Thorax & Lungs Flashcards by B -

Thorax and Lungs

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STRUCTURE AND FUNCTION

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POSITION AND SURFACE LANDMARKS

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The ________ is a bony structure with a conical shape, which is narrower at the top. It is defined by the sternum, 12 pairs of ribs, and 12 thoracic vertebrae.

thoracic cage

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The floor of the thoracic cage is called the ?

Its “floor” is the diaphragm, a musculotendinous septum that separates the thoracic cavity from the abdomen.

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a musculotendinous septum that separates the thoracic cavity from the abdomen.

diaphragm,

a musculotendinous septum that separates the thoracic cavity from the abdomen.

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The first seven ribs attach directly to the sternum via their costal cartilages;
A)true
B)false

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ribs 8, 9, and I 0 attach to the costal cartilage above, (8,9,10 come together form one insertion site at the sternum.
A)true
B)false

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ribs 11 and 12 are “floating,” with free palpable tips.
A)true
B)false

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The costochondral junctions are the points at which the ribs join their cartilages. They are not palpable.
A)true
B)false

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Anterior Thoracic landmarks

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__________. Feel this hollow U-shaped depression just above the sternum, in between the clavicles.

Suprasternal Notch

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. The “breastbone” has three parts-the manubrium, the body, and the xiphoid process. Walk your fingers down the manubrium a few centimeters until you feel a distinct bony ridge, the sternal angle.

Sternum

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Often called the “angle of Louis,” this is the articulation of the manubrium and body of the sternum, and it is continuous with the second rib. The angle of Louis is a useful place to start counting ribs, which helps localize a respiratory finding horizontally. Identify the angle of Louis, palpate lightly to the second rib, and slide down to the second intercostal space

Sternal Angle

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Often called the “angle of Louis,” this is the articulation of the manubrium and body of the sternum, and it is continuous with the second rib.

Sternal angle

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The angle of Louis is a useful place to start counting ribs, which helps localize a respiratory finding horizontally. Identify the angle of Louis, palpate lightly to the second rib, and slide down to the second intercostal space
A)true
B)false

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The angle of Louis is a useful place to start counting ribs, when localizing an respiratory finding horizontally.
A)true
B)false

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The angle of Louis 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 vertebra on the back.
A)true
B)false

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_________ 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 vertebra on the back.

The angle of Louis

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Division into two branches
A)bifurcation
B)spinal

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The right and left costal margins form an angle where they meet at the xiphoid process. Usually 90 degrees or less, this angle increases when the rib cage is chronically overinflated, as in emphysema.

Costal Angle.

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If costal angle increase beyond 90degrees than patient might have

Emphysema

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It’s okay if sternal angle a little less than 90.
A)true
B)false

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Posterior Thoracic landmarks

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________. Start here. Flex your head and feel for the most prominent bony spur protruding at the base of the neck. This is the spinous process of C7. If two bumps seem equally prominent, the upper one is C7 and the lower one is T1.

Vertebra Prominens

Count down these knobs on the vertebrae, which stack together to form the spinal column. Note that the spinous processes align with their same numbered ribs only down to T4. After T4, the spinous processes angle downward from their vertebral body and overlie the vertebral body and rib below.

Spinous Processes.

Spinous process align with the ribs only down to T4 A)true B)false

True

_________The scapulae are located symmetrically in each hemithorax. The lower tip is usually at the seventh or eighth rib.

Inferior Border of the Scapula.

________Palpate midway between the spine and the person's side to identify its free tip.

Twelfth Rib.

To identify the 12th rib in a patient, lay patient on the side and palpate mid way between the spine. A)true B)false

True

Reference lines

Use the reference lines to pinpoint a finding vertically on the chest. A)true B)false

Use reference lines to pinpoint vertical findings A)true B)false

On the anterior chest, note the midsternal line and the midclavicular line. A)true B)false

True

The__________ line bisects the center of each clavicle at a point halfway between the palpated sternoclavicular and acromioclavicular joints

midclavicular

The posterior chest wall has the vertebral (or midspinal) line and the scapular line, which extends through the inferior angle of the scapula when the arms are at the sides of the body A)true B)false

True

Lift up the person's arm 90 degrees, and divide the lateral chest by three lines: the anterior axillary line extends down from the anterior axillary fold where the pectoralis major muscle inserts; the posterior axillary line continues down from the posterior axillary fold where the latissimus dorsi muscle inserts; and the midaxiUary line runs down from the apex of the axilla and lies between and parallel to the other two. A)true B)false

True

THE THORACIC CAVITY

The mediastinum is the middle section of the thoracic cavity containing the esophagus, trachea, heart, and great vessels. A)true B)false

The___________ is the middle section of the thoracic cavity containing the esophagus, trachea, heart, and great vessels.

mediastinum

The right and left pleural cavities, on either side of the mediastinum, contain the lungs. A)true B)false

True

In the anterior chest, the apex, or highest point, of lung tissue is 3 to 4 cm above the inner third of the clavicles. The base, or lower border, rests on the diaphragm at about the sixth rib in the midclavicular line. A)true B)false

In the anterior chest, the apex, or highest point, of lung tissue is 3 to 4 cm above the inner third of the clavicles. A)true B)false

True

The base, or lower border, rests on the diaphragm at about the sixth rib in the midclavicular line. A)true B)false

True

Laterally, lung tissue extends from the apex of the axilla down to the seventh or eighth rib. A)true B)false

True

Posteriorly, the location of C7 marks the apex of lung tissue, and T 10 usually corresponds to the base. Deep inspiration expands the lungs, and their lower border drops to the level of Tl2. A)true B)false

True

Lobes of the Lungs

The right lung is shorter than the left lung because of the liver A)true B)false

True

The left lung is narrower than the right lung because the heart bulges to the left. A)true B)false

True

The right lung has three lobes, and the left lung has two lobes. A)true B)false

True

The lung lobes are not arranged in horizontal bands like dessert layers in a parfait glass. Rather, they stack in diagonal sloping segments and are separated by fissures that run obliquely through the chest. A)true B)false

