thorax and lungs ABN Flashcards
identify
barrel chest
kyphosis
identify
pectus excavatum
identify
pectus carinatum
apnea: characteristic and cause
- characteristic: absence of breathing
- cause: cardiac arrest
Biot’s breathing pattern: characteristic and cause
- characteristic: irregular breathing with long periods of apnea
- cause: increased intracranial pressure; drug induced respiratory depression; brain damage (usually at medullary level)
cheyne-stokes breathing pattern characteristic and cause
- characteristic: irregular breathing with intermittent periods of increased and decreased rates and depths of breaths alternating with periods of apnea
- cause: drug induced respiratory depression; congestive heart failure; brain damage (usually at cerebral level)
Kussmaul’s breathing pattern characteristics and cause
- characteristics: fast and deep
- cause: metabolic acidosis
normal respiratory rate
14-20 breaths per minute
sighing breathing
periodic deeper breaths
two kinds of crepitus you are palpating for
- rib movement from fracture: (bone crepitus)
- subcutaneous emphysema (subQ crepitus)
how do you perform tactile fremitus
- feeling for vibrations through bronchopulmonary tree
- use ulnar surface of hand to appreciate vibrations
- ask patient to say 99
what conditions would give a decreased tactile fremitus
- obstructed bronchus
- COPD
- effusion
- fibrosis
- pneumothorax
what conditions would give a increased tactile fremitus
consolidated pneumonia
rhonchi sound
- coarse low-pitched (snoring quality), continuous
- may clear with cough
- often caused by secretions in larger airways or obstructions.
crackles
fine crackling, high-pitched; discontinuous sounds
wheezes
- high-pitched
- continuous
what is a mediastinal crunch (Hamman sign)
- loud crackles, clicks, and gurgling sounds
- due to mediastinal emphysema
- synchronous with heart beat
- caused by the heart beating against air-filled tissues
stridor
- high-pitched
- largely inspiratory
- usually louder in the neck
- indicates laryngeal/upper airway obstruction
in a normal air-filled lung, breath sounds are predominantly
vesicular
what normally happens to voice sounds the farther away from the larynx you listen
sounds become softer and less distinct
what does a positive bronchophony test indicate
- “99” heard louder and clearer even at a distance from larynx
- indicates presence of fluid or solid tissue in alveoli
- PNA; atelectasis; tumors
what does a positive egophony test indicate
- when “E” sounds like “A” and has a nasal quality
- indicates any consolidation of lung tissue such as pneumonia, atelectasis, or tumor
what is a positive whispered pectoriloquy indicate
- positive: a whisper can be heard more loudly through consolidated lung tissue
- most noticeable when comparing a normal area of lung to an abnormal area
when happens to the voice sounds when a patient has emphysema
- vocal resonance decreases
- due to increased lung expansion and reduced air flow
what does breath sounds sound like when listening over a pneumonia? What signs indicate a PNA?
- sound bronchial or bronchovesicular over involved area
- spoken words are louder, clearer
- egophony
- whispered pectoriloquy
- tactile fremitus increased
what is atelectasis
loss of air from lung or collapse of lung tissue with reduced lung volume
- may hear crackles, rhonchi, or wheezes
- may clear with cough
- normal tactile fremitus and resonance to percussion
- exam may be normal
acute bronchitis
what exam finding would indicate pleurisy/pleuritis
may hear pleural friction rub
clinical presentation
- dyspnea, crackles, tachypnea
- reduced breath sounds
- dullness to percussion
- egophony
PNA
clinical presentation
- dullness to percussion
- reduced breath sounds at base
- decreased fremitus
pleural effusion
what is empyema
pus in pleural space
clinical presentation
- breath sounds decreased unilaterally
- percussion increased
- fremitus decreased
tension pneumothorax
clinical presentation
- inspiration is short, expiratory phase is prolonged
- wheezing, may be heard during inspiration and expiration
- patient may appear to be working hard to breathe
- chest xray is typically normal
asthma
clinical presentation on exam
- hyper-resonant to percussion
- possible purse-lip breathing
- using accessory muscles
xray findings:
- vertical shaped heart
- flattened diaphragm
- increased substernal space
emphysema/COPD
A pleural effusion would have what findings on tactile fremitus, percussion, breath sounds, whispered pectoriloquy, voice sounds, and +/- crackles
- tactile fremitus: decreased or absent
- percussion: dull
- breath sounds: decreased
- whispered pectoriloquy: decreased
- voice sounds: decreased
- crackles: absent
a pneumonia will have what findings on tactile fremitus, percussion, breath sounds, whispered pectoriloquy, voice sounds, and +/- crackles
- tactile fremitus: increased
- percussion: dull or flat
- breath sounds: bronchial
- whispered pectoriloquy: present
- voice sounds: bronchophony and egophony
- crackles: present
what is a normal finding on diaphragmatic excursion
difference between full expansion and full inspiration is 5-6 cm
how do you perform clinical pulmonary function tests
ask patient to walk down hall, climb one flight of stairs and observe rate and effort
forced expiratory time
ask patient to “blow out candles”
- > 6 seconds suggests obstructive pulmonary disease
why would you auscultate during forced expiration
may allow faint wheezes to be heard better
