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NURS518 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is the landmark for needle decompression of a tension pneumo?

A

2nd intercostal space

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2
Q

What is the landmarks for a chest tube insertion?

A

Intercoastal space between the 4th and 5th ribs

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3
Q

What is the landmark for the lower margin for a well-placed ET tube on CXR?

A

Level of the 4th rib.

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4
Q

Why is aspiration pneumonia more common in the RML and RLL?

A

Because the right main bronchus is more vertical.

Also note, that for this reason if an ET is advanced too far it will more likely enter the right mainstem bronchus.

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5
Q

Irritation of the parietal pleura produced pleuritic pain with deep inspiration. What are some examples of conditions where you would see a patient with pleuritic pain?

A

Pneumonia
Pulmonary Embolism
Viral Pleurisy
Pericarditis

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6
Q

What are red flag respiratory symptoms?

A

Cough
SOB or wheezing
Hemoptysis

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7
Q

The degree of dyspnea, combined with spirometry, is a key component of important _________ classification and guides management.

A

Chronic COPD

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8
Q

What is the most common cause of acute cough?

A

Viral upper respiratory infection.

Also consider acute bronchitis, pneumonia, left-sided heart failure, asthma, foreign body, and smoking

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9
Q

Name some causes of a subacute cough.

A

Post-infectious cough, pertussis, acid reflux, bacterial sinusitis, asthma.

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10
Q

Name some causes of a chronic cough.

A

Postnasal drip, asthma, GERD, chronic bronchitis, and bronchiectasis.

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11
Q

What is mucoid sputum? When would you see this?

A

Mucoid sputum is translucent, white, or grey - seen in viral infections and cystic fibrosis.

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12
Q

What is purulent sputum? When would you see this?

A

Purulent sputum is yellow or green - often accompanies bacterial pneumonia.

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13
Q

When would you most likely see foul-smelling sputum?

A

Foul-smelling sputum is present in anaerobic lung abscess

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14
Q

What diagnostically helpful symptoms are present in pneumonia?

A

+ fever
+ productive cough

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15
Q

What diagnostically helpful symptoms are present in acute coronary syndrome?

A

+ chest pain
+ dyspnea
+ orthopnea

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16
Q

What are the 3 main causes of hemoptysis?

A

Bronchitis
Malignancy
Cystic Fibrosis

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17
Q

What is the definition of massive hemoptysis?

A

> 500mL over 24h or >100mL/hr
can be life threatening

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18
Q

What type of cough and sputum would you expect to see in LARYNGITIS? What other associated symptoms would you expect to find?

A

Dry cough may become productive with variable amounts of sputum.

Acute, relatively minor illness with hoarseness. Often associated with viral rhinosinusitis.

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19
Q

What type of cough and sputum would you expect to see in ACUTE BRONCHITIS? What other associated symptoms would you expect to find?

A

Dry or productive cough.

Acute, often viral, illness generally without fever or dyspnea, sometimes with burning retrosternal discomfort.

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20
Q

What type of cough and sputum would you expect to see in MYCOPLASMA & VIRAL PNEUMONIA? What other associated symptoms would you expect to find?

A

Dry hacking cough may become productive of mucoid sputum.

Acute febrile illness, often with malaise, headache, and possibly dyspnea.

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21
Q

What type of cough and sputum would you expect to see in BACTERIAL PNEUMONIA? What other associated symptoms would you expect to find?

A

Sputum is mucoid or purulent and may be blood-streaked, diffusely pinkish, or rusty.

Acute illness with chills, high fever, dyspnea, and chest pain.

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22
Q

What is a classic sign of angina?

A

A clenched fist over the sternum, known as Levine sign.

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23
Q

Describe cheyne-stokes breathing.

A

Periods of deep breathing alternate with periods of apnea. Typical in children and older adults during sleep.

24
Q

What causes lateral displacement of the trachea?

A

Pneumothorax, pleural effusion, or atelectasis.

25
Q

In what condition may you see a barrel chest? What is a barrel chest?

A

A barrel chest is an increase in the AP diameter and is often seen in COPD (also in infancy and aging).

26
Q

What is funnel chest (pectus excavatum)?

A

Depression in the lower portion of the sternum. Anteriorly displaced sternum and depressed cartilages.

Compression of the heart and great vessels may cause murmurs.

27
Q

What is a pigeon chest (pectus carinatum)?

A

The sternum is displaced anteriorly, increasing the AP diameter. The costal cartilages adjacent to the protruding sternum are depressed.

28
Q

What is tactile fremitus?