True

On the anterior chest, the oblique (the major or diagonal) fissure crosses the fifth rib in the midaxillary line and terminates at the sixth rib in the midclavicular line. The right lung also contains the horizontal (minor) fissure, which divides the right upper and middle lobes. This fissure extends from the fifth rib in the right midaxiilary line to the third intercostal space or fourth rib at the right sternal border. A)true B)false

True

. The right lung also contains the horizontal (minor) fissure, which divides the right upper and middle lobes. This fissure extends from the fifth rib in the right midaxiilary line to the third intercostal space or fourth rib at the right sternal border. A)true B)false

True

The most remarkable point about the posterior chest is that it is almost all lower lobe. The upper lobes occupy a smaller band of tissue from their apices at Tl down to T3 or T4. At this level, the lower lobes begin, and their inferior border reaches down to the level of T10 on expiration and to T 12 on inspiration. Note that the right middle lobe does not project onto the posterior chest at all. If the person abducts the arms and places the hands on the back of the head, the division between the upper and lower lobes corresponds to the medial border of the scapulae. A)true B)false

True

At this level, the lower lobes begin, and their inferior border reaches down to the level of T10 on expiration and to T 12 on inspiration. A)true B)false

True

Laterally, lung tissue extends from the apex of the axilla down to the seventh or eighth rib. A)true B)false

The left lung contains only two lobes, upper and lower. These are seen laterally as two triangular areas separated by the oblique fissure. The left upper lobe extends from the apex of the axilla down to the fifth rib at the midaxillary line. The left lower lobe continues down to the eighth rib in the midaxillary line. A) TURE B)false

Take special note of the three points that commonly confuse beginning examiners: I. The left lung has no middle lobe. 2. The anterior chest contains mostly upper and middle lobe with very little lower lobe. 3. The posterior chest contains almost all lower lobe

True

Pleurae

The thin, slippery_________ are serous membranes that form an envelope between the lungs and the chest wall

pleurae

Pleurae form an envelope between the lungs and the chest wall A)true B)false

The visceral pleura lines the outside of the lungs, dipping down into the fissures. It is continuous with the parietal pleura lining the inside of the chest wall and diaphragm. A)true B)false

The visceral pleura lines the outside of the lungs, dipping down into the fissures. A)true B)false

parietal pleura lining the inside of the chest wall and diaphragm. A)true B)false

The inside of the envelope, the pleural cavity, is a potential space filled only with a few milliliters of lubricating fluid. It normally has a vacuum, or negative pressure, which holds the lungs tightly against the chest wall. A)true B)false

The pleurae extend about 3 cm below the level of the lungs, forming the costodiaphragrnatic recess. This is a potential space; when it abnormally fills with air or fluid, it compromises lung expansion. A)true B) false

The pleurae extend about 3 em 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.

costodiaphragrnatic recess

Trachea and Bronchial Tree

The trachea lies anterior to the esophagus and is 10 to 11 cm long in the adult. It begins at the level of the cricoid cartilage in the neck and bifurcates just below the sternal angle into the right and left main bronchi. Posteriorly, tracheal bifurcation is at the level of T4 or T5. The right main bronchus is shorter, wider, and more vertical than the left main bronchus. A)true B)false

The_________ lies anterior to the esophagus and is 10 to 11 cm long in the adult. It begins at the level of the cricoid cartilage in the neck and bifurcates just below the sternal angle into the right and left main bronchi.

trachea

Posteriorly, tracheal bifurcation is at the level of T4 or T5. The right main bronchus is shorter, wider, and more vertical than the left main bronchus. A)true B)false

The trachea and bronchi transport gases between the environment and the lung parenchyma. They constitute the dead space, or space that is filled with air but is not available for gaseous exchange. This is about 150 mL in the adult. A)true B)false

The bronchial tree also protects alveoli from small particulate matter in the inhaled air. The bronchi are lined with goblet cells, which secrete mucus that entraps the particles. The bronchi are lined with cilia, which sweep particles upward where they can be swallowed or expelled. A)true B)false

The bronchial tree also protects alveoli from small particulate matter in the inhaled air. The bronchi are lined with_______ cells, which secrete mucus that entraps the particles.

goblet

The bronchial tree also protects alveoli from small particulate matter in the inhaled air.The bronchi are lined with______, which sweep particles upward where they can be swallowed or expelled

cilia

An acinus is a functional respiratory unit that consists of the bronchioles, alveolar ducts, alveolar sacs, and the alveoli. Gaseous exchange occurs across the respiratory membrane in the alveolar duct and in the millions of alveoli. Note how the alveoli are clustered like grapes around each alveolar duct. This creates millions of interalveolar septa (walls) that increase tremendously the working space available for gas exchange. This bunched arrangement creates a surface area for gas exchange that is as large as a tennis court. A)true B)false

Note how the alveoli are clustered like grapes around each alveolar duct. This creates millions of interalveolar septa (walls) that increase tremendously the working space available for gas exchange. This bunched arrangement creates a surface area for gas exchange that is as large as a tennis court. A)true B)false

MECHANICS OF RESPIRATION

There are four major functions of the respiratory system: (1) supplying oxygen to the body for energy production; (2) removing carbon dioxide as a waste product of energy reactions; (3) maintaining homeostasis (acid-base balance) of arterial blood; and (4) maintaining heat exchange (less important in humans).

True

(1) supplying oxygen to the body for energy production; (2) removing carbon dioxide as a waste product of energy reactions; (3) maintaining homeostasis (acid-base balance) of arterial blood; and (4) maintaining heat exchange (less important in humans).

