Respiratory and Thorax

Question 1

What’s subjective with regards to the thorax?

Answer 1

Cough, shortness of breath, chest pain with breathing, history of respiratory infections, smoking history, environmental exposure, self-care behaviors

Question 2

What to look for when inspecting the thorax?

Answer 2

Shape and configuration of the thorax, skin color and condition, facial expression, LOC, work of breathing?, vital signs

Question 3

What is normal as far as respiratory rate goes? What’s abnormal?

Answer 3

Normal is 10-20 breaths per minute.
Bradypnea is <10 per minute
Tachypnea is >24 per minute

Question 4

How long do acute and chronic coughs last?

Answer 4

Acute lasts less than 2/3 weeks while chronic lasts over 2 months.

Question 5

White or clear sputum?

Answer 5

Colds, bronchitis, viral infections

Question 6

Yellow or green sputum?

Answer 6

Bacterial infections

Question 7

Rust-colored sputum?

Answer 7

TB, pneumococcal pneumonia

Question 8

Pink/frothy sputum?

Answer 8

Pulmonary edema, some sympathomimetic meds have a side effect of pink-tinged mucus

Question 9

Shortness of breath
Difficulty breathing when supine
Awakening from sleep with SOB and needing to be upright to achieve comfort

Answer 9

Dyspnea
Orthopnea
Paroxysmal nocturnal dyspnea

Question 10

What does timing of coughs indicate?

Answer 10

Continuous: acute illness
Afternoon/evening: May be exposure to irritants at work
Night: postnasal drip, sinusitis
Early morning: chronic bronchial inflammation of smokers

Question 11

Explain the ratio of the thoracic cage and what’s to be expected

Answer 11

The anteroposterior (AP) diameter should be less than the transverse diameter. The ratio of AP to transverse is about 0.70 to 0.75 in adults, and it increases with age.

Question 12

Name some objective findings for COPD

Answer 12

AP=transverse diameter, e.g. barrel chested. Ribs are horizontal and the chest appears as if held in continuous inspiration. Occurs from hyperinflation of the lungs.
Neck muscles are hypertrophied from aiding in forced respirations.
Tripod position, leaning forward with arms braced on something.

Question 13

What can be a sign of hypoxia?

Answer 13

Anxiety because of difficulty breathing

Question 14

Fragmented platelets become trapped in the fingertip vasculature, releasing platelet-derived growth factor and promoting growth of vessels.

Answer 14

Clubbing of the nails. Inner edge of nail elevates, nail bed angle is greater than 180 degrees. Distal phalanx looks rounder, wider, and shiny.

Question 15

Taking very rapid, deep breaths to counteract ketoacidosis, trying to blow off CO2.

Answer 15

Kussmaul diabetics

Question 16

A coarse, crackling sensation palpable over the skin surface.

Answer 16

Crepitus
Occurs in subcutaneous emphysema when air escapes the lungs and enters the subcutaneous tissue, as after open thoracic injury or surgery.

Question 17

The low-pitched, clear, hollow sound that predominates in health lung tissue in the adult.
A lower-pitched, booming sound such as found when too much air sip resent such as in emphysema or pneumothorax.
Dull(soft, muffled thud) notes and what they signify?

Answer 17

Resonance
Hyperresonance
Signals abnormal density in the lungs, as with pneumonia, pleural effusion, atelectasis, or tumor

Question 18

What areas might help with labored breathing?

Answer 18

Suprasternal, supraclavicular, subcostal, substernal, intercoastal
Trapezius, scalenus, sternomastoid muscles
Also flared nostrils

Question 19

Where should the hands be placed to check for symmetric chest expansion?

Answer 19

Between the levels of T9 and T10

Question 20

What parts of tissue does percussion set into motion? Abnormal findings?

Answer 20

It sets into motion only the outer 5-7cm of tissue.
An abnormal finding must be 2-3 cm wide to yield an abnormal percussion note. Lesions smaller than this are not detectible by percussion.

Question 21

When standing behind the person listening to breath sounds, where should the scope be placed/which lung areas to listen to?

Answer 21

Posterior from the apices at C7 to the bases around T10

Laterally from the axilla down to the 7th or 8th rib

Question 22

What normal breath sounds are high pitched with a loud amplitude? Explain sounds.

Answer 22

Bronchial/tracheal.
Inspiration takes less time than expiration.
Harsh, hollow, tubular quality.
Located in the trachea and larynx.

