
pliability of tissues
decreased with COPD (stiff lungs)
16
Q
lung volume
A
space available for gas exchange to occur
decreased with lobectomy, pneumonia, pneumothorax, etc
17
Q
adequate perfusion
A
blood supply
decreased with CHF, anemia, etc.
18
Q
adequate diffusion
A
movement of gasses at the cellular/molecular level
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
20
Q
health history cues for respiration
A
orthopnea
dyspnea on exertion
fatigue/lethargy
sputum
smoker
obese
cough
21
Q
orthopnea
A
SOB with laying down (# of pillows/what do you sleep on?)
22
Q
dyspnea on exertion
A
SOB with walking (long or short distances? stairs?)
23
Q
sputum
A
if yes, ask about color/smell/amount/consistency/thickness/how often
24
Q
smoker
A
if yes, quantity (how long, ppd, when quit, etc.)
25
obese
more O2 demand
26
cough
quality
precipitating factors
associated factors
timing
27
quality of cough
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)
28
precipitating factors of cough
exercise (asthma), posture (cough with lying down=sinus drainage/post nasal drip/GERD)
29
associated factors of cough
SOB, fever, chest pain/tightness, congestion, noisy respirations, hoarseness (worrying if out of nowhere), coryza (runny nose), gagging, choking, stress
30
timing of cough
when does it happen? spastic/intermittent/constant?
31
respiratory cues in infants/children
pattern of breathing (tachypnea, irregular, periods of apnea)
stopping play to breathe
retractions/nasal flaring
grunting
32
respiratory testing
TB test?
CXR?
immunizations?
33
general appearance
what the patient looks like to you
OBJECTIVE information (age, LOC, signs of distress, vital signs, height/weight, etc)
34
shape and configuration of cage
**normal=AP diameter
35
barrel chest
ribs are horizontal d/t air trapping, AP>transverse diameter, can be normal with aging; chronic asthma, emphysema, COPD
36
pectus excavatum chest
sunken sternum, funnel chest (congenital, asypmtomatic)
if severe enough can have issues with cardiac output
37
pectus carinatum
protrusion of the sternum, pigeon breast
congenital, asymptomatic
38
scoliosis
lateral S curve in thoracic and lumbar spine
can be problematic (decreased lung volume) if significant enough (>45 degrees)
39
kyphosis
exaggerated posterior curve of thoracic spine (humpback)
can impair cardiac output if severe
40
lordosis
exaggerated curvature of the lumbar spine
often r/t lower back pain
41
dahl's sign (thinker's sign)
redness/calluses above the knees from being in the tripod position/leaning forearms on knees; seen with severe COPD
42
bradypnea
<10 breaths per minutes
hypothyroid, drug induced depression of the medulla, IICP, diabetic coma
43
tachypnea
rapid, shallow, >24 breaths/minute
fever, fear, anxiety, insufficiency, cardiac dysrhythmias
44
biot's
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
cheyne-stokes
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
hyperventilation
increased depth/rate
extreme fear, exertion, DKA, ASA overdose, hepatic coma, midbrain lesion, increased CO2
47
infant inability to feed or smile
obligate nose breathers
RR/nasal flaring evident during these activities
48
purpose of palpation
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
assessment of symmetric expansion
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
tactile fremitus
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
abnormal tactile fremitus
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
purpose of percussion
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
method of percussion
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
normal percussion
resonance throughout all lung fields with loud intensity, low pitch, hollow
indicates an air filled space
55
dullness with percussion
medium intensity, medium-high pitch, thud like:
heard over solid organs (liver, spleen)
sign of PNA (consolidation), atelectasis, or tumor
56
flatness with percussion
soft intensity, high pitch, dull like
heard over scapula/ribs, indicates large pleural effusion
57
hyperresonance with percussion
very loud intensity, lower pitch, booming:
classic sound of over-inflation
indicates air trapping, epmhysema, COPD, asthma
58
tympany with percussion
loud intensity, high pitch, drum like
gastric air bubble/air filled bowel (shouldn't hear in the lungs)
59
diaphragmatic excursion
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
normal diaphragmatic excursion
**3-5 cm**
7-8cm in well conditioned
61
abnormal diaphragmatic excursion
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
anterior auscultation
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
posterior auscultation
**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
tracheal sounds
heard over trachea
loud, high pitched, tubular
I+E
65
bronchial sounds
heard over manubrium
loud, high pitched, E>1
**abnormal when heard over vesicular areas**, as with consolidation (alveolar collapse, fluid-filled, fibrosis)
66
bronchovesicular sounds
transitional, heard over main bronchus area
moderate volume, moderate pitch, I=E
67
vesicular sounds
heard over lung fields
soft, low pitch, rustling, I>E
68
infant upper airway expected sounds
louder, harsher, closer to sound, symmetrical throughout chest, loudest as you move up to neck, almost always inspiratory
69
infant lower airway expected sounds
loudest over site of pathology (if louder on one side, abnormality on that side) asymmetric, occur during expiration
70
crackles (discontinuous)
intermittent, non-musical, sound or air passing through moisture, not cleared with cough
71
fine crackles
soft, high pitched, very brief, , heard at end of inspiration (early CHF, PNA, fibrosis, bronchitis)
72
course crackles
louder, lower pitched, lasts longer, heard in lung base during inspiration (pulmonary edema, fibrosis, PNA)
73
wheezing (continuous)
air being forced through a narrow pathway heard during both inspiration and expiration
74
high pitched (sibilant) wheezing
musical, squeaking, continuous but predominant in expiration (acute asthma, chronic emphysema)
75
low pitched wheezing (rhonchi)
low-pitched, musical snoring, continuous but predominant in expiration
larger airway, may clear with cough (bronchitis, obstruction from airway tumor)
76
stridor
high pitch, crowing, originates in larynx/trachea, upper airway obstruction (croup, acute epiglotitis, foreign body)
77
pleural friction rub
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
absence of sound
no air being moved in or out of area (effusion, atelectasis, consolidation, PNA, tumor)
79
adventitious sounds in infants
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
transmitted voice sounds
performed when you hear **abnormally located bronchovesicular or bronchial sounds**
81
bronchophony
pt says "99" upon auscultation
NORMAL= muffled/indistinct sound
ABNORMaL= clear voice sound seen in lung consolidation (+bronchophony)
82
egophony
pt says "E" upon auscultation
NORMA:= muffled sound
ABNORMAL= "E" sounds like "A"
indicates lung consolidation (+egophony with E to A change)
83
whispered pectoriloquy
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
findings for lobular pneumonia
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
findings for bronchitis
**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
emphysema findings
**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
asthma (if pt is having exacerbation) findings
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
obesity hyperinflation syndrome (pickwickian syndrome)
**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
a positive clinical sign on the physical exam indicating pneumonia is:
dullness on percussion
90
which physical finding is most suggestive of bronchitis?
scattered wheezing or rhonchi
91
what type of sound would you expect to hear with percussion for pneumonia?
dull
92
while auscultating the lungs of an obese patient, you would expect the breath sounds to be what?
softer and more distant
93
expected examination findings in the healthy adult lung include:
muffed voice sounds and symmetric tactile fremitus
94
a mucous plug over a mainstem bronchus would produce:
absent breath sounds
