Thorax & Lungs Flashcards
Ventilation
movement of air in and out of the lungs
What are the primary functions of the pulmonary system?
Ventilation (movement of air in and out of the lungs)
External respiration (diffusion of gases across the alveolar-capillary membrane)
acinus
a functional respiratory unit that consists of the bronchioles, alveolar ducts, alveolar sacs, and the alveoli.
Describe the color of sputum for pulmonary edema
pink frothy
Describe the color of sputum for Bacterial infections
yellow or green
Describe the color of sputum for tuberculosis & pneumococcal pneumonia
rust colored
Describe the color of sputum for cold, bronchitis & viral infections
white or clear
The sudden onset of breathing difficulty that develops during sleep and often causes the patient to either sit straight upright in bed or stand up.
paroxysmal nocturnal dyspnea
Difficulty breathing when lying down (often measured in the number of pillows the patient needs to sleep comfortably)
orthopnea
What are “pack years”?
the number of packs the patient smokes per day by the number of years the person has smoked
sequelae
consequences of a disease
What are two common respiratory-related health-screening activities?
Chest x-ray
TB test
What two immunizations are important for older adults, in particular, to consider?
Pneumococcal vaccine
Influenza vaccine
People who work in coal mines have an increased risk of:
pneumoconiosis
Patient with COPD display what type of breathing in efforts to maintain positive expiratory pressures in the lung?
pursed-lip breathing
Patients w/ COPD sit in which position to maximize their lung volume?
tripod position
Patients w/ COPD may use what to overcome airway obstruction and atelectasis?
accessory muscles
respiratory excursion
the movement of the diaphragm that occurs during inspiration
Tactile Fremitus
palpable vibration
Sounds generated from the larynx are transmitted through patent bronchi and through the lung parenchyma to the chest wall, where you feel them as vibrations
test for vibrations bilaterally using the phrase “ninety nine” (except between the scapulae, where the bronchial bifurcation is closer on the right side, which makes the vibrations stronger)
Decreased fremitus
occurs when anything obstructs transmission of vibrations (e.g., obstructed bronchus, pleural effusion or thickening, pneumothorax, or emphysema). Any barrier that comes between the sound and your palpating hand will decrease fremitus.
Increased fremitus
occurs with compression or consolidation of lung tissue (e.g., lobar pneumonia). This is present only when the bronchus is patent and when the consolidation extends to the lung surface. Note that only gross changes increase fremitus. Small areas of early pneumonia do not significantly affect fremitus
Rhonchal fremitus
is palpable with thick bronchial secretions.
Pleural friction fremitus
is palpable with inflammation of the pleura
Crepitus
a coarse, crackling sensation palpable over the skin surface. It occurs in subcutaneous emphysema when air escapes from the lung and enters the subcutaneous tissue, as after open thoracic injury or surgery
Abnormal asymmetry of diaphragmatic of excursion is usually due to one of which two problems?
Atelectasis or Pleural effusion
What body position does the patient assume during posterior auscultation of the back?
leaning slightly forward
Patient instructions before auscultating the posterior thorax
“Cross your arms and breath deeply in and out when you feel my stethoscope touch your skin”
Bradypnea (breaths per minute)
slower than 10 breaths per minute
Normal (breaths per minute)
12-20 breaths per minute
Tachypnea (breaths per minute)
> 24 breaths per minute
Hyperventilation (breaths per minute)
> 20 breaths per min. w/ DEEP breathing
Sighing (type of breathing)
normal breaths w/ frequently interspersed DEEP breaths
Cheyne-Stokes (type of breathing)
varying speeds of increasing deep interspersed w/ a period of apnea
Kussmaul (type of breathing)
Rapid, deep, labored breaths
Biot (type of breathing)
irregularly interspersed periods of apnea in a disorganized sequence of breaths
Ataxic (type of breathing)
significant disorganization w/ irregular and varying depths of respiration
Fine Crackles
Discontinuous, high-pitched, short crackling, popping sounds heard during inspiration that are not cleared by coughing
you can simulate this sound by rolling a strand of hair between your fingers near your ear or by moistening your thumb and index finger and separating them near your ear
Coarse Crackles
Loud, low-pitched, bubbling and gurgling sounds that start in early inspiration and may be present in expiration
may decrease somewhat by suctioning or coughing but will reappear shortly
sounds like opening a Velcro fastener
Sibilant Wheeze
High-pitched, musical squeaking sounds that sound polyphonic (multiple notes as in a musical chord)
predominate in expiration but may occur in both expiration and inspiration
Sonorous Wheeze
Low-pitched; monophonic single note, musical snoring, moaning sounds
heard throughout the cycle, although they are more prominent on expiration;
may clear somewhat by coughing
What is egophony and why is it used?
The patient says “ee” during auscultation….
Normal lung tissue does not transmit sound well and produces a characteristic muffled “aa” sound.
Consolidated lung tissue, on the other hand, produces a clear and distinct “ee” sound because of its higher density.