A

Vibrations of the chest wall as a result of sound transmitting through lung tissue.

29
Q

What causes decreased tactile fremitus?

A

Excess air in the lungs or increased thickness of the chest wall - as seen in COPD

30
Q

What causes increased tactile fremitus?

A

Lung consolidation, as seen in pneumonia.

31
Q

What would asymmetrical increase tactile fremitus suggest?

A

Unilateral pneumonia - increased transmission through consolidated tissue.

32
Q

What would asymmetrical decreased tactile fremitus suggest?

A

Unilateral pleural effusion or pneumothorax - decreases transmission of low frequency sounds.

32
Q

What would you hear when percussing healthy lungs?

A

Healthy lungs are resonant.

33
Q

__________ replaces resonance when fluid or solid tissue replaces air-containing lungs or occupies the pleural space beneath the fingers.

A

Dullness

34
Q

Describe DULL percussion notes and characteristics. Give an example.

A

Intensity & pitch = medium
Example = lobar pneumonia

35
Q

Describe HYPERRESONANT percussion notes and characteristics. Give an example.

A

Intensity = very loud
Pitch = lower
Example = COPD

36
Q

A silent gap between inspiratory and expiratory sounds suggests __________ breath sounds.

A

Bronchial

37
Q

__________ breath sounds are soft and low pitched, heard throughout inspiration and continue without pause through expiration.

A

Vesicular

38
Q

____________ breath sounds are louder, harsher, and higher pitched, with short silence between inspiratory and expiratory sounds. Expiratory sounds last longer than inspiratory.

A

Bronchial

39
Q

Where are bronchovesicular breath sounds best heard?

A

In the 1st and 2nd interspaces anteriorly and between the scapulae.

40
Q

Where are the crackles of heart failure best heard?

A

The posterior inferior lung fields.

41
Q

What adventitious sounds are caused by abnormalities of the lung parenchyma caused by pneumonia, atelectasis, and heart failure?

A

Crackles

42
Q

What adventitious breath sounds are heard due to narrowed airways of asthma, COPD, and bronchitis?

A

Wheezes

43
Q

________ describes sounds from secretions in large airways that may change with coughing.

A

Rhonchi.

44
Q

When might a pleural friction rub be heard?

A

Pleurisy, pneumonia, and pulmonary embolism.

45
Q

How do fine crackles vary from coarse crackles?

A

Fine crackles are softer, higher pitched and more frequent per breath than coarse crackles. They are heard from mid to late inspiration and change according to body position. They have a shorter duration and higher frequency than coarse crackles. They are generated by the sudden inspiratory opening of small airways held closed by surface forces during the previous expiration.

46
Q

Describe coarse crackles. When might you hear them?

A

Course crackles appear early in inspiration and last throughout expiration (biphasic), have a popping sound, and do not change with body position. They do change or disappear with coughing and are transmitted to the mouth. They appear due to boluses of gas passing through airways as they open and close intermittently.

Examples include COPD, asthma, heart failure

47
Q

Describe wheezes are given examples of when you may hear them?

A

Wheezes are continuous musical sounds produced during rapid airflow when bronchial airways are narrowed. They can be inspiratory, expiratory, or biphasic.

Most commonly seen in asthma.

48
Q

What is a pleural rub?

A

A pleural rub is a discontinuous, low-frequency, grating sound that arises from inflammation and roughening of the visceral pleura as it slides against the parietal pleura. This non-musical sound is biphasic heard best in the axilla and base of the lungs.

49
Q

When should you assess for transmitted voice sounds?

A

Anytime abnormal bronchovesicular or bronchial breath sounds.

50
Q

What is egophony?

A

If “ee” sounds like “A” and has a nasal bleating quality, egophony is present.

51
Q

What is bronchophony?

A

If “99” or “123” sounds loud, bronchophony is present.

52
Q

When would egophony and bronchophony be heard?

A

Lobar consolidations from pneumonia.

53
Q

What is pectoriloquy?

A

A whispered “99” or “123” is heard loudly in whispered pectoriloquy.

54
Q

Bronchial breath sounds are …..

A

Harsher, louder, higher pitch
Heard over the trachea
Heard over main stem bronchi
Expiratory sounds last longer than inspiratory sounds
Silent gap may separate sounds

55
Q

Bronchovesicular breath sounds are ….

A

Heard in 1st and 2nd interspace anteriorly
Heard b/w the scapulae posteriorly
Have intermediate pitch and intensity
Inspiratory and expiratory sounds are equal in duration, and a silent interval separates sounds

56
Q
A

NURS518 (5 decks)

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