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Patient Assessment > Thorax and Lung review > Flashcards

Thorax and Lung review Flashcards

1
Q

2nd intercostal space is used for

A

needle insertion for tension penumothorax

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2
Q

angle of louis

A

sternal angle
-5 cm lower than suprasternal notch

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3
Q

4th intercostal space is used for

A

chest tube insertion

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4
Q

level of the 4th rib

A

endotracheal tube on chest xray

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5
Q

7th intercostal space is for

A

thoracentesis needle

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6
Q

What vertebra is the most protruding process when neck is flexed?

A

c7 vertebra

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7
Q

What spinous process does the lower border of the lung lie around?

A

T10

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8
Q

Where should the RML be assessed along?

A

right anterior axillary line

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9
Q

Traits of the right main bronchus

A

wider, shorter and more vertical

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10
Q

common or concerning symptoms of thorax and lung analysis

A

dyspnea
wheezing
cough
hemoptysis
angina pectoralis
daytime fatigue
snoring

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11
Q

History to obtain for Dyspnea

A

-occurs at rest or exertion?
-pt’s daily exercise as a basis
-Timing, setting, any associated symptom and A/A factors
-

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12
Q

in dyspnea secondary to anxiety

A

-rest and exercise
-hyperventilation
-difficulty breathing/smothering sensation
-paresthesia around lips or extremities

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13
Q

Left sided heart failure

A

slow progression of dyspnea or sudden onset if pulmonary edema
associated symptoms: orthopnea, paroxysmal nocturnal dyspnea, sometimes wheezing

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14
Q

Chronic bronchitis

A

chronic productive cough
slowly progressive dyspnea
-recurrent respiratory infections, wheezing
-HX of smoking, exposure to air pollutants, COPD

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15
Q

COPD

A

-slowly progressive dsypnea
-cough with scant mucoid sputum
-hx of smoking, air pollutants, familial alpha1-antitrypsin deficiency

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16
Q

Asthma

A

reversible bronchoconstriction
-symptom free periods
-nocturnal episodes common
-wheezing, cough, tightness in the chest
-Aggravated by allergens, irritants, respiratory infection, exercise, cold and emotional

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17
Q

Diffuse Interstitial Lung Disease

A

progressive dyspnea with rate variable due to cause
-exertion aggravates
-weakness and fatigue
-cough is less common

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18
Q

Pneumonia

A

acute illness
-aggravated by exertions, smoking
-symptoms: pleuritic pain, sputum, fever (not present in much)

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19
Q

Spontaneous Pneumothorax

A

air pleural space w partial or full lung collapse
-sudden dyspnea
-pleuritic pain, non productive cough
COMMON: tall & young males, hx of emphysema

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20
Q

Acute Pulmonary Embolism

A

sudden dyspnea and tachypnea
-no associated symptoms
(sometimes: unilateral leg swelling, retrosternal oppressive pain, pleuritic pain, cough, syncope, hemoptysis, DVT)
-RISK FACTORS: Post-partum, Post-op, bed-rest, heart failure, COPD, fractures of the hips or legs, DVT, hypercoagubility

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21
Q

Anxiety with Hyperventilation

A

over breathing resulting in alkalosis
-@ rest
-symptoms: sighing, lightheadedness, numbness or tingling, palpitations, angina pectoralis

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22
Q

Duration of Coughs

A

Acute: < 3 weeks
subactute: 3-8 weeks
Chronic: >8 weeks

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23
Q

Color of Sputum

A

Yellow/green=bacterial
Clear/white= viral

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24
Q

Foul odor of sputum

A

indicates lung absess

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25
Q

Symptoms to help determine cause of a cough

A

fever, wheezing, chest pain, dyspnea, orthopnea

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26
Q

Hemopytsis

A

-determine the volume, setting and activity, and associated symptoms

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27
Q

Cough and Hemoptysis

A
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28
Q

Pink frothy sputum seen with

A

left heart failure

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29
Q

What to ask with chest pain

A

location of pain
-attributes of chest pain

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30
Q

Tearing from the front of the chest to the back

A

aortic dissection

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31
Q

Initial Survey signs of Respiratory Distress

A

tachypnea
Cyanosis or pallor
clubbing of fingernails
Audible breath sounds
accessory muscle use
tracheal displacement
shape of chest

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32
Q

Tracheal displacement is seen in

A

tension pneumothorax, pleural effusion, atelectasis

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33
Q

Inspection checks for

A

deformities or asymmetry in chest expansion
intercostal retractions
impaired respiratory movements

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34
Q

Palpation Identifies

A

Areas of tenderness
palpable crepitus (grating sound)
Masses
Test fo chest expansion
Vocal fremitus

