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Assessment > Respiratory & Thorax > Flashcards

Respiratory & Thorax Flashcards

1
Q

Normally we think of the ABCs in an emergency. What order should we consider during cardiac arrest?

A

CAD – we want to move that blood!

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2
Q

Name three anterior thoracic landmarks:

A
  • SUPRASTERNAL NOTCH
  • STERNUM
  • COSTAL ANGLE
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3
Q

Name three posterior thoracic landmarks:

A
  • SPINOUS PROCESSES
  • INFERIOR BORDER OF SCAPULA
  • TWELFTH RIB
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4
Q

The upper lobes of the lungs take up a very ________ amount of space.

A

Small

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5
Q

The right lung is shorter/longer because of the _______.

A

Shorter, liver

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6
Q

How many lobes does the right lung have?

A

3

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7
Q

Name the lobes of the right lung:

A
  • RUL
  • RML
  • RLL
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8
Q

The left lung is ___________ because of the _________.

A

Narrower, heart

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9
Q

Name the lobes of the left lung:

A
  • LUL

* LLL

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10
Q

The left lung has no ___________ lobe.

A

Middle

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11
Q

Anterior lung fields are best heard where?

A

Upper lobes

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12
Q

When auscultating the RML, how should the patient be positioned if they are laying down?

A

On their side

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13
Q

Posterior lung fields begin at ____ spinous process.

A

C7

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14
Q

Posterior lung fields extend to ______ on expiration.

A

T10

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15
Q

Posterior lung fields extend to ______ on inspiration.

A

T12 (with full lung capacity)

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16
Q

Posterior lung fields are best heard where?

A

Lower lobes

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17
Q

Which lobe is not accessible posteriorly?

A

RML

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18
Q

Pneumonia is more likely to be heard in the _____________ lungs.

A

Lower posterior

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19
Q

What are some things to ask when doing a health history re: respiratory?

A

• CHRONIC RESPIRATORY PROBLEMS (COPD, ASTHMA, CHRONIC BRONCHITIS)
• COUGH
- PRODUCTIVE – COLOR, NONPRODUCTIVE, HEMOPTYSIS
• SHORTNESS OF BREATH
• CHEST PAIN WITH BREATHING (plural friction)
• SMOKING/VAPING HISTORY
- PACK (PPD), & # OF YEARS
• ENVIRONMENTAL EXPOSURE
• OCCUPATIONAL EXPOSURE
• MEDICATIONS
• SELF-CARE BEHAVIORS

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20
Q

What is hemoptysis?

A

The spitting of blood that originated in the lungs or bronchial tubes

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21
Q

This to observe during inspection re: respiratory:

A 
ANY VISIBLE DISTRESS?
• EASE AND EFFORT OF BREATHING
• (DYSPNEA, ORTHOPNEA)
• CHEST MOVEMENT (USE OF ACCESSORY MUSCLES) 
• SPUTUM – COLOR, CONSISTENCY, AMOUNT
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22
Q

What is orthopnea?

A

The sensation of breathlessness in the recumbent position, relieved by sitting or standing.

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23
Q

When auscultating the chest, what are you listening for?

A

Can you hear any audible breath sounds?

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24
Q

Name some problematic breath sounds:

A

Stridor, wheeze, bubbling/gurgling, snoring, gasping.

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25
Q

When assessing HOW the patient is breathing, what are you checking?

A
  • RATE (TACHYPNEA, BRADYPNEA, APNEA)
  • VOLUME (HYPERVENTILATION, HYPOVENTILATION)
  • DEPTH (DEEP, NORMAL, SHALLOW)
  • RHYTHM (REGULAR, PAUSES)
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26
Q

What is a normal respiratory rate?

A

12-20 breaths per minute

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27
Q

What is a normal breathing rate called (fancy medical term)?

A

Eupnea

28
Q

What is the normal breathing rate for a newborn?

A

30-60 breaths per minute

29
Q

What is the name for an increased respiration rate?

A

Tachypnea

30
Q

What are some causes of tachypnea?

A

PNEUMONIA, PULMONARY EDEMA, ACIDOSIS, SEPTICEMIA, PAIN

31
Q

What is the name for a decreased respiration rate?

A

Bradypnea

32
Q

What is a potential cause of bradypnea?

A

ICP INCREASE DUE TO DRUG OD

33
Q

What happens during hyperventilation?

