Thorax Flashcards
congestive heart failure (trachea, tactile fremitus, percussion, breath sounds, adventitious sounds)
- Trachea - midline
- Tactile Fremitus - decreased
- Percussion – resonant Breath sounds – vesicular
- Adventitious sounds – late inspiratory crackles in the dependent portions of lungs; possibly wheezes.
Notes: engorged capillaries where air exchange is occurring in the lungs
Makes dependent airways deflate.
Pneumothorax (trachea, tactile fremitus, percussion, breath sounds, adventitious sounds)
Trachea – shifted toward opposite side if much air
Tactile Fremitus – decreased to absent over pleural air
Percussion –hyperresonant to tympanic over pleural air
Breath sounds – decreased to absent over pleural air
Adventitious sounds – none, except a possible pleural rub
Pleural Effusion (trachea, tactile fremitus, percussion, breath sounds, adventitious sounds)
Trachea – shifted toward opposite side in large effusion
Tactile Fremitus – decreased to absent
Percussion – dull to flat over fluid
Breath sounds – decreased to absent, but bronchial sounds may be heard near top of large effusion
Adventitious sounds – none, except a possible rub
Note: blocks the transmission of sound and also collapses the alveoli
Asthma (trachea, tactile fremitus, percussion, breath sounds, adventitious sounds)
Trachea - midline
Tactile Fremitus - decreased
Percussion – resonant to hyperresonant
Breath sounds – often obscured by wheezes
Adventitious sounds – wheezes, possibly crackles
Notes:
- constriction in the bronchi, also get edema
- Lungs will overinflate when you have an asthma attack
- Widespread narrowing of the trachobronchial tree as well as bronchospasms
Emphysema (trachea, tactile fremitus, percussion, breath sounds, adventitious sounds)
Trachea - midline Tactile Fremitus - decreased Percussion – hyperresonant Breath sounds – decreased to absent Adventitious sounds –none or scattered coarse crackles in early inspiration and perhaps expiration; or wheezes and rhonchi associated with chronic bronchitis
Note:
- alveoli become distended and patient cannot get the air out
- Hyperresonant percussions – not quite tympanic, like you would hear over the stomach, but there is more air trapped in the lung
Bronchitis (trachea, tactile fremitus, percussion, breath sounds, adventitious sounds)
Trachea - midline
Tactile Fremitus - normal
Percussion – resonant
Breath sounds – vesicular except perhaps over large bronchi or trachea
Adventitious sounds –none or scattered coarse crackles in early inspiration and perhaps expiration; or wheezes and rhonchi
Notes:
- inflammation in the bronchioles
- Copious secretions of mucus
- You can get some airway obstruction
- Productive cough
Consolidation-Pneumonia (trachea, tactile fremitus, percussion, breath sounds, adventitious sounds)
Trachea - midline
Tactile Fremitus – increased over involved area with bronchophony, egophony, whispered pectoriloquy
Percussion – dull over airless area
Breath sounds – bronchial over involved area
Adventitious sounds – late inspiratory crackles over involved area
Atelectasis- Lobar Obstruction (trachea, tactile fremitus, percussion, breath sounds, adventitious sounds)
Trachea: may be shifted towards involved side
Tactile Fremitus: usually absent
Percussion: dull over airless area
Breath sounds: usually absent when bronchial plug.
Adventitious sounds: none
normal lung (trachea, tactile fremitus, percussion, breath sounds, adventitious sounds)
- Trachea: midline
- Tactile Fremitus: normal
- Percussion: resonant
- Breath sounds: vesicular except perhaps over large bronchi or trachea
- Adventitious sounds: none
developmental considerations for older adults
- Chest shows an increased anteroposterior diameter and kyphosis. Person compensates by holding the head extended and tilted back.
- Chest expansion may be somewhat decreased.
- Older person may fatigue easily. Allow brief rest periods with quiet breathing.
developmental considerations for infants and children
- Let the parent hold supported against the chest or shoulder. Offer the stethoscope to children.
- Infants have a rounded thorax until age 6.
- Infants breath through the nose rather than mouth until age 3 months.
- The diaphragm is the major respiratory muscle.
- Infant Rate 30-40
- Auscultation normally is bronchovesicular breath sounds in the peripheral lung field up to age 6.
Anterior Thoracic Cage
- Suprasternal notch
- Sternum (Manubrium, Body, Xiphoid process)
- Manubriosternal angle (“Angle of Louis”)
- Costal angle
Posterior Thoracic Cage
- Vertebra Prominens (C7)
- Spinous Processes
- The inferior border of the scapula is usually at the 7th or 8th rib.
- 12th Rib - palpate midway between spine and side to find the location free tip
what are the 3 lateral reference lines?
- Anterior Axillary
- Posterior Axillary
- Midaxillary lines
subjective data - health history questions
Cough Sputum Dyspnea Orthopnea Chest pain with breathing Hemoptysis Past history of respiratory infections Smoking history Environmental exposure
7 key points of thorax physical assessment
- Inspection
- Respiratory excursion
- Palpate for tactile fremitus
- Percuss for symmetry
- Diaphragmatic excursion
- Auscultate posterior chest
- Repeat inspection, palpation, percussion and auscultation on anterior chest
configurations of the thorax (5 abnormalities)
- barrel chest
- Pectus Excavatum
- Pectus Carinatum
- Scoliosis
- Kyphosis
Anteroposterior : Transverse diameter
Anterior posterior/transverse 1:2
Costal angle should be
facial expressions
- pink puffer: pink complexion, shortness of breath, sitting in tripod position
- blue bloater: cyanosis, right-sided heart failure, this is also caused by COPD, whether that’s chronic bronchitis or emphysema
respiration patterns (normal vs. 5 abnormalities)
- Tachypnea
- Bradypnea
- Kussmaul
- Cheyne-Stokes
- Biot’s
Biot’s
- Less regular than Cheyne-Stokes; periods of increased depth and flow followed by a period of apnea
- Occurs from brain trauma, heat stroke, abscess in the brain
Cheyne-Stokes
- respirations wax and wane in an irregular pattern – shallow to deep, then period of 20 seconds with no breathing at all, and so on
- occurs with increase ICP, renal failure
Kussmaul
- Tachypnea (rapid) but a much deeper breathing than regular tachypnea
- occurs with diabetics
Bradypnea
- less than 10 respirations per minute
- can occur as a result of drugs (morphine), increased intracranial pressure