Respiratory functions

By supplying oxygen to the blood and eliminating excess carbon dioxide, respiration maintains the pH or the acid-base balance of the blood. A)true B)fase

Supplying oxygen to the blood and eliminating carbon dioxide, respirations maintain ph balance A)true B)false

hypoventilation (slow, shallow breathing) causes carbon dioxide to build up in the blood. A)true B)false

_____causes carbon dioxide to build up in the the blood

Hypoventilation

hyperventilation (rapid, deep breathing) causes carbon dioxide to be blown off. A)true B)false

________ (rapid, deep breathing) causes carbon dioxide to be blown off.

hyperventilation

Control of Respirations

Normally, our breathing pattern changes without our awareness in response to cellular demands. This involuntary control of respirations is mediated by the respiratory center in the brainstem (pons and medulla). A)true B)false

brainstem

The major feedback loop is humoral regulation, or the change in carbon dioxide and oxygen levels in the blood and, less important, the hydrogen ion level. A)true B)false

The normal stimulus to breathe for most of us is an increase of carbon dioxide in the blood, or hypercapnia. A)true B)false

The normal stimulus to breathe for most of us is an increase of carbon dioxide in the blood, or __________

hypercapnia

hypercapnia is the normal stimulus for us to breath do to increase of carbon dioxide. A)true B)false

A decrease of oxygen in the blood (hypoxemia) also increases respirations but is less effective than hypercapnia. A)true B)false

A decrease of oxygen in the blood (__________) also increases respirations but is less effective than hypercapnia.

hypoxemia

Changing Chest Size

Respiration is the physical act of breathing; air rushes into the lungs as the chest size increases (inspiration) and is expelled from the lungs as the chest recoils (expiration). A)true B)false

Respiration is the physical act of breathing; A)true B)false

The mechanical expansion and contraction of the chest cavity alters the size of the thoracic container in two dimensions: (1) the vertical diameter lengthens or shortens, which is accomplished by downward or upward movement of the diaphragm; and (2) the anteroposterior (A-P) diameter increases or decreases, which is accomplished by elevation or depression of the ribs

True

In inspiration, increasing the size of the thoracic container creates a slightly negative pressure in relation to the atmosphere, so air rushes in to fill the partial vacuum. The major muscle responsible for this increase is the diaphragm. During inspiration, contraction of the bell-shaped diaphragm causes it to descend and flatten. This lengthens the vertical diameter. Intercostal muscles lift the sternum and elevate the ribs, making them more horizontal. This increases the anteroposterior diameter. A)true B)false

In _________, increasing the size of the thoracic container creates a slightly negative pressure in relation to the atmosphere, so air rushes in to fill the partial vacuum. The major muscle responsible for this increase is the diaphragm.

inspiration

During _________, contraction of the bell-shaped diaphragm causes it to descend and flatten. This lengthens the vertical diameter. Intercostal muscles lift the sternum and elevate the ribs, making them more horizontal. This increases the anteroposterior diameter.

inspiration

Expiration is primarily passive. As the diaphragm relaxes, elastic forces within the lung, chest cage, and abdomen cause it to dome up. All this squeezing creates a relatively positive pressure within the alveoli, and the air flows out. A) true B) false

___________is primarily passive. As the diaphragm relaxes, elastic forces within the lung, chest cage, and abdomen cause it to dome up. All this squeezing creates a relatively positive pressure within the alveoli, and the air flows out.

Expiration

Negative pressure is on inspirations A)true B)false

Positive pressure is on explorations A)true B)false

Inspiration diaphragm is descend and flatten A)true B)false

Forced____________, such as that after heavy exercise or occurring pathologically with respiratory distress, commands the use of the accessory neck muscles to heave up the sternum and rib cage. These neck muscles are the sternomastoids, the scaleni, and the trapezii.

inspiration

In forced _______, the abdominal muscles contract powerfully to push the abdominal viscera forcefully in and up against the diaphragm, making it dome upward and making it squeeze against the lungs.

expiration

DEVELOPMENTAL COMPETENCE | Infants and Children

During the first 5 weeks of fetal life, the primitive lung bud emerges; by 16 weeks, the conducting airways reach the same number as in the adult; at 32 weeks, surfactant, the complex lipid substance needed for sustained inflation of the air sacs, is present in adequate amounts; and by birth, the lungs have 70 million primitive alveoli ready to start the job of respiration. A)true B)false

During the first 5 weeks of fetal life, the primitive lung bud emerges A)true B)false

Fetal life by 16 weeks, the conducting airways reach the same number as in the adult; A)true B)false

Fetal life at 32 weeks, surfactant, the complex lipid substance needed for sustained inflation of the air sacs, is present in adequate amounts; A)true B)false

by birth, the lungs have 70 million primitive alveoli ready to start the job of respiration. A)true B)false

When the newborn inhales the first breath, the lusty cry that follows reassures straining parents that their baby is all right. A)true B) false

When the newborn inhales the first breath, the lusty cry that follows, reassures straining parents that their baby is all right A)true B)false

respiratory system alone does not function until birth. A)true B)false

When the cord is cut, blood is cut off from the placenta and it gushes into the pulmonary circulation. A)true B)false

Relatively less resistance exists in the pulmonary arteries than in the aorta, so the foramen ovale in the heart closes just after birth. A) true B)false

foramen ovale in the heart closes just after birth do to Relatively less resistance exists in the pulmonary arteries than in the aorta, A)true B)false

The ductus arteriosus (linking the pulmonary artery and the aorta) contracts and closes some hours later, and pulmonary and systemic circulation are functional. A)true B)false

The ductus arteriosus (linking the pulmonary artery and the aorta) contracts and closes hours later, and pulmonary and systemic circulation are functional. A)true B)false

Respiratory development continues throughout childhood, with increases in diameter and length of airways and increases in size and number of alveoli, reaching the adult range of 300 million by adolescence. A)true B)false

The relatively smaller size and immaturity of children's pulmonary systems and the presence of parents and caregivers who smoke result in enormous vulnerability and increased risks to child health. A)true B)false

Prenatal exposure causes chronic hypoxia and low birth weight. A)true, for smoking B)false

Deficiency in the amount of oxygen reaching the tissues

Hypoxia

Passive smoking affect the child it sensitizes the fetal brain to nicotine, which increases risk for addiction when the child is exposed to nicotine at a later age. A)true B)false

