Thorax & Lungs Flashcards
Atopic allergies
Genetic predisposition to hypersensitivity reactions to common allergens, including rhinitis, eczema, asthma, food allergies
5 A’s of tobacco cessation
Ask about smoking Advise pts to stop Assess readiness to quit Assist pts to set up plan Arrange for follow up visits, referrals
Tripod positioning
Gravity helps diaphragm
Pursed lip breathing
Elongates respirations and helps forcefully blow of CO2
Respiratory Muscles/ Muscles used for breathing
Diaphragm- vertical expansion/down
Parasternal/scalene- expand thorax/out
Accessory muscles of inspiration
Sternomastoid
Scalene
Accessory muscles of expiration
Abdominal
Internal intercostals
Pectus excavatum
Sternum and adjacent cartilages appear sunken
Pectus carinatum
“Pigeon chest”
Sternum protrudes and rubs slope back
Barrel chest
- Describe
- Cause
- Assessment
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
Normal adult chest ratio
A/P diameter < transverse (1:2)
Systemic signs of poor oxygenation
Cyanosis (fingers, lips, nose, ears, toes)
Clubbing (enlargement of CT in terminal phalanges)
Poor physical endurance, activity intolerance, fatigue, DOE
Palpation
Tenderness, pain
Crepitus (SC emphysema)
Respiratory expansion
Tactile fremitus
Tactile fremitus: normal findings
Should feel more vibrations of apex
Decreased tactile fremitus
Transmission of vibration from larynx to chest surface is impeded
Ex: pleural effusion, which displaces the lung upwards
Increased tactile fremitus
Ex: consolidation, when lung becomes engorged with fluid or tissue (usually iso PNA)
Hyper-resonance
Air is more abundant than usual
Ex: emphysema
Dull
Tissue is rich in solid or fluid and poor in air
Ex: consolidation, bone, tumor, effusion
Respiratory excursion
- Method
- Normal
- Causes of increased/decreased
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
Bronchial breath sounds
Over trachea
Sounds like snoring
E>I
Vesicular breath sounds
Over lesser bronchi, bronchioles, lobes
Softer sound
I>E
Bronchovesicular breath sounds
Over main bronchus
I=E
Reasons for decreased breath sounds (4)
- pt isn’t breathing deeply enough
- thick chest wall/obesity
- sounds are distant, e.g., COPD
- poor transmission, e.g., effusion, atelectasis
Bronchial sounds where you should hear vesicular
Air-filled lung has been replaced with fluid or solid tissue
Adventitious sounds that clear with coughing
Due to secretions, bronchitis, atelectasis
Rales
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
Rhonchi
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
Rales
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
Wheezes
Whistling-type noises produced during expiration (and sometimes inspiration)
Generated when air is forced through narrow airways
Ex. bronchoconstriction, secretions, mucosal edema
Pleural Rub
Scratching, grating sound related to respiration
Hear sound better by compressing harder with stethoscope and have pt take deep breaths
D/t roughened pleura
Bronchophony
Say “99”
Sounds become loud, sharp, distinct
Whispering pectoriloquy
Whisper “99”
Whispered words sound clear and distinct
Egophony
Say “E”
Sounds like “A”
Alteration in transmitted voice sounds- cause
Lung has become consolidated
Thorax/Respiratory PE
- Inspect anterior and posterior chest- shape, AP diameter, symmetry, resp effort, retractions, accessory muscles
- Palpate a&p for tenderness and tactile fremitus
- Assess respiratory expansion and symmetry– hands on back, take a deep breath
- Percuss a&p
- Percuss to assess diaphragmatic excursion
- Auscultate a&p breath sounds and air exchange
- Assess for egophony
- Assess for bronchophony
- Assess for whispered pectoriloquy
