Thorax and Lungs Flashcards
Health Hx Questions
cough, SOB, chest pain with breathing, wheezing, stridor, cyanosis, past hx respiratory infections, smoking hx, environmental exposure, self-care behaviors
Tobacco Use Hx
#packs/day x years = pack year hx always offer cessation support
Cough
beneficial reflex, abnormal if persistent or recurrent
Sputum or phlegm - always abnormal
bacterial pneumonia
phlegm rusty pink
expectoration in AM
positional, chronic bronchitis
Hemoptysis
expectoration of blood or blood-tinged from respiratory tract, must differentiate if from resp or GI
coughed up usually bright red, alkaline, mixed with frothy
GI dark, acidic and with food
SOB (dyspnea)
Left sided heart failure: can be slowly progressing or acute
COPD: slowly progressing
Asthma: acute episode with nocturnal episodes common
Pneumonia: depends on causative agent, acute or progressive
Spontaneous Pneumothorax: sudden onset
Pulmonary emboli: sudden onset
Anxiety with hyperventilation: episodic, recurrent
Chest pain with breathing
Pain caused by pulmonary disorder originates in pleura, airways, or chest wall
Pain: Pleura
stretch during inspiration, localized, may hear rub
Pain: Airways
pronounced after coughing, occurs w/ infection and inflammation of trachea or bronchi
Pain: Chest wall
muscle or rib pain, trauma, excessive coughing, rib fracture, muscle sore
Inspection
Facial expression and breathing effort
Count respirations
quality of resp.
skin abn and color
Estimate diameter of chest wall
AP/Lateral 1:2
inc in aging and COPD
Inspect posterior chest
shape
movement
deformities/assymetry –> pleural effusion
abn retraction –> asthma, COPD, upper obstruction
impaired movement
Configurations of the thorax
Normal Barrel chest Scoliosis Pectus Excavatum Pectus Carinatum Kyphosis
Respiratory Excursion
symmetry
accessory muscle involvement, retraction
Tactile Fremitis
say “99”
Percuss for symmetry
Resonant - normal
Hyperesonant - increased air (COPD, pneumothorax)
Tympany - air-filled, viscous (stomach, intestine) or pneumothorax
Dull - dense tissue, penumonia
Flat - no air present, over bone, pleural effusion
Diaphragmatic Excursion
distance between level of dullness on full expiration and level of dullness on full inspiration
normal 3.5-5 cm
Abnormally high level may indicate pleural effusion or high diaphragm as in atelectasis or phrenic nerve paralysis
Auscultate Breath sounds
Vesicular breath sounds Adventitious breath sounds Crackles or Rales Wheezing Rhonchi
Vesicular Sounds
Vesicular - inspiratory longer than expiratory
Bronchovesicular - insp = exp (anteriorly)
Bronchial - exp longer (over manubrium)
Tracheal - insp and exp sounds equal (over trachea and neck)
Crackles (Rales)
discontinuous intermittent, nonmusical, brief fine coarse Abnormalities of lung: pneumonia, fibrosis, heart failure Abn of airway: bronchitis
Wheezes and Rhonchi
continuous
musical, prolonged
Wheezes: high pitched with hissing or shrill
asthma, COPD, bronchitis
Rhonchi: low pitched with snoring quality
suggestive of secretions
Stridor
high pitched crowing with inspiration
indicates obstruction - EMERGENCY
croup, upper airway obstruction
Acute Epiglotitis - do not look in mouth, collapsed airway
Transmitted sounds: Egophany
Egophany - say ee, should hear muffled long E, if turns to a then suspect pneumonia
Transmitted sounds: Bronchophony
say 99
if heard increased transmission of voice sounds, lungs not filled with air
-PE, pneumonia, or tumor
Transmitted sounds: Whispered petoriloquy
ask to whisper 99
normally not heard increased sound
increased sound with consolidation
Normal Lung
Trachea - midline Tactile Fremitus - normal Percussion - resonant Breath Sounds - vesicular except over bronchi or trachea Adventitious sounds - non
Asthma
Inspection – anxious , labored breathing, exhalation prolonged, audible wheezing, retraction of respiratory muscles, cough
Palpation- decrease tactile fremitus
Percussion - resonant or hyperresonant, excursion may be limited
Auscultation – prolonged expiration, wheezes, diminished breath sounds
Bronchitis
Inspection- may be normal or rasping cough in acute; plethoric appearance with wheezing in chronic
Palpation – normal fremitus
Percussion- normal resonance
Auscultation- normal breath sounds, but coarse crackles or rhonchi may be present.
Chronic Bronchitis, COPD
- sputum most days for 3mo for 2 consecutive years
- exposed to tobacco smoke or inhaled irritants
- dyspnea, fatigue, or cyanosis
- inspection- flush face often wheezing
- cough rattling sound, fremitus normal or inc
- percussion resonant to hyperres.
- auscultation - prolong expiratory phase and usually crackles
Emphysema COPD
Inspection - increased AP/L diameter, barrel chest, use of accessory muscles to aid respiration
Palpation- tactile fremitus decreased, chest expansion decreased
Percussion – hyperresonant, excursion decreased
Auscultation – breath sound decreased with prolonged expiration, occasional wheezes, and fine crackles
Atelectasis (Lobar obstruction) (collapsed lung)
Inspection – trachea deviation toward affected side
Palpation – expansion decreased on affected side; fremitus decreased to absent
Percussion –dull over area involved
Auscultation – decreased vesicular breath sounds; wheezes, rhonchi and crackles depending on extent of collapse
Consolidation (filled with fluid)
Inspection – increase rate, guarding
Palpation -fremitus increased, expansion limited
Percussion- dull over airless area
Auscultation - breath sounds louder in intensity with bronchovesicular or bronchial sounds over affected area, inspiratory crackles
Bronchophony, egophony, whispered pectoriloquy present
Pleural Effusion
Inspection – increased rate, dyspnea
Palpation –expansion decreased on affected side, fremitus decreased or absent
Tracheal deviation maybe present
Percussion – dull to flat, no excursion of affected side
Auscultation – breath sounds decreased or absent, voice sounds decreased or absent; no adventitious sounds
*trachea deviated
Pneumothorax
EMERGENCY
Inspection –restricted lung expansion on affected side, tachypnea, respiratory distress,
Tracheal deviation to opposite side
Palpation – diminished or absent tactile fremitus,
Percussion- hyperresonant, decreased diaphragmatic excursion
Auscultation- breath sounds usually decreased or absent; no adventitious sounds
Possible pleural rub
