Respiratory, Breast, & Axillae Flashcards
Functional unit of the lungs
alveoli
The true ribs are?
1 to 7
Rib 8 to 10 are connect to?
cartilage of the 7th rib
The floating ribs are?
11 & 12
Angle of Louis
the articulation between the manubrium and body of the sternum; in line with the second rib
Normal sound of indirect percussion of the lungs?
resonance
Hyperresonace
when air is trapped in the lungs
Tracheal sound
- harsh, high-pitched
- over trachea
- I < E
Bronchial sound
- loud, high-pitched
- next to trachea
- E > I
Bronchial vesicular sound
- next to sternal border; between scapulae
- medium-pitched
- I = E
Vesicular
- soft, low-pitched
- over remainder of lungs
- I > E
How to assess bronchophony
Ausculation Technique
say “99”
normal: muffled
How to assess egophony
Ausculation Technique
say “E:
normal: “eeeee”
How to assess whispered pectoriloquy
whisper “ 1, 2, 3”
normal: faint, almost indistinguishable
Technique used to elicit tactile fremitus?
palpation
Causes of increased tactile fremitus
- fluid in the lungs
- fibrosis
- tumor
- infection
Causes of decreased tactile fremitus
- soft voice
- thick chest muscles
- obesity
- COPD
- pleaural effusion
How to assess for diaphragmatic excursion
percussion
Normal diaphragmatic excursion
3-5 cm; may go up to 7-8 cm in well-fit, althlectic individuals
Causes of decrease diaphragmatic excursion
< 3 cm
- lungs not fully expanding
- emphysema
- atelectasis
- respiratory depression
Asymmetric diaphragmatic excursions indicates?
paralysis or pleural effusion of higher side of chest
Bronchophony sound when lungs are filled with fluid
loud, clear sounds
Ronchi Wheezes (sibilant)
continuous, high-pitched
expected with asthma (blocked airflow)
Ronchi (sonorous)
continuous, low-pitched, snorring, rattling
common with COPD, pneumonia, chronic bronchitis, & cystic fibrosis
Crackles
crackling, bubbling
common in lobar pneumonia
Causes of loud, moist, low-pitched bubbling
coarse crackles
alveoli are filled with fluid
Atelectasis breath sounds
decreased at the lower lobe of the lungs
Causes of atelectasis
- prolonged bed rest of post-op clients
- ineffective coughing
- hypoventilation
External respiration
exchange of O2 and CO2 at the alveoli level of the lungs
Internal respiration
exchange of O2 and CO2 at the cellular level of the lungs
Active phase of respiration
inspiration
Passive phase of respiration
exhalation
Eupnea
normal breathing; regular, rhythmic, even, and labored
Normal breathing for newborns
40-80 breaths/min
Eupnea with occasional sigh still normal breathing
true
Frequent sighs will result in?
hyperventilation
Choanal atresia
- congenital defect
- membrane obstructs the nasal passage of the newborn
- must be managed right away bc it can lead to respiratory failure
Tachypnea
rapid, shallow
Hyperventilation
rapid, deep
Bradypnea
slow, regular
Hypoventilation
slow, irregular, shallow
Cheyne Stokes breathing
regular pattern with periods of apnea
in elderly, dying patients
Ataxia (Biots) breathing
irregular pattern with periods of apnea
common in pts with brain damage
Most common breathing for COPD, asthma, and chronic bronchitis?
obstructive breathing, prolonged expiration
Stridor
heard without stethascope
Pleural friction rub
produced outside of airway; rubbing and dry
Causes of loud, scratchy breath sounds
patient with pleurisy caused by inflammation of the pleura
What to advise a client when using spirometer
- secure lips around the mouthpiece
- take a deep breath in
Elliptical
- normal configuration of chest in adults
- lateral diameter of the chest is 2:1 with anterior posterior diameter of the chest
Normal chest configuration of newborns & toddlers
barrel chest
abnormal finding found in COPD
Scoliosis
lateral deviation of spinal process
Kyphosis
exaggerated curvature of thoracic vertebrae
common in elderly
Lordosis
exaggerated curvature of the lumbar vertebrae
common in pregnant women
Pectus excavatum
(funnel chest)
- funnel chest
- congenital deformity
- depression of the sternum and adjacent cartilage
- compresses the heart and lungs
- cardiac murmurs may be heard
- surgery is indicated
Pectus carinatum
(pigeon chest)
- pigeon chest
- congenital deformity
- forward displacement of the sternum with depression of adjacent cartilage
- no management necessary
Clubbing of the fingers are due to?
- chronic smoking
- hypoxia
- poor tissue perfusion
- nail angle > 160 degrees
Early signs of hypoxia
- ALOC
- anxiety or confusion
- if not corrected, results in hypertension
Most important question to as a patient with rhinitis
Hx of allery
Normal findings of tansillumination of the sinuses
red glow
Absence of transillumination of sinuses indicates?
fluid filled sinuses
What to do if patient complains of sinus headache
- assess for transillumination of sinuses
or - direct percussion of sinuses
What is responsible for milk production in post-partum patients?
acini cells
Supernumerary nipples
minor congenital malformation
- additional nipples that occurs along the breastline from the armpit to the groin
- misdiagnosed as moles
Most breast tumors are located in the?
upper outer quadrant of the breast
SB for elderly
same day and same time
monthly
SB for female still menstruating
3-5 days after cycle
hormones are more stable
Fibroadenoma
- well-defined breast tumor
- no tenderness/discharge
- common in adolescent girls to 30 y/o
Intraductal papilloma
most common cause of benign nipple discharge of menopausal female
Orange peel appearance on skin of breast is a sign of?
breast malignancy or cancer
Action for asthma exacerbations
- measure airflow (pulmonary function test)
- admin albuterol as prescribed
- monitor PICC flow
- monitor for development of sudden absence of wheezing