A
  • DEPTH & RATE INCREASES
  • DEEP AND REGULAR
  • > 24 BREATH/MIN
34
Q

What happens during hypoventilation?

A
  • DEPTH & RATE DECREASE, SHALLOW & IRREGULAR
  • < 10 BREATHS/MIN
  • CAN SEE WITH PROLONGED BED REST, NARCOTICS
35
Q

What is apnea?

A

Not breathing (transient cessation of breathing, 10-20 seconds)

36
Q 
Name this breathing pattern:
• RATE AND DEPTH ARE VARIABLE, REGULAR-
IRREGULAR RHYTHM CYCLES SLOW AND SHALLOW TO DEEP AND FAST, WITH PERIODS OF APNEA
• DEATH RATTLES
• DEATH RALES
A

Cheyne-stokes

37
Q

Name this breathing pattern:
• RATE & DEPTH CAN BE VARIABLE, IT IS IRREGULAR,
IMAGE SHOWS INCREASED DEPTH AND RATE W/ ABRUPT PAUSES
• ASSOC W/ H ICP (INCREASED INTRACRANIAL
PRESSURE)
• Also called “ataxic breathing”

A

Biots

38
Q 
Name this breathing pattern:
• REGULAR BUT ABNORMALLY DEEP AND
INCREASED IN RATE
• AIR HUNGER 
• ACIDOTIC BREATHING
• RAPID AND DEEP
A

Kussmaul respirations

This is a type of hyperventilation

39
Q

What breathing pattern is seen with things like TBI, post-stroke, carbon monoxide poisoning?

A

Cheyne-stokes

40
Q

What breathing pattern is seen with things like diabetic ketoacidosis, exercise, metabolic acidosis, renal failure.

A

Kussmaul

41
Q

What is pectus carinatu?

A

An uncommon birth defect in which a child’s breastbone protrudes outward abnormally.

42
Q

What is pectus excatavum?

A

A condition in which a person’s breastbone is sunken into his or her chest.

43
Q

What posture is a curvature of the spine measuring 50 degrees or greater on an X-ray, presents hunchback, stooped; from damaged or compressed vertebrae?

A

Kyphosis

44
Q

What posture is a sideways curvature of the spine assessed often in middle-school, can be idiopathic.

A

Scoliosis

45
Q

For what are you assessing in the spine?

A
  • TENDERNESS
  • TEMPERATURE
  • SKIN INTEGRITY
  • POSITION OF TRACHEA
  • THORACIC EXPANSION
46
Q

What is tactile fremitus?

A

Also known as tactile vocal fremitus, refers to the vibration of the chest wall that results from sound vibrations created by speech or other vocal sounds

47
Q

How do you test for tactile fremitus?

A
  • USE PALMAR OR ULNAR SURFACE
  • PALPATE VOCAL SOUNDS, I.E. PATIENT REPEATS “99”
  • SYSTEMATICALLY PALPATE SIDE TO SIDE IN SAME ARE
48
Q

What are “normal” tactile fremitus results?

A

PALPABLE (FAINT) VIBRATIONS OF CHEST WALL OVER LUNG FIELDS FROM SPEECH OR SOUNDS

49
Q

What is crepitus?

A
  • SUBCUTANEOUS EMPHYSEMA

* AIR LEAKS INTO THE SUB-Q TISSUE

50
Q

Re: Palpation over lungs. What do healthy lungs feel like?

A
  • RESONANCE OVER LUNG FIELDS: LOW PITCHED, CLEAR, HOLLOW
51
Q

What are some unhealthy lung palpation feels?

A
  • ASYMMETRY IN PERCUSSION NOTES

* AREAS OF DULLNESS OR FLATNESS OVER LUNG TISSUE

52
Q

Name 3 normal breath sounds:

A

BRONCHIAL, BRONCHO - VESICULAR, and VESICULAR

53
Q

Talk about vesicular breath sounds (where are they heard? Where are they heard best? What is making these sounds?):

A
  • AUDIBLE OVER MOST OF THE ANTERIOR, POSTERIOR AND LATERAL LUNG AREAS
  • HEARD BEST AT BASES
  • SOFT BREEZY QUALITY AND OCCUR MAINLY DURING INSPIRATIONS
  • CREATED BY AIR MOVING THROUGH THE BRONCHIOLES AND ALVEOLI
54
Q

