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Physical Assessment > Thorax & Lungs > Flashcards

Thorax & Lungs Flashcards

1
Q

Atopic allergies

A

Genetic predisposition to hypersensitivity reactions to common allergens, including rhinitis, eczema, asthma, food allergies

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2
Q

5 A’s of tobacco cessation

A 
Ask about smoking
Advise pts to stop
Assess readiness to quit
Assist pts to set up plan 
Arrange for follow up visits, referrals
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3
Q

Tripod positioning

A

Gravity helps diaphragm

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4
Q

Pursed lip breathing

A

Elongates respirations and helps forcefully blow of CO2

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5
Q

Respiratory Muscles/ Muscles used for breathing

A

Diaphragm- vertical expansion/down

Parasternal/scalene- expand thorax/out

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6
Q

Accessory muscles of inspiration

A

Sternomastoid

Scalene

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7
Q

Accessory muscles of expiration

A

Abdominal

Internal intercostals

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8
Q

Pectus excavatum

A

Sternum and adjacent cartilages appear sunken

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9
Q

Pectus carinatum

A

“Pigeon chest”

Sternum protrudes and rubs slope back

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10
Q

Barrel chest

  • Describe
  • Cause
  • Assessment
A

Increased AP diameter d/t increased residual volume and air trapping from age-related changes of obstructive lung disease
Assess: distant heart sounds, pursed lip breathing, increased effort, hyper-resonance

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11
Q

Normal adult chest ratio

A

A/P diameter < transverse (1:2)

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12
Q

Systemic signs of poor oxygenation

A

Cyanosis (fingers, lips, nose, ears, toes)
Clubbing (enlargement of CT in terminal phalanges)
Poor physical endurance, activity intolerance, fatigue, DOE

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13
Q

Palpation

A

Tenderness, pain
Crepitus (SC emphysema)
Respiratory expansion
Tactile fremitus

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14
Q

Tactile fremitus: normal findings

A

Should feel more vibrations of apex

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15
Q

Decreased tactile fremitus

A

Transmission of vibration from larynx to chest surface is impeded
Ex: pleural effusion, which displaces the lung upwards

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16
Q

Increased tactile fremitus

A

Ex: consolidation, when lung becomes engorged with fluid or tissue (usually iso PNA)

17
Q

Hyper-resonance

A

Air is more abundant than usual

Ex: emphysema

18
Q

Dull

A

Tissue is rich in solid or fluid and poor in air

Ex: consolidation, bone, tumor, effusion

19
Q

Respiratory excursion

  • Method
  • Normal
  • Causes of increased/decreased
A

Percuss during inspiration and expiration
Normal: 3.5-5 cm
Increased in well conditioned ppl
Decreased: pleural effusion, LL PNA, diaphragm paralysis, atelectasis, displaced by enlarged liver

20
Q

Bronchial breath sounds

A

Over trachea
Sounds like snoring
E>I

21
Q

Vesicular breath sounds

A

Over lesser bronchi, bronchioles, lobes
Softer sound
I>E

22
Q

Bronchovesicular breath sounds

A

Over main bronchus

I=E

23
Q

Reasons for decreased breath sounds (4)

A
  • pt isn’t breathing deeply enough
  • thick chest wall/obesity
  • sounds are distant, e.g., COPD
  • poor transmission, e.g., effusion, atelectasis
24
Q

Bronchial sounds where you should hear vesicular

A

Air-filled lung has been replaced with fluid or solid tissue

25
Q

Adventitious sounds that clear with coughing

A

Due to secretions, bronchitis, atelectasis

26
Q

Rales

A

Aka fine crackles
Interrupted sounds
Air filled lung replaced with consolidation or fluid
Generated as alveoli pop open from collapsed state of air circulates in very moist areas

27
Q

Rhonchi

A

AKA coarse crackles
Long continuous sounds
Generated by obstruction to airways, ex. COPD
Localized = obstruction of any etiology, ex. tumor, foreign body, mucous
May disappear with coughing if d/t mucous

28
Q

Rales

A

AKA fine crackles
Interrupted sounds
Air-filled lung replaced with consolidations or fluid
Generated as alveoli pop open from collapsed state or air circulates in very moist areas
Ex. PNA, atelectasis, CHF, bronchitis

29
Q

Wheezes

A

Whistling-type noises produced during expiration (and sometimes inspiration)
Generated when air is forced through narrow airways
Ex. bronchoconstriction, secretions, mucosal edema

30
Q

Pleural Rub

A

Scratching, grating sound related to respiration
Hear sound better by compressing harder with stethoscope and have pt take deep breaths
D/t roughened pleura

31
Q

Bronchophony

A

Say “99”

Sounds become loud, sharp, distinct

32
Q

Whispering pectoriloquy

A

Whisper “99”

Whispered words sound clear and distinct

33
Q

Egophony

A

Say “E”

Sounds like “A”

34
Q

Alteration in transmitted voice sounds- cause

A

Lung has become consolidated

35
Q

Thorax/Respiratory PE

A
  1. Inspect anterior and posterior chest- shape, AP diameter, symmetry, resp effort, retractions, accessory muscles
  2. Palpate a&p for tenderness and tactile fremitus
  3. Assess respiratory expansion and symmetry– hands on back, take a deep breath
  4. Percuss a&p
  5. Percuss to assess diaphragmatic excursion
  6. Auscultate a&p breath sounds and air exchange
  7. Assess for egophony
  8. Assess for bronchophony
  9. Assess for whispered pectoriloquy

Physical Assessment (5 decks)

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