Postnatal exposure to secondhand tobacco smoke leads to sudden infant death, lower respiratory illnesses, acute and chronic otitis media, breathlessness, asthma, and adverse lung function throughout childhood. A)true B)false

DEVELOPMENTAL COMPETENCE | The Pregnant Woman

The enlarging uterus elevates the diaphragm 4 cm during pregnancy. This decreases the vertical diameter of the thoracic cage, but this decrease is compensated for by an increase in the horizontal diameter. A)true B)false

The enlarging uterus elevates the diaphragm 4 em during pregnancy. This decreases the vertical diameter of the thoracic cage, but an increase in the horizontal diameter compensates A)true B)false

The increase in estrogen level relaxes the chest cage ligaments. This allows an increase in the transverse diameter of the chest cage by 2 cm, and the costal angle widens. A)pregnancy B)infant

The total circumference of the chest cage increases by 6 cm during pregnancy A)true B)false

Although the diaphragm is elevated, it is not fixed. It moves with breathing even more during pregnancy, which results in an increase in tidal volume. A)true B)false

The growing fetus increases the oxygen demand on the mother's body. This is met easily by the increasing tidal volume (deeper breathing) A)true B)fase

The growing fetus increases the oxygen demand on the mother's body. This is met easily by the increasing tidal volume which is deeper breathing. A) true B)false

An increased awareness of the need to breathe develops, even early in pregnancy, and some pregnant women may interpret this as dyspnea although, structurally, nothing is wrong. A)true B)false

Early pregnancy as the need to breath. pregnant women may interpret dyspnea although, structurally, nothing is wrong. A)true B)false

DEVELOPMENTAL COMPETENCE | The Aging Adult

The costal cartilages become calcified, which produces a less mobile thorax. Respiratory muscle strength declines after age 50 years and continues to decrease into the 70s. A)aging adult B)pregnancy

A more significant change is the decrease in elastic properties within the lungs, making them less distensible and lessening their tendency to collapse and recoil. A)aging adult B)infant

A significant change in aging adult is the decrease in elastic properties within the lungs, making them less distensible and lessening their tendency to collapse and recoil. A)true B)false

In all, the aging lung is a more rigid structure that is harder to inflate. A)true B)false

These changes result in an increase in small airway closure, and that yields a decreased vital capacity (the maximum amount of air that a person can expel from the lungs after first filling the lungs to maximum) and an increased residual volume (the amount of air remaining in the lungs even after the most forceful expiration). A)aging adult B)infant

the maximum amount of air that a person can expel from the lungs after first filling the lungs to maximum

Vital capacity

the amount of air remaining in the lungs even after the most forceful expiration

Residual volume

These changes result in an increase in small airway closure, and that yields a decreased vital capacity and an increased residual volume. A)aging adult B)infant

With aging, histologic changes (i.e., a gradual loss of intraalveolar septa and a decreased number of alveoli) also occur, so less surface area is available for gas exchange. A)true B)false

Also, the lung bases become less ventilated as a result of closing off of a number of airways. This increases the older person's risk for dyspnea with exertion beyond his or her usual workload. A)true B)false

the lung bases become less ventilated as a result of closing off of a number of airways. This increases the older person's risk for dyspnea with exertion beyond his or her usual workload. A)true B)false

The histologic changes also increase the older person's risk for postoperative pulmonary complications. A)true B)false

histologic changes increase the older person's risk for postoperative pulmonary complications. A)true B)false

the older person has a greater risk for postoperative atelectasis and infection from a decreased ability to cough, a loss of protective airway reflexes, and increased secretions. A)true B)false

CULTURE AND GENETICS

10 times higher in foreign-born than in U.S. born; 8 times higher among Hispanic and Blacks than among whites; and 23 times higher among Asians than among whites A)TB B)FALSE

Asthma occurs in about 5% to 12% of the U.S. population and is the most common chronic disease in childhood. A)true B)false

Groups at increased risk include African Americans who reside in inner cities and premature or low-birth-weight infants. A)asthma B)herpes

Asthma prevalence is highest among African American and American Indian adults; it is lowest among Asian and Hispanic adults. A)true B)false

African Americans, Hispanics, and especially American Indians experience more than do whites or Asians. A)asthma B)false

``` Extrinsic/allergic asthma (or pediatric onset) involves a complex interaction between genetic susceptibility (bronchial hyperresponsiveness, atopy, elevated immunoglobulin E) and environmental factors (viral respiratory infections, air pollution). A)true B)false ```

Extrinsic/allergic asthma involves a complex interaction between genetic susceptibility and environmental factors. A)true B)false

Biocultural differences in the size of the thoracic cavity significantly influence pulmonary functioning as determined by vital capacity and forced expiratory volume. In descending order, the largest chest volumes are found in whites, Blacks, Asians, and American Indians. Even when the shorter height of Asians is considered, their chest volume remains significantly lower than that of whites and Blacks. A)true B)false

SUBJECTIVE DATA

``` Cough History of respiratory infections Environmental exposure Shortness of breath Smoking history Self-care behaviors Chest pain with breathing A)subjective data B)objective data ```

COUGH

Cough. Do you have a cough? When did it start? Gradual or sudden? • How long have you had it? A)Acute cough lasts less than 2 or 3 weeks; chronic cough lasts over 2 months. B) false

Acute cough lasts less than 2 or 3 weeks; A)true B)false

chronic cough lasts over 2 months. A)true B)false

How often do you cough? At any special time of day or just on arising? Cough wake you up at night? A)Conditions with characteristic timing of cough: (l) continuous throughout day- acute illness (e.g., respiratory infection); (2) afternoon/evening-may reflect exposure to irritants at work; (3) nightpostnasal drip, sinusitis; ( 4) early morning-chronic bronchial inflammation of smokers. B)none

Conditions with characteristic timing of cough:

continuous throughout day- acute illness (e.g., respiratory infection); A)true B)false

coughing in afternoon/evening-may reflect exposure to irritants at work A)true B)false

night postnasal drip, indicates sinusitis; A)true B)false

early morning coughing indicates -chronic bronchial inflammation of smokers. A)true B)false

