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Exam 2 > Respiratory Powerpoint > Flashcards

Respiratory Powerpoint Flashcards

1
Q

Examine the posterior thorax and lungs while the patient is

A

sitting

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2
Q

Examine the anterior thorax and lungs with the patient

A

supine

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3
Q

Anteriorly with percussion, the heart normally produces an area of

A

dullness to the left of the sternum from the 3rd to 5th rib interspaces. Supraclavicular retraction is often present

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4
Q

Inspect the chest; front and back; noting thoracic landmarks for the following:

A

Size and shape, symmetry, color, superficial venous patterns, prominence of ribs

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5
Q

Evaluate respirations for the following

A

rate and rhythm or pattern

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6
Q

Inspect chest movements with breathing for the following

A
  • Symmetry

- Use of accessory muscles

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7
Q

Palpate the thoracic muscles/skeleton

A
  • pulsations
  • tenderness
  • bulges/depressions
  • unusual movement/position
  • elasticity of rib cage
  • immovability of sternum
  • rigidity of thoracic spine
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8
Q

Palpate the chest for the following

A
  • symmetry
  • thoracic expansion
  • sensations such as crepitus, grating vibration
  • tactile fremitus
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9
Q

Percuss on the chest, comparing sides, for the following:

A
  • diaphragmatic excursion

- percussion tone intensity, pitch, duration, and quality

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10
Q

Auscultate the chest with the stethoscope diaphragm, from apex to base, comparing sides for the following:

A
  • Intensity, pitch, duration, and quality of breath sounds
  • Adventitious breath sounds (crackles, rhonchi, wheezes, friction rub)
  • Vocal resonance
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11
Q

Inspect the posterior chest from a midline position behind the patient, note

A

the shape of the chest and the way in which it moves

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12
Q

Percuss chest anterior, lateral, posterior

A

-compare tones bilaterally

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13
Q

Percussion

-Perform from side to side to assess for asymmetry

A
  • strike using the tip of your tapping finger

- use the lightest percussion that produces a clear note

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14
Q

Percussion helps establish whether the underlying tissues (5-7cm deep) are

A

air-filled, fluid-filled, or solid

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15
Q

Percussion Tones

Resonance

A

is normal

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16
Q

Percussion Tones

Hyperresonance indicates

A

hyperinflation

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17
Q

Percussion Tones

Dullness indicates

A

diminished air exchange

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18
Q

Tactile Fremitus - place thumbs at the level of the

A

10th rib with fingers loosely grasping and parallel to the lateral rib cage; watch the distance b/t the thumbs as they move apart during inspiration

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19
Q

Tactile Fremitus

Estimate the extent of

A

diaphragmatic excursion. Descent may be limited by several types of pathologic processes such as pleural effusion, atelectaisis, or diaphragmatic paralysis

20
Q

Posterior Chest
Auscultation
Listen to the breath sounds with the

A

diaphragm of a stethoscope after instructing the patient to breathe deeply through an open mouth

21
Q

Posterior Chest
Auscultation
Move from one side to the other and compare

A

symmetric areas of the lungs

22
Q

Normal breath sounds

Vesicular:

A

Soft and low pitched, low intensity; usually heard over most of both lungs

23
Q

Normal breath sounds

Bronchial:

A

louder and higher in pitch and intensity; usually heard over the manubrium

24
Q

Normal breath sounds:

Bronchovesicular:

A

intermediate intensity and pitch; usually heard over the 1st and 2nd interspaces (major bronchi)

25
Q

Normal breath sounds

Tracheal:

A

very loud and high pitched, heard over trachea and neck

26
Q

Adventitious Sounds

Crackles (formerly called rales)

A

-Heard more often during inspiration and characterized by discrete discontinuous sounds

27
Q

Adventitious Sounds

Fine Crackles

A

High pitched and relatively short in duration

28
Q

Adventitious Sounds

Coarse Crackles

A

Low pitched and relatively longer in duration

29
Q

Adventitious Sounds

Rhonchi

A

Deeper, more rumbling, more pronounced during expiration, more likely to be prolonged and continuous, and less discrete than crackles

30
Q

Adventitious Sounds
Rhonchi
Caused by

A

the passage of air through an airway obstructed by thick secretions, muscular spasm, new growth, or external pressure

31
Q

Adventitious Sounds

Wheezes

A

Continuous, high-pitched, musical sound (almost a whistle) heard during inspiration or expiration

32
Q

Adventitious Sounds
Wheezes
Caused by

A

a relatively high-velocity air flow through a narrowed or obstructed airway

33
Q

Adventitious Sounds
Wheezes
May be caused by the

A

bronchospasm of asthma (reactive airway disease) or acute or chronic bronchitis

34
Q

Adventitious Sounds

Friction Rub

A
  • Occurs outside the respiratory tree

- Dry, crackly, grating, low-pitched sound and is heard in both expiration and inspiration

35
Q

Adventitious Sounds
Friction Rub
Caused by

A

inflamed, roughened surfaces rubbing together

36
Q 
Adventitious Sounds 
Mediastinal Crunch (Hammam Sign)
A

Dry, crackly, grating, low-pitched sound and is heard in both expiration and inspiration

37
Q

Adventitious Sounds
Mediastinal Crunch (Hammam Sign)
Caused by

A

inflamed, roughened surfaces rubbing together

-Occurs outside the respiratory tree

38
Q

Vocal Resonance

Spoken voice transmits sounds through

A

the lung fields that may be heard with the stethoscope

39
Q

The following auditory changes may be present in any condition that consolidates lung tissue

A
  • Bronchophony
  • Pectoriloquy
  • Egophony
40
Q

Vocal resonance diminishes and loses intensity when there is

A

loss of tissue within the respiratory tree (ex. with the barrel chest of emphysema)

41
Q

Bronchophony

A

greater clarity and increased loudness of spoken sounds

42
Q

Pectoriloquy

A

extreme brinchophony where even a whisper can be heard clearly through the stethoscope

43
Q

Egophony

A

Intensity of the spoken voice is increased and there is a nasal quality (E’s become stuffy broad A’s)

44
Q

The sternal angle, also called the manubriosternal joint or Angle of Louis, is the angle formed by the

A

junction of the manubrium and the body of the sternum in the form of a secondary cartilaginous joint (symphysis)

45
Q

The sternal angle is a ____ clinical landmark

A

palpable. The angle is 140 degrees

46
Q

The Angle of Louis or sternal angle marks the approx. level of the

A

2nd pair of costal cartilages and the level of the intervertebral disc b/t T4 and T5

Exam 2 (4 decks)

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