Respiratory Cases Flashcards
Thorax, adventitious sounds, abnormal sounds, normal sounds, bronchitis, emphysema
What is meant by “quality” when assessing the thorax?
Depth: deep or shallow
Which should skin characterisitic should the nurse assess when inspecting the thorax?
A. pallor
B. jaundice
C. erythema
D. cyanosis
D. Cyanosis
Which of the following is an expected finding of respirations?
A. Relaxed, automatic, effortless, regular, even, silent
B. Relaxed, automatic, effortless, regular
C. Relaxed, automatic, use of accessory muscles, grade of 2
D. Relaxed, automatic, regular, easily heard, shallow
A. Relaxed, automatic, effortless, regular, even, silent
Name two steps of palpating the thorax
- Assessing symmetrical expansion
- Assessing tactile fremitus
Where does percussion of the thorax take place?
Over intercostal areas
Where should the nurse begin when percussing the thorax
Begin at apices
How should the nurse compare when percussing the thorax?
Side to side comparison
How far should percussion of the thorax take place?
Down to bases
Which sounds should the nurse be listening for when percussing the thorax?
Resonant sound (normal)
Hyporesonant sound (dullness)
Hyperresonant sound (too loud)
How should the nurse auscultate the thorax?
A. With the bell (low sounds)
B. Placed gently against chest
C. Over breast tissue
D. With the diaphragm (high sounds)
D. With the diaphragm (high sounds)
- Should be placed firmly
- Not over breast tissue or scapula
How should the nurse auscultate the thorax?
A. Left side first before beggining right side
B. Bilaterally in a latter pattern
C. Listen to inhalation
D. Listen to exhalation
B. Bilaterally in a latter pattern
- Listen to full inhale and exhale
How should the nurse instruct the client to breath with auscultating breath sounds?
A. Breath normally
B. Deep breaths
C. Monitor for diziness
D. Both A and C
E. Both B and C
E. Both B and C
Deep breaths and monitor for SOB/ dizziness
Where do we percuss and auscultate the posterior thorax?
10 spots
- Above 1st rib (T1)
- 4th ICS (T4)
- 6th ICS (bottom of scapulae)
- 8th ICS
- 9th ICS
Both left and right sides = 10 spaces
Where should the nurse auscultate and percuss the lateral chest?
5th ICS on the right transverse
Where should the nurse ausultate and percuss the anterior chest?
Above clavicles
2nd ICS
3rd ICS
4th ICS
Right and left = 8 spaces
How many total sites are there for auscultation and percussion of the thorax?
19
Describe the tracheal breath sounds
Pitch: highest
Amplitude: loud
Duration: inspiration equal to expiration
Quality: Very harsh and hollow
Describe bronchial breath sounds
Pitch: high
Amplitude: loud
Duration: Inspiration less than expiration
Quality: Harsh, hollow, tubular
Describe bronchovesicular breath sounds
Pitch: medium
Amplitude: moderate
Duration: Inspiration equal to expiration
Quality: soft blowing
Describe vesicular breath sounds
Pitch: low
Amplitude: soft
Duration: Inspiration greater than expiration
Quality: rustling
What is the definition of fine crackles?
A. discontinuous, high pitched popping heard on inspiration
B. loud, low pitched bubbling heard on early inspiration
C. high pitched musical squeaking heard on expiration
D. high pitched monophonic crowing on inspiration
A. discontinuous, high pitched popping heard on inspiration
Why do fine crackles happen and what could they indicate?
Sudden airway opening
restrictive disease: pneumonia or HF
Obstructive disease: COPD
What is the definiton of course crackles?
A. discontinuous, high pitched popping heard on inspiration
B. loud, low pitched bubbling heard on early inspiration
C. high pitched musical squeaking heard on expiration
D. high pitched monophonic crowing on inspiration
B. loud, low pitched bubbling heard on early inspiration
Why do course crackles happen and what could they indicate?