Do you cough up any phlegm or sputum? How much? What color is it? A)Chronic bronchitis is presents with a history of productive cough for 3 months of the year for 2 years in a row. B)false

Cough up any blood? Does this look like streaks or frank blood? Does the sputum have a foul odor? A)assessing for Hemoptysis. B)Some conditions have characteristic sputum production: (l) white or dear mucoid-colds, bronchitis, viral infections; (2) yellow or green-bacterial infections; (3) rust colored-tuberculosis, pneumococcal pneumonia; (4) pink, frothypulmonary edema, some sympathomimetic medications have a side effect of pinktinged mucus. C)both a and b

Some conditions have characteristic sputum production:

white or dear mucoid indicates colds, bronchitis, viral infections; A) true B)false

yellow or green-bacterial infections; A)true B)false

rust colored-tuberculosis, pneumococcal pneumonia; A)true B)false

pink, frothypulmonary edema, some sympathomimetic medications have a side effect of pinktinged mucus. A)true B)false

How would you describe your cough: hacking, dry, barking, hoarse, congested, bubbling? A)Some conditions have a characteristic cough: mycoplasma pneumonia-hacking; early heart failure-dry; croup-barking; colds, bronchitis, pneumonia-congested. B)false

Some conditions have a characteristic cough: mycoplasma pneumonia-hacking; A)true B)false

Some conditions have a characteristic cough; early heart failure-dry; A)true B)false

Some conditions have a characteristic cough; croup-barking; colds, bronchitis, pneumonia-congested. A)true B)false

Does the cough seem to come with anything: activity, position (lying), fever, congestion, talking, anxiety? A)assessing cough B)none

Does activity make it better or worse? A)assessing cough B)none

What treatment have you tried? Prescription or over-the-counter medications, vaporizer, rest, position change? A)Assess the effectiveness of coping strategies B)none

Does the cough bring on anything: chest pain, ear pain? Is it tiring? Are you concerned about it? A)Note severity of the cough B)none

SHORTNESS OF BREATH

Shortness of breath. Ever had any shortness of breath or hard-breathing spells? What brings it on? How severe is it? How long does it last? A)Determine how much activity precipitates the shortness of breath (SOB)- state specific number of blocks walked, number of stairs B)none

Is it affected by position, such as lying down? A)Orthopnea is difficulty breathing when supine. State number of pillows needed to achieve comfort (e.g., "two-pillow orthopnea") B)none

SOB does it, Occur at any specific time of day or night? A)Paroxysmal nocturnal dyspnea is awakening from sleep with SOB and needing to be upright to achieve comfort. B)none

_______________ is awakening from sleep with SOB and needing to be upright to achieve comfort

Paroxysmal nocturnal dyspnea

Shortness of breath episodes associated with night sweats? A)assessing for Diaphoresis B)none

Or cough, chest pain, or bluish color around lips or nails? Wheezing sound? A)I'm assessing for Cyanosis which signals hypoxia. B)none

Episodes seem to be related to food, pollen, dust, animals, season, or emotion? A)assessing for asthma B)Asthma attacks may be associated with a specific allergen or extreme cold, anxiety. C)both a and b

What do you do in a hard-breathing attack? Take a special position, or use pursed-lip breathing? Use any oxygen, inhalers, or medications? A)Assess effect of coping strategies and the need for more teaching B) none

How does the shortness of breath affect your work or home activities? Getting better or worse or staying about the same? A)Assess effect on activities of daily living. B)none

CHEST PAIN WITH BREATHING

Chest pain with breathing Any chest pain with breathing? Please point to the exact location A)Chest pain of thoracic origin occurs with muscle soreness from coughing or from inflammation of pleura overlying pneumonia. Distinguish this from chest pain of cardiac origin or from heartburn of stomach acid. B)none

Chest pain of thoracic origin occurs with muscle soreness from coughing A)true B)false

Chest pain of thoracic origin occurs from inflammation of pleura overlying pneumonia. A)true B)false

Distinguish this from chest pain of cardiac origin or from heartburn of stomach acid. A)true B)false

When did it start? Constant, or does it come and go? Describe the pain: burning, stabbing? Brought on by respiratory infection, coughing, or trauma? Is it associated with fever, deep breathing, unequal chest inflation? What have you done to treat it? Medication or heat application? A)assessing for chest pain B)none

History of respiratory infections

History of respiratory infections. Any past history of breathing trouble or lung diseases such as bronchitis, emphysema, asthma, pneumonia? A)consider sequelae after these conditions when assessing B)none

Any unusually frequent or unusually severe colds? A)Because most people have had some colds, it is more meaningful to ask about excess number or severity. B)none

Any family history of allergies, tuberculosis, or asthma? A)Assess possible risk factors B)false

SMOKING HISTORY

Smoking history. Do you smoke cigarettes or cigars? At what age did you start? How many packs per day do you smoke now? For how long? A) have the patient State number of packs per day and the number of years smoked. B)false

Have you ever tried to quit? What helped? Why do you think it did not work? What activities do you associate with smoking? A)Most people already know they should quit smoking. Instead of admonishing, assess smoking behavior, ways to modify daily smoking activities, identify triggers, how to manage withdrawal. B)false

Environmental exposure.

Environmental exposure. Are there any environmental conditions that may affect your breathing? Where do you work? At a factory, chemical plant, coal mine, farming, outdoors in a heavy trafnc area? A)assessing Pollution exposure. B)false

Farmers may be at risk for grain inhalation, pesticide inhalation. A)assessing people who are affected by environmental factors B)false

People in the rural Midwest have a risk for histoplasmosis exposure; A)assessing people who are affected by environmental factors B)false

those in the Southwest and Mexico have a risk for coccidioidomycosis. A)assessing people who are affected by environmental factors B)false

Coal miners have a risk for pneumoconiosis. A)assessing people who are affected by environmental factors B)false

Stone cutters, miners, and potters have a risk for silicosis. Other irritants: asbestos, radon A)assessing people who are affected by environmental factors B)false

Do you do anything to protect your lungs, such as wear a mask or have the ventilatory system checked at work? Do you do anything to monitor your exposure? Do you have periodic examinations, pulmonary function tests, x-ray examination? A)Assess self-care measures. B)false

Do you know what specific symptoms to note that may signal breathing problems? A)General symptoms: cough, shortness of breath. B)Some gases produce specific symptoms: carbon monoxide-dizziness, headache, fatigue; sulfur dioxide-cough, congestion. C)both a and b

specific symptoms to note that may signal breathing problems would be coughing, and shortness of breath. A) true B)false.