Talk about bronchial breath sounds (where are they heard? What do they sound like?):

A
  • HEARD AROUND THE TRACHEA

* HIGH PITCHED AND “HARSH” WITH A LONG, LOUD EXPIRATION

55
Q

Talk about broncho-vesicular breath sounds (where are they heard? What do they sound like? When are they heard?):

A
  • NEAR THE STERNUM AND BETWEEN THE SCAPULAE
  • MODERATE PITCH AND INTENSITY—”BLOWING”
  • OCCUR EQUALLY OVER INSPIRATION AND EXPIRATION
56
Q

Name this breath sound:
• CRACKLING OR POPPING SOUNDS OF VARYING INTENSITY
• MAY BE DESCRIBED AS FINE OR COARSE
• CANNOT BE CLEARED BY COUGHING
• CAUSED BY AIR PASSING THROUGH FLUID OR MUCUS
• FINE VS COURSE

A

CRACKLES (FKA RALES)

57
Q

Name this breath sound:
• LOW-PITCHED, COARSE, GURGLING, LOUDER SOUNDS
• MAY HAVE MOANING OR SNORING QUALITY
• MAY BE ALTERED OR CLEARED BY COUGHING
• CAUSED BY AIR PASSING THROUGH NARROWED AIR PASSAGES DUE TO SECRETIONS, SWELLING OR TUMORS

A

RHONCHI (FKA GURGLES)

58
Q

Name this breath sound:
• WHISTLING SOUND
• MAY BE DESCRIBED AS SONOROUS, MUSICAL, MOANING
• DESCRIBE RELATED TO INSPIRATION/EXPIRATION
• CAUSED BY AIR PASSING THROUGH A CONSTRICTED BRONCHUS DUE TO SECRETIONS, SWELLING OR TUMOR
• MORE PRONOUNCED ON EXPIRATION
• CAN SOMETIMES HEAR WITH NO STETHOSCOPE

A

Wheezing

59
Q

Name this breath sound:
• SQUEAKING OR GRATING SOUND
• HEARD IN LATERAL LUNG FIELDS DURING INSPIRATION AND EXPIRATION
• HEARD OFTEN IN AREA OF AREAS OF GREATEST THORACIC EXPANSION
• CAUSED BY THE RUBBING TOGETHER OF INFLAMED PLEURAL SURFACE

A

PLEURAL FRICTION RUB

60
Q 
Name this breath sound:
• USUALLY CAN BE HEARD WITHOUT A STETHOSCOPE
• CROWING NOISE
• HEARD DURING INSPIRATION
• THINK OBSTRUCTION OR SWELLING
A

STRIDOR

61
Q

If you ask you patient to cough, which sound will NOT go away and which will?

A

Crackles will not go away, rhonchi will

62
Q

What is egophony?

A

Increased resonance of voice sounds heard when auscultating the lungs.

63
Q

What is pectoriloquy?

A

The sound of words heard through the chest wall and usually indicating a cavity or consolidation of lung tissue

64
Q

What is bronchophony?

A

The abnormal transmission of sounds from the lungs or bronchi. Bronchophony is a type of pectoriloquy.

65
Q

What are some tests related to pulmonary function?

A
  • PEAK FLOW METER
  • PULMONARY FUNCTION TEST (tidal volume, etc)
  • ARTERIAL BLOOD GAS
  • INCENTIVE SPIROMETER (10/hr)
66
Q

Talk about how the effects ageing has on pulmonary function?

A

• THORAX MAY BECOME MORE ROUNDED, DUE TO
KYPHOSIS (OSTEOPOROSIS).
• LOSS OF SKELETAL MUSCLE STRENGTH + CONSTANT
LUNG INFLATION CAUSES THE ANTEROPOSTERIOR
DIAMETER OF THE CHEST TO WIDEN—BARREL CHEST.
• BREATHING RATE AND RHYTHM ARE UNCHANGED AT
REST—INCREASED WITH EXERCISE—TAKES LONGER
TO RETURN TO BASELINE.
• DEFLATION OF LUNGS IS INCOMPLETE
• ELASTIC TISSUE OF THE ALVEOLI LOSES IT
STRECHABILITY AND CHANGES FIBROUS TISSUE,
WHICH DECREASES EXERTIONAL CAPACITY.

Assessment (5 decks)

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