Thorax and Lungs Flashcards
sternal angle/angle of louie
horizontal bridge joining the manubrium to the body of the sternum T4/T5
physical landmarks for lungs
Apex: 2-4 cm above clavicle
Lower border: 6th rib MCL, 8th rib midaxillary line,
T10 posterior
right bronchus v. left bronchus
right bronchus is wider, shorter and more vertical, more susceptible to aspiration of FB
What may cause an increase in AP diameter?
aging, chronic obstructive pulmonary disease (emphysema, chronic bronchitis)
Stridor
a wheeze that is high pitched &largely inspiratory, usually louder in the neck. Results from turbulent airflow in upper airway. Indicates laryngeal/upper airway obstruction
What are some possible signs of COPD?
Clubbing of the fingers-fingertips spread out and become rounder
pursed lip breathing- reduces respiratory rate, increased tidal volume
Why do we percuss the lungs?
to determine if underlying tissues are air-filled, fluid or solid. Also detects areas of tenderness
resonance over air, dullness over solid or fluid filled areas
hyper-resonant percussion tone
very loud, low pitch
ex. emphysematous lungs (diffuse) pneumothorax (local)
resonant percussion tone
loud, low pitch
ex. healthy lungs
tympanic percussion tone
loud, high pitch
ex. gastric bubble, puffed out cheek
Dull percussion tone
soft-moderate intensity, moderate-high pitch
ex. liver, consolidation (pna), pleural effusion
Flat percussion tone
soft, high pitch
ex. muscle, consolidation (pna), pleural effusion
What side of the stethoscope should you use to auscultate the lungs?
diaphragm
listen for one full breath at each area
Where can you heard bronchial breath sounds?
over the manubrium
suspect fluid filled lung if heard at a distant location
Where can you hear bronchovesicular breath sounds?
in 1st and 2nd interspaces anteriorly and between scapula posteriorly
suspect fluid filled lung if heard at a distant location
Crackles (rales)
discontinuous high pitched, caused by “popping open” of small airways & alveoli that have collapsed. Fluid in the lungs can cause this
Rhonchi
snoring quality (coarse, low pitch) , caused by airway secretion & narrowing/partial obstruction
may clear with cough
Wheeze
high pitched, whistle, caused by airway obstruction
Biot’s
irregular breathing with long periods of apnea
causes: increased ICP, drug induced respiratory depression, brain damage
Cheyne-stokes
irregular breathing with intermittent periods of increased and decreased rates and depths of breathing alternating with periods of apnea
causes:drug induced respiratory depression, brain damage, CHF
Kussmaul’s
fast and deep pattern of breathing
causes: metabolic acidosis
Atelectasis
loss of air from lung or collapse of lung tissue with reduced lung volume, can result from blockage of air passages with mucus or from pleural effusion
Tension pneumothorax
large amount of air entering the chest when a one-way valve (air in) is formed by an area of damaged tissue
Pneumonia/consolidation
pneumonitis (inflammation of the lung) usually due to infection but sometimes has noninfectious cause; has the addition feature of pulmonary infiltrates/consolidation
consolidation
lung tissue becomes firm and solid due to accumulated fluids & tissue debris
pulmonary infiltrate
filling of the air spaces with fluid, can cause consolidation
Pleural effusion
collection of fluid in the pleural space
hemothorax
blood in the pleural space
empyema
pus in the pleural space, usually results from infection that spread from the lungs
Pleurisy/Pleuritis
inflammation of the pleura
Acute bronchitis
inflammation of the bronchi (no involving the lungs, bronchi are considered part of the upper airway
Asthma
obstructive airway disease
bronchial tubes are hyper-responsive, airways become inflamed & produce excess mucous, muscles around the airway tighten making the airways narrower, which obstructs breathing
COPD
associated with airway resistance & RV even after full expiration, can result in hyper inflated lungs
Pleural friction rub
squeaking or grating sound of the pleural lines rubbing together, associated with pleurisy. Heard on inspiration & expiration
Crepitus
palpable grating or crunching, can occur with rib movement due to fracture
What does tactile fremitus look for?
consolidation- vibrations transmitted through the bronchopulmonary tree
palpate “99”
increased fremitus = consolidation
decreased fremitus = air/effusions
What can coarse crackles be indicative of?
airway disease such as damage to bronchi
Stridor
a wheeze that is high pitched & largely inspiratory, usually louder in the neck
results from turbulent airflow in the upper airway
Mediastinal crunch (Hamman sign)
loud crackles, clicks and gurgling sounds
due to pnuemo-mediastinum
synchronous with heart beat
How can you perform a clinical PFT?
ask pt to walk down hall or climb one flight of stairs, observe rate and effort
How can you test forced expiratory time?
ask pt to “blow out the candles” >6 seconds suggests obstructive pulmonary disease
Why would you auscultate during forced exhalation?
may allow faint wheezes to be heard better
What would pna do to tactile fremitus? percussion?
increased tactile fremitus
percussion would be dull
What breath sounds would you hear on a pt with pna? voice sounds? Adventitious sounds?
bronchial
increased voice sounds
crackles
What breath sounds would you hear on a pt with COPD ? voice sounds? Adventitious sounds?
diminished breath sounds
decreased voice sounds
may hear wheeze or rhonchi
What breath sounds would you hear on a pt with pleural effussion? voice sounds? Adventitious sounds?
diminished breath sounds
decreased voice sounds
may hear pleural friction rub
Tactile fremitus for pt with COPD? percussion sounds?
decreased tactile fremitus
hyper-resonant percussion
Tactile fremitus for pt with pleural effusion? percussion sounds?
decreased or absent tactile fremitus
dull or flat