Some gases produce specific symptoms of breathing problems : carbon monoxide-dizziness, headache, fatigue A)true B)false

Some gases produce specific symptoms of breathing problems; sulfur dioxide-cough, congestion. A)true B)false

Self-care behaviors

Self-care behaviors.ask the patient when the he/she had their Last tuberculosis skin test, chest x-ray study, pneumonia vaccine or influenza immunization? A)"Flu" vaccine is modified yearly; recommended for adults with chronic medical conditions, residents of nursing homes and group care, health care workers, and those who are immunosuppressed. B)false

Additional History for Infants and Children

Has the child had any frequent or very severe colds? A)Limit of 4 to 6 uncomplicated upper respiratory infections per year is expected in early childhood. B)false

Limit of 4 to 6 uncomplicated upper respiratory infections per year is expected in early childhood. A)true B)false

Is there any history of allergy in the family? • (For child younger than 2 years): At what age were new foods introduced? Was the child breastfed or bottle-fed? A)Consider new foods or formula as possible allergens for the infant and child B)false

Does the child have a cough? Seem congested? Have noisy breathing or wheezing? A)Screen for onset and follow course of childhood chronic respiratory problems: asthma, bronchitis B)false

What measures have you taken to child-proof your home? Yard? Is there any possibility of the child inhaling or swallowing toxic substances? A)Young child is at risk for accidental aspiration, poisoning, and injury. B)false

Has anyone taught you emergency care measures in case of accidental choking or a hard-breathing spell? A)Assess knowledge level of parent and caregivers. B)false

Any smokers in the home or in the car with child? A)Environmental smoke increases the risk for acute and chronic ear and respiratory infections in children. B)

Additional History for the Aging Adult

Have you noticed any shortness of breath or fatigue with your daily activities? A)Older adults have a less efficient respiratory system (decreased vital capacity, less surface area for gas exchange), so they have less tolerance for activity. B)false

Ask the aging adult, Tell me about your usual amount of physical activity? A)May have reduced exercise capacity because of pulmonary function deficits. B)Sedentary or bedridden people are at risk for respiratory dysfunction. C)both a and b

__________May have reduced exercise capacity because of pulmonary function deficits.

Aging adult

Aging adult may have decrease in exercise capacity ,which may be do to pulmonary function deficits A)true B)false

For those with a history of chronic obstructive pulmonary disease [ COPD j, lung cancer, or tuberculosis): How are you getting along each day? Any weight change in the past 3 months? How much? A)Assess coping strategies. B)false

How about energy level? Do you tire more easily? How does your illness affect you at home? At work? A)in aging adults Activities may decrease because of increasing shortness of breath or pain. B)false

In aging adults Activities may decrease do to increasing shortness of breath or pain. A)true B)false

Do you have any chest pain with breathing? A)Some older adults feel pleuritic pain less intensely than younger adults. B)false

Any chest pain after a bout(short period) of coughing? After a fall? A)Precisely localized sharp pain (points to it with one finger)-consider fractured rib or muscle injury. B)false

In aging adult a Precisely localized sharp pain (points to it with one finger)-consider fractured rib or muscle injury. A)true B)false

OBJECTIVE DATA

PREPARATION

Ask the person to sit upright. Ask a man to disrobe to the waist. Ask a woman to leave the gown on and open at the back; when examining the anterior chest, lift up the gown and drape it on her shoulders rather than removing it completely. A)true B)false

These provisions will ensure further comfort: a warm room, a warm diaphragm endpiece, and a private examination time with no interruptions. A)true B)false

For smooth choreography in a complete examination, begin the respiratory examination just after palpating the thyroid gland when you are standing behind the person. A)true B)false

Perform the inspection, palpation, percussion, and auscultation on the posterior and lateral thorax. A)true B)false

Finally, clean your stethoscope endpiece with an alcohol wipe. Because your stethoscope touches many people, it is a possible vector for both aerobic and anaerobic bacteria. Cleaning with an alcohol wipe is very effective. A)true B)false

EQUIPMENT NEEDED

``` Stethoscope Small ruler, marked in centimeters Marking pen Alcohol wipe A)true B)false ```

INSPECT THE POSTERIOR CHEST

Thoracic Cage

Note the shape and configuration of the chest wall. The spinous processes should appear in a straight line. The thorax is symmetric, in an elliptical shape, with downward sloping ribs, about 45 degrees relative to the spine. The scapulae are placed symmetrically in each hemithorax. A)true B)false

Abnormal finding is Skeletal deformities which may limit thoracic cage excursion: scoliosis, kyphosis. A)true B)false

The anteroposterior diameter should be less than the transverse diameter. The ratio of anteroposterior to transverse diameter is from 1:2 to 5:7. A)true B)false

AP = transverse diameter, or "barrel chest." Ribs are horizontal, chest appears as if held in continuous inspiration. This occurs in chronic emphysema from hyperinflation of the lungs. A)true B)false

AP = transverse diameter, or "barrel chest." .occurs in chronic emphysema from hyperinflation of the lungs A) true B)false

The neck muscles and trapezius muscles should be developed normally for age and occupation. A)true B)false

Neck muscles are hypertrophied in COPD from aiding in forced respirations. A)abnormal findings B)normal findings

Note the position the person takes to breathe. This includes a relaxed posture and the ability to support one's own weight with arms comfortably at the sides or in the lap. A)true B)false

People with COPD often sit in a tripod position, leaning forward with arms braced against their knees, chair, or bed. This gives them leverage so that their rectus abdominis, intercostal, and accessory neck muscles all can aid in expiration. A) true B) false

Assess the skin color and condition. Color should be consistent with person's genetic background, with allowance for sun-exposed areas on the chest and the back. No cyanosis or pallor should be present. Note any lesions. Inquire as to any change in a nevus on the back, for example, where the person may have difficulty monitoring A)true B)false

Cyanosis occurs with tissue hypoxia. A) true B)false

PALPATE THE POSTERIOR CHEST

Symmetric Expansion

Confirm symmetric chest expansion by placing your warmed hands on the posterolateral chest wall with thumbs at the level of T9 or T10. Slide your hands medially to pinch up a small fold of skin between your thumbs. A)true B)false

Ask the person to take a deep breath. Your hands serve as mechanical amplifiers; as the person inhales deeply, your thumbs should move apart symmetrically. Note any lag in expansion. A)assessing symmetry chest expansion B)false

Unequal chest expansion occurs with marked atelectasis, lobar pneumonia, pleural effusion; with thoracic trauma, such as fractured ribs; or with pneumothorax. A)abnormal finding B)normal findings

Pain accompanies deep breathing when the pleurae are inflamed. A)true B)false

Tactile Fremitus