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35
Q

Palpation Process

A

-Chest expansion (front and back- check how far your thumbs expand)
-Tactile Fremitus (say 99 and use ulna down the chest. 4 on the back and 3 down the front)
-assess for masses

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36
Q

Causes of Unilateral Decrease in chest expansion

A

chronic fibrosis
pleural effusion
lobar pneumonia
pleural pain with splinting
unilateral bronchial obstruction
paralysis of hemi-diaphragm

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37
Q

Causes of asymmetric decreased tactile fremitus

A

chest impeded by thick chest wall
obstructed bronchus
COPD
pleural effusion
fibrosis
pneumothorax
malignancy
asthma

38
Q

cause of asymmetric increased tactile fremitus

A

unilateral pneumonia

39
Q

Percussion process

A

Percuss the back (14 total, 5 down the middle, 2 on the sides)
Diaphragmatic excursion

40
Q

Flat percussion sound examples

A

pleural effusion

41
Q

Dull percussion sound

A

lobar pneumonia
atelectasis
pleural effusion
hemothorax
tumor

42
Q

Resonant

A

Healthy lung sound!
Chronic bronchitis
asthma (between attacks)

43
Q

Hyperresonant

A

Unilateral with pneumothorax
COPD
Asthma attack

44
Q

Tympanitic

A

Large pnuemothorax

45
Q

Diaphragmatic excursion

A

Identify the diaphragm and then find the dullness
mark the dullness at full inspiration and full expiration

46
Q

Normal diaphragmatic excursion

A

3-5.5cm

47
Q

Auscultation

A

Ask for the pt to breath through their mouth
-ladder position, 14 on the back, 12 on the front

Go through Egophony, bronchophony and whispered pectoriloquy

48
Q

Vesicular Breath Sounds

A

Inspiratory > Expiratory
soft
low pitch
heard over both lungs

49
Q

Broncho-Vesicular breath sounds

A

inspiratory = expiratory
intermediate sound
intermediate pitch
-in the 1st and second interspaces and between the scapula

50
Q

Bronchial Breath sounds

A

Expiratory > inspiratory
Loud
high Pitch
over the large proximal airways

51
Q

Tracheal breath sounds

A

inspiratory=expiratory
very loud
high pitch
over the trachea

52
Q

Crackles (Rales)

A

popping
-dots in time, non musical, brief
-Fine=high pitched
-Coarse= louder and lower pitched

53
Q

Wheezing Breath Sounds

A

Asthma, COPD, airway obstruction
-dashes in time
-high pitched

54
Q

Rhonchi

A

“snoring”
secretions in the large airways
-dashes in time
-low pitched

55
Q

Crackles is caused by

A

abnormalities of the lungs
pneumonia
lung disease
pulmonary fibrosis
heart failure
bronchitis and bronchiectasis

56
Q

Wheezing is caused by

A

narrowed airways of asthma
COPD
bronchitis

57
Q

Egophony

A

ask pt to say “eee”
negative (“eee”)
positive (“aye”)
positive= lung consolidation

58
Q

Whispered Pectoriloquy

A

ask pt whisper “99”
normal (heard faintly)
abnormal (words heard clerarly)
Indicates= tissue has lost air (pneumonia)

59
Q

Bronchophony

A

ask pt to say “99”
normal (sounds are muffled and indistinct)
abnormal (sounds are clear)

High pitched sounds indicates lung tissue has lost air

60
Q

Egophony, bronchophony and whispered pectoriloquy are seen in

A

lobar consolidation and pneumonia

61
Q

Normal adult chest inspection

A

Lateral Diameter > AP diameter
0.7-0.9 ratio
Increases with age

62
Q

Funnel Chest

A

Pectus excavtum
-depression in lower portion of the sternum
-cause murmurs and heart compression

63
Q

Pectus Carinatum

A

Pigeon chest
Sternum displaced anteriorly, increases the diameter of AP
-costal cartilages near sternum are depressed

64
Q

Barrel Chest

A

increased AP diameter
-normal during infancy and old age
-COPD

65
Q

Traumatic Flail Chest

A

Multiple rib fractures cause paradoxical movement of the thorax
-Inspiration: injured area caves inward
-expiration: it moves outward

66
Q

Thoracic Kyphoscoliosis

A

Abnormal spinal curvatures
vertebral rotation deform the chest

67
Q

Special Techniques

A

6-minute walk test
Forced Expiratory Time (FET)
Fractured rib test

68
Q

6 minute walk test

A

measures the distance a patient can walk on hard, flat, for 6 minutes
-100 ft minimum
-predictor of clinical outcome of COPD

69
Q

FET

A

PT: deep breath in and out as quickly as possible with mouth open
Listen over the trachea
slow expiratory time >5 seconds

