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Physical Assessment > Thorax and Lungs > Flashcards

Thorax and Lungs Flashcards

1
Q

Health Hx Questions

A

cough, SOB, chest pain with breathing, wheezing, stridor, cyanosis, past hx respiratory infections, smoking hx, environmental exposure, self-care behaviors

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2
Q

Tobacco Use Hx

A 
#packs/day x years = pack year hx
always offer cessation support
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3
Q

Cough

A

beneficial reflex, abnormal if persistent or recurrent

Sputum or phlegm - always abnormal

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4
Q

bacterial pneumonia

A

phlegm rusty pink

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5
Q

expectoration in AM

A

positional, chronic bronchitis

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6
Q

Hemoptysis

A

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

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7
Q

SOB (dyspnea)

A

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

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8
Q

Chest pain with breathing

A

Pain caused by pulmonary disorder originates in pleura, airways, or chest wall

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9
Q

Pain: Pleura

A

stretch during inspiration, localized, may hear rub

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10
Q

Pain: Airways

A

pronounced after coughing, occurs w/ infection and inflammation of trachea or bronchi

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11
Q

Pain: Chest wall

A

muscle or rib pain, trauma, excessive coughing, rib fracture, muscle sore

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12
Q

Inspection

A

Facial expression and breathing effort
Count respirations
quality of resp.
skin abn and color

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13
Q

Estimate diameter of chest wall

A

AP/Lateral 1:2

inc in aging and COPD

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14
Q

Inspect posterior chest

A

shape
movement
deformities/assymetry –> pleural effusion
abn retraction –> asthma, COPD, upper obstruction
impaired movement

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15
Q

Configurations of the thorax

A 
Normal
Barrel chest
Scoliosis
Pectus Excavatum
Pectus Carinatum
Kyphosis
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16
Q

Respiratory Excursion

A

symmetry

accessory muscle involvement, retraction

17
Q

Tactile Fremitis

A

say “99”

18
Q

Percuss for symmetry

A

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

19
Q

Diaphragmatic Excursion

A

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

20
Q

Auscultate Breath sounds

A 
Vesicular breath sounds
Adventitious breath sounds
Crackles or Rales
Wheezing
Rhonchi
21
Q

Vesicular Sounds

A

Vesicular - inspiratory longer than expiratory
Bronchovesicular - insp = exp (anteriorly)
Bronchial - exp longer (over manubrium)
Tracheal - insp and exp sounds equal (over trachea and neck)

22
Q

Crackles (Rales)

A 
discontinuous
intermittent, nonmusical, brief
fine
coarse
Abnormalities of lung: pneumonia, fibrosis, heart failure
Abn of airway: bronchitis
23
Q

Wheezes and Rhonchi

A

continuous
musical, prolonged
Wheezes: high pitched with hissing or shrill
asthma, COPD, bronchitis

Rhonchi: low pitched with snoring quality
suggestive of secretions

24
Q

Stridor

A

high pitched crowing with inspiration
indicates obstruction - EMERGENCY
croup, upper airway obstruction
Acute Epiglotitis - do not look in mouth, collapsed airway

25
Q

Transmitted sounds: Egophany

A

Egophany - say ee, should hear muffled long E, if turns to a then suspect pneumonia

26
Q

Transmitted sounds: Bronchophony

A

say 99
if heard increased transmission of voice sounds, lungs not filled with air
-PE, pneumonia, or tumor

27
Q

Transmitted sounds: Whispered petoriloquy

A

ask to whisper 99
normally not heard increased sound
increased sound with consolidation

28
Q

Normal Lung

A 
Trachea - midline
Tactile Fremitus - normal
Percussion - resonant
Breath Sounds - vesicular except over bronchi or trachea
Adventitious sounds  - non
29
Q

Asthma

A

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

30
Q

Bronchitis

A

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.

31
Q

Chronic Bronchitis, COPD

A
  • 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
32
Q

Emphysema COPD

A

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

33
Q

Atelectasis (Lobar obstruction) (collapsed lung)

A

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

34
Q

Consolidation (filled with fluid)

A

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

35
Q

Pleural Effusion

A

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

36
Q

Pneumothorax

A

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

Physical Assessment (5 decks)

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