Air collides with secretions
Pulmonary edema: pneumonia, fribrosis, terminally ill
What is the definition of wheezing?
A. discontinuous, high pitched popping heard on inspiration
B. loud, low pitched bubbling heard on early inspiration
C. high pitched musical squeaking heard on expiration
D. high pitched monophonic crowing on inspiration
C. high pitched musical squeaking heard on expiration
Why does wheezing occur and what could it indicate?
Narrowed passage ways
Diffuse air way obstruction
COPD
What is the definition of stridor?
A. discontinuous, high pitched popping heard on inspiration
B. loud, low pitched bubbling heard on early inspiration
C. high pitched musical squeaking heard on expiration
D. high pitched monophonic crowing on inspiration
D. high pitched monophonic crowing on inspiration
Why does stridor occur and what could it indicate?
Upper airway obstruction
Croup or acute epiglottitis
Foreign body inhalation
What is atelectasis?
Collapsed area of lung
What is pneumothorax?
Air in the pleural space
What is PPD?
Purified protein derivative
Tests for TB
How should you record tactile fremitus?
In a normal patient: tactile fremitus equal bilaterally
How should you document ausculation of respiratory assessment?
Healthy patient: Vesicular breath sounds over peripheral lung fields and equal bilaterally. No adventitious sounds
Which of the following is unique to chronic bronchitis?
A. Daily non-productive cough for three months or more in at least two consecutive years
B. Daily productive cough for three months or more in at least two consecutive years
C. Severe dyspnea
D. Permanent enlargement and destruction of airspaces distal to terminal bronciole
B. Daily productive cough for three months or more in at least two consecutive years
Which of the following is unique to emphysema?
A. Daily non-productive cough for three months or more in at least two consecutive years
B. Elevated hemoglobin
C. Peripheral edema
D. Permanent enlargement and destruction of airspaces distal to terminal bronciole
D. Permanent enlargement and destruction of airspaces distal to terminal bronciole
Abnormal findings: Chronic bronchitis
- Overweight
- Elevated hemoglobin
- Cyanotic
- Peripheral edema
- Thick sputum
- Rhonchi and wheezing
- Daily productive cough for three months or more, in at least two consecutive years
Abnormal findings: emphysema
- Older and thin
- Severe dyspnea
- Quiet chest
- X-ray: hperinflation with flattened disphragms
- Permanent enlargement and destruction of airspaces distal to the terminal bronchiole
A nurse is performing percussion on a patient with chronic bronchitis. What would this sound like?
A. Resonant
B. Hyperresonant
C. Hyporesonant
A. Resonant
When auscultating a patient with chronic bronchitis, what would be expected?
A. Prolonged inspiration
B. Crackles in RUL and LUL
C. Wheezing in RLL and LLL
D. Prolonged inspiration
D. Prolonged inspiration
Crackles: present in RLL and LLL
Wheezing: present in RUL and LUL
Mucous plugs and inflammation in upper airway
Which of the following are subjective findings in a patient with emphysema?
A. Dyspnea on exertion, orthopnea, nocturia, early morning cough
B. Productive cough for 3 months, increasing fatigue and dyspnea over last week, smoking
A. Dyspnea on exertion, orthopnea, nocturia, early morning cough
Answer choice B: related to chronic bronchitis
What inspection finding could indicate emphysema?
Tri-pod position and pursed lip breathing
True or False: A patient with emphysema presents with barrel chest.
True
How would a patient with emphysema breathe?
Shallow
RR 24 (example)
Intercostal retractions
Which of the following percussion sounds could present on a patient with emphysema?
A. Resonance
B. Hyporesonance
C. Hyperresonance
C. Hyperresonance
Abnormally loud breathing sounds
When ausculating the breath sounds of a patient with emphysema, what is expected?
A. Hyporesonance
B. Breath sounds abnormally loud
C. Breath sounds diminished
D. Course crackles
C. Breath sounds diminished
+ expiratory wheeze posterior chest