70
Q

Pts >60 yo and FET of >9 seconds are

A

4x more likely to have COPD

71
Q

Identification of a Fractured Rib

A

Compress the chest in the AP plane
-one hand on sternum and one on the thoracic spine and squeeze
-pain distal to your hands=rib fracture

72
Q

Normal Physical Findings

A

Resonant
Trachea Midline
Vesicular Breath sounds
No adventitious sounds
Normal tactile fremitus and voice sounds

73
Q

Left sided heart failure physical findings

A

Resonant
midline trachea
vesicular breath sounds
Late inspiratory crackles
possible wheezing
normal tactile fremitus and voice sounds

74
Q

Chronic Bronchitis Physical Findings

A

Resonant
Midline trachea
Vesicular breath sounds
no adventitious sounds (sometimes scattered wheezing, crackles or rhonchi)
normal tactile fremitus

75
Q

Lobar Pneumonia Physical Findings

A

Dull
Midline Trachea
Bronchial sounds (Over affected lobe)
Late inspiratory crackles
Increased tactile fremitus
Abnormal egophony, bronchophony and whispered pectorlioquy

76
Q

Partial Lobar Obstruction (atelectasis) Physical findings

A

Dull
Tracheal shift (toward injured side)
Absent breath sounds
No adventitious sounds
absent tactile fremitus and transmitted voice sounds

77
Q

Pleural Effusion Physical findings

A

Dull to flat
shifted trachea toward the unaffected side
Decreased breath sounds
No adventitious sounds (sometimes wheezes, crackles, rhonchi)
Decreased tactile fremitus or voice sounds

78
Q

Pneumothorax Physical Findings

A

Hyperresonant/tympanitic
Shifted toward opposite side (in tension)
Decreased breath sounds over the pleural air
No adventitious sounds
Decreased tactile fremitus and voice sounds

79
Q

COPD physical findings

A

Diffusely hyperresonant
Midline trachea
Decreased breath sounds (w delayed expiration)
No adventitious sounds (unless assoc. w chronic bronchitis)
normal tactile fremitus and voice sounds

80
Q

Asthma physical findings

A

Resonant to diffusely hyperresonant
Midline trachea
Breath sounds obscured by wheezing
Wheezing, rales
Decreased tactile fremitus and voice sounds

81
Q

Example of normal Inspection documentation

A

Breathing is easy without signs of distress. Chest wall is symmetric without deformity. No retractions.

82
Q

Palpation example of normal documentation

A

No areas of tenderness to palpation. No palpable masses. Symmetric lung expansion A and P. Tactile fremitus is symmetric A and P.

83
Q

Percussion normal documentation example

A

Percussion is resonant to all areas of the lung anteriorly and posteriorly. Diaphragmatic excursion is 5cm L and R.

84
Q

Auscultation normal documentation example

A

Vesicular breath sounds are heard throughout the lung fields anteriorly and posteriorly with good aeration. There are no adventitious sounds noted. No abnormalities of egophony, bronchophony, or whispered pectoriloquy detected.

85
Q

Example of a normal lung exam

A

Breathing is easy without signs of distress. Chest wall is symmetric without deformity. No retractions. No areas of tenderness to palpation. No palpable masses. Symmetric lung expansion A and P. Tactile fremitus is symmetric A and P. Percussion is resonant to all areas of th elung A and P. Diaphragmatric excursion is 5 cm L and R. Vesicular breath sounds are hear throughout the lungs fields A and P with good aeration. There are no adventitious sounds noted. No abnormalities of egophony, bronchophony, or whispered pectoriloquy.

86
Q

Emphysema

A

pathologic DX, permanent enlargment of respiratory zone.
-older and thin
-severe dyspnea
-quiet chest
-Xray- hyperventilation with flattened diaphragm

87
Q

Chronic bronchitis

A

clinical dx of daily productive cough for 3 or more months for 2 years.
-overweight and cyanotic
-elevated hemoglobin
-rhonchi and wheezing
-edema

88
Q

Typical Community Acquired Pneumonia

A

Acute infection of lung parenchyma
-from hospital
-Fever, cough, sputum, rigors, pleuritics, dyspnea, tachycardia

Bronchiol breath sounds
Rales
Egophony positive
whispered pectoriloquy
increased tactile fremitus

Streptococcus pneumonae is most common

88
Q

Exudative Pleural Effusion

A

occurs due to inflammation and icnreased capillary permeability
-pneumonia, cancer, TB, automimmune

high protein and LDH
Yellow

88
Q

Transudative Pleural Effusion

A

increased hydrostatic pressure or low plasma oncotic pressure
(CHF, cirrhosis, nephrotic syndrome, PE, Hypoalbuminemia)

Low in protein and LDH
Clear color

Patient Assessment (20 decks)

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