``` Assess tactile (or vocal) fremitus. Fremitus is a 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. A)true B)false ```

._________ is a 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.

Fremitus

Use either the palmar base (the ball) of the fingers or the ulnar edge of one hand, and touch the person's chest while he or she repeats the words "ninetynine" or "blue moon." These are resonant phrases that generate strong vibrations. Start over the lung apices and palpate from one side to another.

Assess tactile (or vocal) fremitus.

ninetynine" or "blue moon." are resonant phrases that generate strong vibrations. To assess fremitus A)true B)false

Fremitus varies among persons A)true B)false

However, just between the scapulae, fremitus may feel stronger on the right side than on the left side because the right side is closer to the bronchial bifurcation. A)true B)false

Avoid palpating over the scapulae because bone damps out sound transmission.of testing for fremitus. A)true B)false

The following factors affect the normal intensity of tactile fremitus:

Relative location of bronchi to the chest wall. • Normally, fremitus is most prominent between the scapulae and around the sternum, sites where the major bronchi are closest to the chest wall. Fremitus normally decreases as you progress down because more and more tissue impedes sound transmission. A)true B)false

fremitus is most prominent between the scapulae and around the sternum, sites where the major bronchi are closest to the chest wall. Fremitus normally decreases as you progress down because more and more tissue impedes sound transmission. A)true B)fase

Thickness of the chest wall. • Fremitus feels greater over a thin chest wall than over an obese or heavily muscular one where thick tissue damps the vibration. A)true B)false

Fremitus feels greater over a thin chest wall than over an obese or heavily muscular one where thick tissue damps the vibration. A)true B)false

Pitch and intensity. • A loud, low-pitched voice generates more fremitus than a soft, high-pitched one. A)true B)false

A loud, low-pitched voice generates more fremitus than a soft, high pitched one A)true B)false

CONTD....

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. A)true B)false

Decreased fremitus occurs when anything obstructs transmission of vibrations (e.g., obstructed bronchus, pleural effusion or thickening, pneumothorax, or emphysema). A)true B)false

Any barrier that comes between the sound and your palpating hand will decrease fremitus. A)true B)false

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. A)true B)false

Note any areas of abnormal fremitus. Sound is conducted better through a uniformly dense structure than through a porous one, which changes in shape and solidity (as does the lung tissue during normal respiration). Thus conditions that increase the density of lung tissue make a better conducting medium for sound vibrations and increase tactile fremitus A)true B)fase

Rhonchal fremitus is palpable with thick bronchial secretions. A)true B)false

Pleural friction fremitus is palpable with inflammation of the pleura. A) true B)false

Using the fingers, gently palpate the entire chest wall. This enables you to note any areas of tenderness, to note skin temperature and moisture, to detect any superficial lumps or masses, and to explore any skin lesions noted on inspection. A)true B)false

Crepitus is 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. A)true B)false

Crepitus is a coarse, crackling sensation palpable over the skin surface. occurs in subcutaneous emphysema when air escapes from the lung and enters the subcutaneous tissue, as after open thoracic injury or surgery. A)true B)false

__________is 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.

Crepitus

PERCUSS THE POSTERIOR CHEST

lung Fields

Determine the predominant note over the lung fields. Start at the apices and percuss the band of normally resonant tissue across the tops of both shoulders. Then, percussing in the interspaces, make a side-to-side comparison all the way down the lung region. Percuss at 5-cm intervals. Avoid the damping effect of the scapulae and ribs. A)assessing lung field B)none

Resonance is the low-pitched, clear, hollow sound that predominates in healthy lung tissue in the adult. However, resonance is a relative term and has no constant standard. The resonant note may be modified somewhat in the athlete with a heavily muscular chest wall and in the heavily obese adult in whom subcutaneous fat produces scattered dullness. A)true B)false

Hyperresonance is a lower-pitched, booming sound found when too much air is present, such as in emphysema or pneumothorax A)true B)false

Hyperresonance occurs with emphysema or pneumothorax. A)true B)false

_________is a lower-pitched, booming sound found when too much air is present, such as in emphysema or pneumothorax

Hyperresonance

A dull note (soft, muffled thud) signals abnormal density in the lungs, as with pneumonia, pleural effusion, atelectasis, or tumor. A)true B)false

A dull note signals abnormal density in the lungs, as with pneumonia, pleural effusion, atelectasis, or tumor. A)true, abnormal finding B)false,normal finding

A______ note (soft, muffled thud) signals abnormal density in the lungs, as with pneumonia, pleural effusion, atelectasis, or tumor.

dull

The depth of penetration of percussion has limits. Percussion sets into motion only the outer 5 to 7 cm of tissue. It will not penetrate to reveal any change in density deeper than that. A)true B)false