-used to determine resonance
Asthma is characterized by…
inflammation, bronchiolar edema and viscous mucus
Lobar pneumonia is characterized by…
infection of lung parenchyma and consolidation of alveoli
Tuberculosis is characterized by…
Gohn lesions with potential for cavitation and necrosis
Pneumothorax is characterized by…
free air in the pleural space causing collapse of lunge tissue
Broncitis is characterized by…
excessive mucus and inflammation of the bronchi
Emphysema is characterized by…
permanent enlargement of air sacs and rupture of intraalveolar walls
Atelectasis is characterized by…
a collapsed shrunken section of alveoli
are costochondral junctions palpable?
no p.411
angle of louis
is the articulation of the manubrium and body of the sternum, and it is continuous with the second rib, is it useful place to start counting ribs
also marks the site of tracheal bifurcation into the right and left main bronchi; it corresponds with the upper border of the atria of the heart, and it lies above the fourth thoracic vertera on the back.
mediastinum
middle section of the thoracic cavity containing the esophagus,trachea,heart and great vessels.
the right and left pleural cavities are on either side of the mediastinu, they contain the lungs.
the highest point of the lungs
apex
the lower border of the lungs
base; rest on the diaphragm at about the 6th rib in the midclavicular line.
posteriorly, the location of ___ marks the apex of lung tissue, and __ usually corresponds to the base. deep inspirations expands the lungs, and their lower border drops to the level of ___.
c7, t10, t12
the __lung is shorter than the __ lung because of the underlying ___.
right, left, liver
the ___ lung is narrower than the ___ lung because the heart bulges to the ___.
left, right, left
how many lobes do the right and left lung have and how are they arranged?
left- 2 lobes
right- 3 lobes
these lobes are not arranged in horizontal bands like dessert layers in a parfait glass. rather, they are stack in diagonal sloping segments are and seperated by fissures that run obliquely throughout the chest.
what are the special note of the three points that commonly confuse beginning examiners?
- the left lung has no middle lobe
- the anterior chest contains mostly upper and middle lobe with very little lower lobe.
- the posterior chest contains almost all lower lobe.
the _____ pleura lines the outside of the lungs, dipping down into the fissures. it is continuous with the ____ pleura lining the inside of the chest wall and diaphragm.
visceral , parietal
the pluera extend about 3 cm below the level of the lungs, forming the ____. this is a potential space; when it abnormally fills with air or fluid, it compromises lung expansion.
costodiaphragmatic recess
the trachea lies ___ to the esophogus and is _____cm long in adults. it begins at the level of the _____ in the neck and bifurcates just below the ____ into the right and left main bronchi.
anterior, 10 to 11, cricoid cartilage, sternal angle.
the bronchi are lined with cilia, which?
sweep particles upward where they can be swallowed and expelled.
what are the 4 major functions of the respiratory system?
- supplying the o2 to the body for energy production
- removing co2 as a waste product of energy reactions
- maintaining homeostasis (acid-base balance) of arterial blood.
- maintaing heat exchange (less important in humans).
hypoventilation (slow, shallow breathing) causes co2 to _____, and hyperventilation (fast, deep breathing) causes co2______.
build up in the blood, to be blown off .
hypercapnia
increase of co2 in the blood
hypoxemia
decrease of o2 in the blood.
the normal stimulus to breathe for most of us is _______.
increase of co2 in the blood, or hypercapnia.
respiratory muscle strength declines age the age ____ and continues to decrease into the _____.
50s, 70s
biocultural differences in the ______ significantly influence pulmonary functioning as determined by vital capacity and forced expiratory volume.
size of the thoracic cavity
acute cough last _____; chronic cough last ______.
less than 2 to 3 weeks. over 2 months
condition with characteristics timing of cough: 1. continuous thoughout the day (_______). 2. afternoon/evening (______). 3. night-(______) 4. early morning (_____)
continuous throughout the day - acute illnesses (e.g, respiratory infection)
afternoon/evening- may reflect exposure to irritants at work
night- postnasal drip, sinusitis
early morning- chronic brinchial inflammation of smokers.
chronic bronchitis presents with a history of productive cough for ____ of the year for __ years in a row.
3 months, 2 years
some conditions have a characteristic cough: myoplasma pneumonia ? early heart failure? croup? colds, bronchitis,pneumonia?
hacking
dry
barking
congested
Some gases produce specific symptoms:
Carbon monoxide –
Sulfur dioxide–
Dizziness,headache,fatigue
Cough,congestion
in older adults…. precisely localized sharp pain (points to it with one finger)— consider?
fractured rib or muscle injury
The ratio of the anterooms terror to transverse diameter is from ______. If it is not within that range then patient is considered _____. This condition occurs with _______.
1:2 to 5:7 , “barrel chest”, chronic emphysema from hyperinflation of the lungs
Symmetric chest expansion
Slide your hand medially to pinch up a small fold of skin between your thumbs. Ask the person to take a deep breath. Your hands serve as mechanical amplifiers. As the person inhales, your thumbs should move apart symmetrically.
Unequal chest expansion occurs with marked atelectasis, lobar pneumonia, pleural effusion, with thoracic trauma, such as fractured ribs; or with pneumothorax.
Fremitus, the vibrations should feel the same in the corresponding area on each side with the exception of?
Just between the scapula, fremitus may feel stronger on the right side than on the left side because the right side is close to the bronchial bifurcation.
Low pitched, clear, hollow sound that predominates in healthy lung tissue in the adult
Resonance
The resonant note may be modified somewhat in athlete with muscular chest wall and in the heavily obese adult with subcutaneous fat produces _____.
Scattered dullness
Bronchial (tracheal)
Normal breath sounds
Pitch=high Amplitude=loud Duration= inspiration <expiration Quality= harsh, hollow tubular Normal location= trachea and larynx
Bronchovesicular
Pitch..high Amplitude.. Moderate Duration..inspiration =expiration Quality .. Mixed Normal location ..toward the middle by the sternum on posterior and anterior.... P.428
Vesicular
Pitch..low
Amplitude..soft
Duration.. Inspiration>expiration
Quality..rustling, like the sound of the wind in the trees
Normal location… Over peripheral lung fields where air flows through smaller bronchioles and alveoli
________will enhance the voice sounds making the words more distinct.
Consolidation or compressions the lung tissue
