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Health Assessment > Thorax and Lungs > Flashcards

Thorax and Lungs Flashcards

1
Q

Sternal angle

Angle of Louis

A

where the manubrium and sternum touch.

It is continuous with the 2nd rib.

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2
Q

Anterior reference lines

A

Anterior axillary
Midclavicular- “nipple line”. Midclavical to the umbilicus.
Midsternal

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3
Q

Posterior reference lines

A

vertebral
scapular
posterior axillary

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4
Q

Lateral reference lines

A

Midaxillary
anterior axillary
posterior axillary

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5
Q

Apex of lung

A

Highest point, lung tissue is 3 to 4 cm above the inner third of the clavicle.

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6
Q

Base of lung

A

Lower border, rests on the diaphragm at about the 6th rib in the midclavicular line.

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7
Q

Cough

A 
Do you have a cough?
When did it start?
Acute coughs lasts less than 2-3 weeks.
Chronic cough lasts over 2 months
Do you cough up any phlegm or sputum? If yes what color and how much?
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8
Q

Hemoptysis

A

Blood in sputum.

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9
Q

Dyspnea

A

Short of breath or difficulty breathing

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10
Q

Orthopnea

A

Difficulty breathing while laying down.

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11
Q

Paroxysmal nocturnal dyspnea (PND)

A

awakening from sleep with shortness of breath and needing to be upright to achieve comfort.

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12
Q

Chest pain with breathing

A

pain in thoracic cavity can be soreness from coughing or inflammation of the pleura overlying pneumonia.
Have patient describe the pain.

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13
Q

Order of exam

A 
Inspection
Palpation
Percussion
Ausculation
Do in order. Do not start with lateral.
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14
Q

Thoracic cage

A
  • shape and configuration
  • position patient takes to breathe. COPD patients often lean forward with arms braced against knees, chair or bed when breathing.
  • Skin color and condition- skin should be consistent with person’s genetic background.
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15
Q

AP Diameter

A
  • Anterior-Posterior (front to back) TO Transverse (side to side)
  • Normal ratio 1:2. 2 hands on the back and 1 hand laterally.
  • Barrell Chested 1:1
  • Long term lung issue people use accessory muscles to breathe causing change in the shape. Compensatory Hypertropy.
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16
Q

Palpation- posterior chest

Symmetric chest expansion

A
  • Looking for symmetry.
  • Place both hands on back with thumbs touching and have them take a deep breath. Watching for symmetrical rise and fall.
  • Also checking for lumps, bumps, and anything abnormal.
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17
Q

Tachypnea

A
  • rapid and shallow

- > 24 breaths per minute

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18
Q

Bradypnea

A
  • Slow breathing

- <10 breaths per minute

19
Q

Tactile (or vocal) fremitus

A
  • Vibration when the person says 99.
  • Vibration all the way through the lung.
  • Looking for symmetrical vibrations bilaterally
  • Loudest at apex
  • Asymmetric findings suggest dysfunction
  • Use palm
20
Q

Decreased fremitus

A

Occurs with obstructed bronchus, pleural effusion, pneumothorax or emphysema. Any barrier that comes between the sound and your palpating hand decreases fremitus.

21
Q

Increased fremitus

A

Occurs with compression or consolidation of lung tissue. (e.g. Lobar pneumonia)
-Gross changes increase fremitus.

22
Q

Percussion of thorax

A
23
Q

Percussion sounds

A
  • Resonance- normal sound in lungs. Low pitched, clear, hollow. May be duller in an athlete with more muscle mass or an obese person.
  • Hyperresonance- abnormal for adults. Happens with infection. Lower pitched, booming sound when too much air is present as in pneumothorax or emphysema.
24
Q

Hyperventilation

A

Increase in rate and depth. Inspiration=Expiration.

25
Q

Hypoventilation

A

Irregular shallow caused by an overdose of narcotics or anesthetics.

26
Q

Sigh

A

Normal breathing pattern and are purposeful to expand alveoli. Emotional response.

27
Q

Normal breathing

A

Rate is 10-20 breaths per minute. I=E.

28
Q

Cheyne-Stokes respiration

A

Respirations wax and wane in a regular pattern, increasing in rate and depth and then decreasing.
-Early sign of death.

29
Q

Biot’s respirations

A
  • Similar to cheyne-stokes but the pattern is irregular. A series of normal respirations followed by apnea. cycle length is variable.
  • Seen with head trauma, brain abscess, heat stroke, spinal meningitis, and encephalitis.
30
Q

Chronic obstructive breathing

A

Normal inspiration and prolonged expiration to overcome increased airway resistance.

31
Q

Auscultation interference

A
  • Stethoscope tubing bumping together
  • patient shivering
  • patient’s hairy chest rustling
32
Q

Vesicular sounds

A
  • Normal
  • Sounds like wind rustling in the trees. Breezy
  • Duration- I>E
  • Located over peripheral lung fields.
  • Often stated as clear breath sounds.
33
Q

Bronchiovesicular Sounds

A
  • Normal
  • Duration- I=E. Inspiration is louder.
  • Location- over major bronchi, Posterior- between scapulae, anterior-upper sternum 1st-2nd intercostal space.
34
Q

Bronchial (Tracheal) Sound

A
  • Normal
  • Location- over the trachea.
  • Duration- I
35
Q

Adventitious Sounds

A

Added sounds that are not normally heard in the lungs. I.E. crackles, wheezing.
-If heard describe them as inspiratory versus expiratory, loudness, pitch, and location on the chest wall.

36
Q

Crackles

A
  • Caused by fluid in the lungs

- Discontinuous sound because it comes and goes.

37
Q

Coarse Crackles

A
  • More fluid in the lungs
  • Start in early expiration and may be present in expiration.
  • May decrease with suctioning or coughing but reappear.
38
Q

Pleural Friction Rub

A
  • Caused by inflammation of pleural space.
  • Tissue is rubbing together.
  • Discontinuous sound
  • Coarse and low pitched. Grating quality-sounds like leather is being rubbed together.
39
Q

Stridor

A
  • Upper airway occlusion
  • Crowing sound
  • Continuous- Starts with inspiration and continues to the start of expiration.
40
Q

Wheeze

A
  • High pitched. (Sibilant)
  • Musical
  • Continuous- end of inspiration and continues through expiration.
  • Cause by airway tightness due to constriction
41
Q

Sonorous Rhonchi

A
  • Low pitched
  • continuous- end of inspiration to the end of expiration.
  • Gunk in chest due to infection
  • Cleared by coughing
42
Q

Bronchophony

A
  • Ask patient to repeat “99” as you LISTEN over the chest wall.
  • Normal: soft, muffled, indistinct.
  • Abnormal: sound mor distinct over areas of increased density. (consolidated areas i.e pneumonia, tumor)
43
Q

Egophony

A
  • Ask patient to repeat “E” while you LISTEN over the chest wall.
  • Normal: soft, muffled, hear “e”
  • Abnormal: sounds louder, changes to “a” over areas of consolidation.
44
Q

Whispered Pectoriloquy

A
  • Ask patient to whisper “123” as you listen over lungs
  • Normal: faint, muffled, almost inaudible
  • Abnormal: clear, distinct (like whispering directly into the stethoscope) over areas of consolidation.

Health Assessment (3 decks)

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