subjective data Flashcards
often seen with common colds, viral infection or bronchitis
white or yellow mucoid sputum
often associated with bacterial infections
yellow or green sputum
indicates blood in the sputum
brown or black sputum
brown or black sputum
hemoptysis
associated with tuberculosis or pneumococcal penumonia
rust colored sputum
may be indicative of pulmonary edema
pink, frothy sputum
indicates narrowing of the airways due to spasm or obstruction
wheezing
another irritant that can seriously affect a person’s respiratory health
second-hands smoke
seen with labored respirations (especially in small children) and is indicative of hypoxia
nasal flaring
normal angle between the nail base and the skin
160 degree
pale or cyanotic nails may indicate
hypoxia
early clubbing
180 degree
late clubbing
greater than 180 degree
spinous process that deviates laterally in the thoracic area may indicate
scoliosis
the ratio of anteroposterior to transverese diameter is
1:2
an increased curve in the thoracic spine common in olfer clients
kyphosis
clients lean forward and use arms to support weight and lift chest to increase breathing capacity , referred to as often seen in COPD
tripod position
pain over the intercostal spaces may be from
inflamed pleurae
pain over the ribs, especially at the costal chondral junctions is a symptoms of
fractured ribs
amos called subcutaneous emphysema, is a crackling sensation (like bone or hairs rubbing against each other) that occurs when air passes through fluid or exudate
crepitus
vibrations of air in the bronchial tubes transmitted to the chest wall
fremitus
is symmetric and easily identified in the upper regions of the lungs
fremitus
usually the result of consolidation +which increases fremitus) or bronchial obstruction, air trapping in emphysema, pleural effusion, or pneumothorax (which all decrease fremitus)
unequal fremitus
unequal chest expansion can occur with
atelectasis
collapse of incomplete expansion
atelectasis
decreased chest excursion at the base of the lungs is characteristics of COPD this is due to decreased
diaphragmatic function
percussion tone elicited during normal lung tissue
resonance
elicits flat tones over the scapula
percussion
elicited in cases of trapped air such as in emphysema and pneumothorax
hyperresonance
excursion should be equal bilaterally and messure ____ in adults
3-5 cm
present when fluid or solid tissue replaces air in the lungs or occupies the pleural space
dullness
three types of normal breath sounds
bronchial, bronchovesicular and vesicular
are popping or crackling sounds heard on inspiration that occur in association with conditions that cause fluid to accumulate within the alveolar and interstitial spaces, such as heart failure or pneumonia.
rales or crackles
low-pitched wheezes or snore-like sounds that can be heard with a stethoscope. Their presence means an obstruction or an increased amount of secretions is in the airways.
rhonchi or whezzes
anteroposterior equals traverses diameter, resulting in a
barrel chest