Question 23

What normal breath sounds are moderately pitched and moderate amplitude?

Answer 23

Bronchiovesicular.
Inspiration and expiration are equal.
The quality is mixed.
Located over major bronchi where fewer alveoli are located. Posterior it’s between scapulae especially on the right; anterior around upper sternum in the 1st and 2nd intercostal spaces.

Question 24

What normal breath sounds are low pitched with soft amplitude?

Answer 24

Vesicular
Inspiration takes more time than expiration.
Rustling quality.
Located over the puerperal lung fields where air flows through smaller bronchioles and alveoli.

Question 25

Added sounds that are not normally heard in the lungs. If present, they are heard as being superimposed on the breath sounds.

Answer 25

Adventitious sounds.
Caused by moving air colliding with secretions in the tracheobronchial passageways or by the popping open of previously deflated airways.

Question 26

Discontinuous popping sounds heard over inspiration that are not cleared by coughing

Answer 26

Fine crackles. Inhaled air collides with previously deflated airways; airways suddenly pop open, creating sound.
Exploratory crackles are sudden airway closing.

Question 27

Continuous high pitched musical sounds. Predominate in expiration but may occur in both.

Answer 27

High pitched wheeze. Sibilant. Air squeezed or compressed through passageways narrowed almost to closure by things. The walls oscillate in apposition between the closed and barely open positions.

Question 28

Non-pathologic short, popping sounds that last only a few breaths. Caused by?

Answer 28

Atelectatic crackles.
When sections of alveoli are not fully aerated, they deflate slightly and accumulate secretions. Crackles are heard when secretions are expanded by a few deep breaths. Disappear after the first few breaths or a cough.

Question 29

What are special considerations for the older adult when it comes to respiratory?

Answer 29

Costal cartilage becomes calcified with aging. Thorax is less mobile. Chest expansion is decreased. Chest cage anteroposterior diameter may be increased.

Question 30

What are the current American Cancer Society guidelines for breast cancer?

Answer 30

Yearly mammograms at age 45. Clinical breast exams (CBE) every three years until 40, then yearly. Self exams to detect changes between doctor visits, using three patterns: spiral, spoke, zigzag

Question 31

Increase in both rate and depth of breathing. Normally occurs with extreme exertion, fear, anxiety.

Answer 31

Hyperventilation.

Blows off CO2, causing a decreased level in the blood (alkalosis).

Question 32

An irregular shallow pattern cause by an overdose of narcotics or anesthetics. May also occur with prolonged bed rest or conscious splinting of the chest to avoid respiratory pain.

Answer 32

Hypoventilation

Question 33

A cycle in which respirations gradually wax and wane in a regular pattern, increasing in rate and depth and then decreasing.

Answer 33

Cheyne-Stokes respiration
The breathing periods last 30-45 seconds, with periods of apnea for 20 seconds alternating the cycle. Most common cause is severe heart failures.
Occurs normally in infants and aging persons during sleep.

Question 34

Similar to Cheyne-Stokes respiration except that the pattern is irregular. The cycle length is variable lasting anywhere from 10 seconds to 1 minute.

Answer 34

Biot respiration

Question 35

Normal inspiration and prolonged expiration to overcome increased airway resistance. Any situation calling for increased heart rate may lead to dyspneic episode because the person doesn’t have enough time for full expiration.

Answer 35

Chronic obstructive breathing

Dyspneic means air trapping

Question 36

Loud, low pitched bubbling and gurgling sounds that start early in inspiration and may be present in expiration. May decrease somewhat by auctioning or vouching. It reappear shortly.

Answer 36

Coarse crackles. Inhaled air collides with secretions in the trachea and large bronchi.

Question 37

A very superficial sound that is coarse and low pitched, grating quality. Just like crackles but close to the ear, both inspiratory and expiratory.

Answer 37

Pleural friction rub. When pleurae become inflamed and lose their normal lubricating fluid. Heard in anterolateral wall where greatest lung mobility exists.

Question 38

Low pitched monophonic single note musical snoring, moaning sounds. Heard through the cycle although more prominent on expiration. May clear somewhat by coughing.

Answer 38

Low pitched wheeze. Sonorous rhonchi

Airflow obstruction by the vibrating reed mechanism, same as other wheeze

Question 39

High picture monophonic inspiratory crowing sound, louder in neck than over the chest wall

Answer 39

Stridor

Originating in larynx or trachea, upper airway obstruction from swollen, inflamed tissues or lodged foreign body.