Respiratory and Thorax Flashcards
What’s subjective with regards to the thorax?
Cough, shortness of breath, chest pain with breathing, history of respiratory infections, smoking history, environmental exposure, self-care behaviors
What to look for when inspecting the thorax?
Shape and configuration of the thorax, skin color and condition, facial expression, LOC, work of breathing?, vital signs
What is normal as far as respiratory rate goes? What’s abnormal?
Normal is 10-20 breaths per minute.
Bradypnea is <10 per minute
Tachypnea is >24 per minute
How long do acute and chronic coughs last?
Acute lasts less than 2/3 weeks while chronic lasts over 2 months.
White or clear sputum?
Colds, bronchitis, viral infections
Yellow or green sputum?
Bacterial infections
Rust-colored sputum?
TB, pneumococcal pneumonia
Pink/frothy sputum?
Pulmonary edema, some sympathomimetic meds have a side effect of pink-tinged mucus
Shortness of breath
Difficulty breathing when supine
Awakening from sleep with SOB and needing to be upright to achieve comfort
Dyspnea
Orthopnea
Paroxysmal nocturnal dyspnea
What does timing of coughs indicate?
Continuous: acute illness
Afternoon/evening: May be exposure to irritants at work
Night: postnasal drip, sinusitis
Early morning: chronic bronchial inflammation of smokers
Explain the ratio of the thoracic cage and what’s to be expected
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.
Name some objective findings for COPD
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.
What can be a sign of hypoxia?
Anxiety because of difficulty breathing
Fragmented platelets become trapped in the fingertip vasculature, releasing platelet-derived growth factor and promoting growth of vessels.
Clubbing of the nails. Inner edge of nail elevates, nail bed angle is greater than 180 degrees. Distal phalanx looks rounder, wider, and shiny.
Taking very rapid, deep breaths to counteract ketoacidosis, trying to blow off CO2.
Kussmaul diabetics
A coarse, crackling sensation palpable over the skin surface.
Crepitus
Occurs in subcutaneous emphysema when air escapes the lungs and enters the subcutaneous tissue, as after open thoracic injury or surgery.
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?
Resonance
Hyperresonance
Signals abnormal density in the lungs, as with pneumonia, pleural effusion, atelectasis, or tumor
What areas might help with labored breathing?
Suprasternal, supraclavicular, subcostal, substernal, intercoastal
Trapezius, scalenus, sternomastoid muscles
Also flared nostrils
Where should the hands be placed to check for symmetric chest expansion?
Between the levels of T9 and T10
What parts of tissue does percussion set into motion? Abnormal findings?
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.
When standing behind the person listening to breath sounds, where should the scope be placed/which lung areas to listen to?
Posterior from the apices at C7 to the bases around T10
Laterally from the axilla down to the 7th or 8th rib
What normal breath sounds are high pitched with a loud amplitude? Explain sounds.
Bronchial/tracheal.
Inspiration takes less time than expiration.
Harsh, hollow, tubular quality.
Located in the trachea and larynx.
What normal breath sounds are moderately pitched and moderate amplitude?
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.
What normal breath sounds are low pitched with soft amplitude?
Vesicular
Inspiration takes more time than expiration.
Rustling quality.
Located over the puerperal lung fields where air flows through smaller bronchioles and alveoli.
Added sounds that are not normally heard in the lungs. If present, they are heard as being superimposed on the breath sounds.
Adventitious sounds.
Caused by moving air colliding with secretions in the tracheobronchial passageways or by the popping open of previously deflated airways.
Discontinuous popping sounds heard over inspiration that are not cleared by coughing
Fine crackles. Inhaled air collides with previously deflated airways; airways suddenly pop open, creating sound.
Exploratory crackles are sudden airway closing.
Continuous high pitched musical sounds. Predominate in expiration but may occur in both.
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.
Non-pathologic short, popping sounds that last only a few breaths. Caused by?
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.
What are special considerations for the older adult when it comes to respiratory?
Costal cartilage becomes calcified with aging. Thorax is less mobile. Chest expansion is decreased. Chest cage anteroposterior diameter may be increased.
What are the current American Cancer Society guidelines for breast cancer?
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
Increase in both rate and depth of breathing. Normally occurs with extreme exertion, fear, anxiety.
Hyperventilation.
Blows off CO2, causing a decreased level in the blood (alkalosis).
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.
Hypoventilation
A cycle in which respirations gradually wax and wane in a regular pattern, increasing in rate and depth and then decreasing.
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.
Similar to Cheyne-Stokes respiration except that the pattern is irregular. The cycle length is variable lasting anywhere from 10 seconds to 1 minute.
Biot respiration
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.
Chronic obstructive breathing
Dyspneic means air trapping
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.
Coarse crackles. Inhaled air collides with secretions in the trachea and large bronchi.
A very superficial sound that is coarse and low pitched, grating quality. Just like crackles but close to the ear, both inspiratory and expiratory.
Pleural friction rub. When pleurae become inflamed and lose their normal lubricating fluid. Heard in anterolateral wall where greatest lung mobility exists.
Low pitched monophonic single note musical snoring, moaning sounds. Heard through the cycle although more prominent on expiration. May clear somewhat by coughing.
Low pitched wheeze. Sonorous rhonchi
Airflow obstruction by the vibrating reed mechanism, same as other wheeze
High picture monophonic inspiratory crowing sound, louder in neck than over the chest wall
Stridor
Originating in larynx or trachea, upper airway obstruction from swollen, inflamed tissues or lodged foreign body.
