Respiratory Flashcards
Posteriorly upper lung lobes are separated from lower lobes at ___
T3
Where is the angle of louis
The sternal angle, the anterior angle formed by the junction of the manubrium and the body of the sternum
Posteriorly lungs at rest end at______
T10
Posteriorly when you take a big breath in lungs end at __
T12
If you listen only posterior chest you will hear almost no__
upper lobes and no right middle lobe
If you listen anteriorly on the Rt side you will hear what lobes
Upper and middle right
Horizontal fissure separates
Rt upper and Rt middle lobes
Horizontal fissure separated Rt upper and Rt middle lobes at __
4th intercostal space
4th rib
Location of oblique fissure on anterior
6 rib (separates RML and RLL, LUL and LLL)
A patient using accessory muscles in respiration, you look for retractions at
suprasternal notch
You listen at 2 intercostal space and it’s located
At the angle of Louis to the right
Lift shirt to inspect ___
skin, muscle and chest deformities, accessory muscle use/retractions
Normal AP diameter
2;1
Pectus excavatus
Funnel chest, wider front than side to side
Pectus carinatum
Pigeon chest. The bulging gives the chest a birdlike appearance.
Palpate anterior
Tracheal position, chest wall tenderness, tactile fremitus, thoracic expansion/diaphragmatic excursion
When palpate for chest wall tenderness, you check for
Fractured rib, inflamed pleura, costochondritis
Tactile fremitus is
Transmission of vibration from larynx to chest
Increased tactile fremitus means
Consolidation of tissue (pneumonia)
Decreased/absent tactile fremitus
Obstructed bronchus, tumor, effusion, too much air (COPD),
If a patient has high pitch voice tactile fremitus may be
Decreased, less vibration
When assessing tactile fremitus, you look for
symmetrical vibration
Anterior tactile fremitus location
2 intercostal space, at nipple line (4-5 intercostal space), and laterally
Posterior tactile fremitus location
Avoid scapulae
where and how is respiratory excursion
Posterior, hands at the base lungs at T10, have patient breathe in, look for equal movement of hand when patient is breathing out
Percussion sound FLAT
over a bone
percussion sound DULL
over an organ (dull)
RESONANT percussion sound
over a lung ( airy)
HYPER-RESONANT sound
over a bronchus, louder than resonant
Abdomen (like a drum)
Tympanic percussion sound
Percuss chest in what pattern
ladder pattern
If patient exhales, percussion will sound__ posteriorly at T10-T12
Dull
If patient inhales deeply, persucussion at T10-T12 posteriorly will sound
Resonant (T10-T12 - 3-5 cm)
breath sounds
bronchial, bronchovesicular, vesicular
bronchial
over trachea and heard bronchus
bronchovesicular
heard Anterior mid chest, posterior between scapulae, mix of vesicular and bronchial
vesicular
the soft, low-pitched, normal breath sounds heard over peripheral lung fields
vesicular
soft and low
*Heard over most of lung
Adventitious breath sounds
- Rales/crackles
- Rhonchi
- Wheeze
- Friction rub
- Stridor
- Grunting
posterior breath sounds
no bronchial
adventitious breath sounds
rales/crackles, rhonchi/wheezes, friction rub, stridor, grunting
rales/crackles
Intermittent, non-musical, brief (bubbly). pneumonia
rhonchi
Low-pitch, continuous, snoring (mucus is moving). CHF, bronchitis.
wheezes
Continuous, high pitches, musical, hissing or shrill in quality
friction rub
Low-pitched, grating, inflamed pleural surfaces rubbing
stridor
harsh inspiratory noise from larynx or trachea when obstructed
Egophony
patient says “ee”, sounds like “ay” over area of pneumonia
Bronchophony
Patient says “99”. positive if louder in area of consolidation (pneumonia)
Whispered pictoriloquy
Patient whispers “99”.Sound is increased in area of pneumonia
Egophony, bronchophony, whispered pectoriloquy
positive in pneumonia
what does a normal chest look like
AP diameter 2:1
No tenderness, fremitus equal bilaterally
Resonant throughout
BS equal and easily heard throughout
what is pleural effusion
May have a cough
Fremitus decreased over effusion
Dullness over effusion
Decreased sounds over effusion
May have pleural friction rub
pneumonia
May look ill, feverish ,erythema, sweating, may cough
Fremitus increased over pneumonia
Percuss dullness over pneumonia
Decreased sounds over pneumonia, crackles over involved area
COPD
Barrel chest
Decreased fremitus on palpation
Hyper-resonant percussion
Decreased/ distant breath sounds
pneumothorax
Shortness of air
Fremitus decreased/absent over area
Percussion hyper resonant over area in pleural space.
Decreased or absent breath sound
what are the changes with aging
Decreased vital capacity
Decreased rate of breathing
Can have increased AP diameter-Kyphosis
site 1 auscultation
Rt upper and Lt upper lobes at midclavicular line
site 2 auscultation
Rt and Lt, 2nd intercostal space lateral to sternal border
site 3 auscultation
4th intercostal space lateral to sternal border, Rt Middle and Left Upper (Rt middle starts at 4th intercostal)
site 4 auscultation
5th intercostal space, lateral to sternal border, Rt middle, Lt upper
site 5 auscultation
5th intercostal space, Midaxillary line, Rt middle, Left lower
site 6 auscultation
6th intercostal space, midaxillary line, Rt lower, Lt lower
Suprasternal notch
look for retractions
anatomical locations
Suprasternal notch
*Manubrium
*Angle of Louis
* Flush joint between
manubrium and
sternum
*Sternum
*Xiphoid
normal anterior -posterior
transverse diameter
increased diameter
posterior diameter
what does age increase
posterior diameter
what chest is a sx of COPD
barrel chest
wht cant hear sounds d/t too much air
COPD , pneumothorax
T10 hands on base of lungs. what does breathing in tell us about pt
are hands equal when pt is breathing in if not equal =blockage or pneumothorax
