Respiratory Powerpoint Flashcards
Examine the posterior thorax and lungs while the patient is
sitting
Examine the anterior thorax and lungs with the patient
supine
Anteriorly with percussion, the heart normally produces an area of
dullness to the left of the sternum from the 3rd to 5th rib interspaces. Supraclavicular retraction is often present
Inspect the chest; front and back; noting thoracic landmarks for the following:
Size and shape, symmetry, color, superficial venous patterns, prominence of ribs
Evaluate respirations for the following
rate and rhythm or pattern
Inspect chest movements with breathing for the following
- Symmetry
- Use of accessory muscles
Palpate the thoracic muscles/skeleton
- pulsations
- tenderness
- bulges/depressions
- unusual movement/position
- elasticity of rib cage
- immovability of sternum
- rigidity of thoracic spine
Palpate the chest for the following
- symmetry
- thoracic expansion
- sensations such as crepitus, grating vibration
- tactile fremitus
Percuss on the chest, comparing sides, for the following:
- diaphragmatic excursion
- percussion tone intensity, pitch, duration, and quality
Auscultate the chest with the stethoscope diaphragm, from apex to base, comparing sides for the following:
- Intensity, pitch, duration, and quality of breath sounds
- Adventitious breath sounds (crackles, rhonchi, wheezes, friction rub)
- Vocal resonance
Inspect the posterior chest from a midline position behind the patient, note
the shape of the chest and the way in which it moves
Percuss chest anterior, lateral, posterior
-compare tones bilaterally
Percussion
-Perform from side to side to assess for asymmetry
- strike using the tip of your tapping finger
- use the lightest percussion that produces a clear note
Percussion helps establish whether the underlying tissues (5-7cm deep) are
air-filled, fluid-filled, or solid
Percussion Tones
Resonance
is normal
Percussion Tones
Hyperresonance indicates
hyperinflation
Percussion Tones
Dullness indicates
diminished air exchange
Tactile Fremitus - place thumbs at the level of the
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
Tactile Fremitus
Estimate the extent of
diaphragmatic excursion. Descent may be limited by several types of pathologic processes such as pleural effusion, atelectaisis, or diaphragmatic paralysis
Posterior Chest
Auscultation
Listen to the breath sounds with the
diaphragm of a stethoscope after instructing the patient to breathe deeply through an open mouth
Posterior Chest
Auscultation
Move from one side to the other and compare
symmetric areas of the lungs
Normal breath sounds
Vesicular:
Soft and low pitched, low intensity; usually heard over most of both lungs
Normal breath sounds
Bronchial:
louder and higher in pitch and intensity; usually heard over the manubrium
Normal breath sounds:
Bronchovesicular:
intermediate intensity and pitch; usually heard over the 1st and 2nd interspaces (major bronchi)
Normal breath sounds
Tracheal:
very loud and high pitched, heard over trachea and neck
Adventitious Sounds
Crackles (formerly called rales)
-Heard more often during inspiration and characterized by discrete discontinuous sounds
Adventitious Sounds
Fine Crackles
High pitched and relatively short in duration
Adventitious Sounds
Coarse Crackles
Low pitched and relatively longer in duration
Adventitious Sounds
Rhonchi
Deeper, more rumbling, more pronounced during expiration, more likely to be prolonged and continuous, and less discrete than crackles
Adventitious Sounds
Rhonchi
Caused by
the passage of air through an airway obstructed by thick secretions, muscular spasm, new growth, or external pressure
Adventitious Sounds
Wheezes
Continuous, high-pitched, musical sound (almost a whistle) heard during inspiration or expiration
Adventitious Sounds
Wheezes
Caused by
a relatively high-velocity air flow through a narrowed or obstructed airway
Adventitious Sounds
Wheezes
May be caused by the
bronchospasm of asthma (reactive airway disease) or acute or chronic bronchitis
Adventitious Sounds
Friction Rub
- Occurs outside the respiratory tree
- Dry, crackly, grating, low-pitched sound and is heard in both expiration and inspiration
Adventitious Sounds
Friction Rub
Caused by
inflamed, roughened surfaces rubbing together
Adventitious Sounds Mediastinal Crunch (Hammam Sign)
Dry, crackly, grating, low-pitched sound and is heard in both expiration and inspiration
Adventitious Sounds
Mediastinal Crunch (Hammam Sign)
Caused by
inflamed, roughened surfaces rubbing together
-Occurs outside the respiratory tree
Vocal Resonance
Spoken voice transmits sounds through
the lung fields that may be heard with the stethoscope
The following auditory changes may be present in any condition that consolidates lung tissue
- Bronchophony
- Pectoriloquy
- Egophony
Vocal resonance diminishes and loses intensity when there is
loss of tissue within the respiratory tree (ex. with the barrel chest of emphysema)
Bronchophony
greater clarity and increased loudness of spoken sounds
Pectoriloquy
extreme brinchophony where even a whisper can be heard clearly through the stethoscope
Egophony
Intensity of the spoken voice is increased and there is a nasal quality (E’s become stuffy broad A’s)
The sternal angle, also called the manubriosternal joint or Angle of Louis, is the angle formed by the
junction of the manubrium and the body of the sternum in the form of a secondary cartilaginous joint (symphysis)
The sternal angle is a ____ clinical landmark
palpable. The angle is 140 degrees
The Angle of Louis or sternal angle marks the approx. level of the
2nd pair of costal cartilages and the level of the intervertebral disc b/t T4 and T5