Also, an abnormal finding must be 2 to 3 cm wide to yield an abnormal percussion note. Lesions smaller than that are not detectable by percussion. A)true B)false

Diaphragmatic Excursion

Determine diaphragmatic excursion. Percuss to map out the lower lung border, both in expiration and in inspiration. First, ask the person to "exhale and hold it" briefly while you percuss down the scapular line until the sound changes from resonant to dull on each side. This estimates the level of the diaphragm separating the lungs from the abdominal viscera. It may be somewhat higher on the right side (about l to 2 cm) because of the presence of the liver. Mark the spot. A)true B)false

Determine __________. Percuss to map out the lower lung border, both in expiration and in inspiration. First, ask the person to "exhale and hold it" briefly while you percuss down the scapular line until the sound changes from resonant to dull on each side. This estimates the level of the diaphragm separating the lungs from the abdominal viscera. It may be somewhat higher on the right side (about l to 2 cm) because of the presence of the liver. Mark the spot.

diaphragmatic excursion

Now ask the person to "take a deep breath and hold it." Continue percussing down from your first mark and mark the level where the sound changes to dull on this deep inspiration. Measure the difference. This diaphragmatic excursion should be equal bilaterally and measure about 3 to 5 cm in adults, although it may be up to 7 to 8 cm in well-conditioned people. A)true B)false

Now ask the person to "take a deep breath and hold it." Continue percussing down from your first mark and mark the level where the sound changes to dull on this deep inspiration. Measure the difference. This ___________ should be equal bilaterally and measure about 3 to 5 cm in adults, although it may be up to 7 to 8 cm in well-conditioned people.

diaphragmatic excursion

Note an abnormally high level of dullness and absence of excursion. These occur with pleural effusion (fluid in the space between the visceral and parietal pleura) or atelectasis of the lower lobes.

Diaphragmatic Excursion

Always hold your own breath when you ask your patient to. When you run out of air, the other person surely has too, especially if that person has a respiratory problem A)true B)false

AUSCULTATE THE POSTERIOR CHEST

The passage of air through the tracheobronchial tree creates a characteristic set of noises that are audible through the chest wall. These noises also may be modified by obstruction within the respiratory passageways or by changes in the lung parenchyma, the pleura, or the chest wall. A)true B)false

Breath Sounds

The person is sitting, leaning forward slightly, with arms resting comfortably across the lap. Instruct the person to breathe through the mouth, a little bit deeper than usual, but to stop if he or she begins to feel dizzy. Be careful to monitor the breathing throughout the examination and offer times for the person to rest and breathe normally. The person is usually willing to comply with your instructions in an effort to please you and to be a "good patient." Watch that he or she does not hyperventilate to the point of fainting. A)true B) false

Make sure patient does not hyperventilate during examination. A)true B)false

Clean the flat diaphragm endpiece of the stethoscope and hold it firmly on the person's chest wall. Listen to at least one full respiration in each location. Side-to-side comparison is most important A) true B)false

Do not confuse background noise with lung sounds. Become familiar with these extraneous noises that may be confused with lung pathology if not recognized:

l. Examiner's breathing on stethoscope tubing 2. Stethoscope tubing bumping together 3. Patient shivering 4. Patient's hairy chest: movement of hairs under stethoscope sounds like crackles (rales)-minimize this by pressing harder or by wetting the hair with a damp cloth 5. Rustling of paper gown or paper drapes

True

Use a damp wash cloth if patient is hairy, to listen to lung sounds A)true B)false

CONTD.....

Crackles are abnormal lung sounds. A)true B)false

While standing behind the person, listen to the following lung areas posterior from the apices at C7 to the bases (around T 10), and laterally from the axilla down to the seventh or eighth rib. A) true B)false

As you listen, think (I) what Am I'm hearing over this spot? and (2) what should I EXPECT to be hearing? You should expect to hear three types of normal breath sounds in the adult and older child: bronchial (sometimes called tracheal or tubular), bronchovesicular, and vesicular. A)true B)false

You should expect to hear three types of normal breath sounds in the adult and older child: bronchial (sometimes called tracheal or tubular), bronchovesicular, and vesicular. A)true B)false

Decreased or absent breath sounds occur:

1. When the bronchial tree is obstructed at some point by secretions, mucus plug, or a foreign body 2. In emphysema as a result of loss of elasticity in the lung fibers and decreased force of inspired air; also, the lungs are already hyperinflated so the inhaled air does not make as much noise 3. When anything obstructs transmission of sound between the lung and your stethoscope, such as pleurisy or pleural thickening, or air (pneumothorax) or fluid (pleural effusion) in the pleural space

Decreased or absent breath sounds occur:

A silent chest means no air is moving in or out, which is an ominous sign. A)true B)false

A silent chest means no air is moving in or out, gives an ominous sign. A)true B)false

Increased breath sounds mean that sounds are louder than they should be (e.g., bronchial sounds are abnormal when they are heard over an abnormal location, the peripheral lung fields). They have a high-pitched, tubular quality, with a prolonged expiratory phase and a distinct pause between inspiration and expiration They sound very close to your stethoscope, as if they were right in the tubing close to your ear. They occur when consolidation (e.g., pneumonia) or compression (e.g., fluid in the intrapleural space) yields a dense lung area that enhances the transmission of sound from the bronchi. When the inspired air reaches the alveoli, it hits solid lung tissue that conducts sound more efficiently to the surface. A)true B)false

Increased breath sounds mean that sounds are louder than they should be. They have a high-pitched, tubular quality, with a prolonged expiratory phase and a distinct pause between inspiration and expiration.They sound very close to your stethoscope, as if they were right in the tubing close to your ear. They occur when consolidation or compression yields a dense lung area that enhances the transmission of sound from the bronchi. When the inspired air reaches the alveoli, it hits solid lung tissue that conducts sound more efficiently to the surface. A)true B)false

They occur when consolidation (e.g., pneumonia) or compression (e.g., fluid in the intrapleural space) yields a dense lung area that enhances the transmission of sound from the bronchi. When the inspired air reaches the alveoli, it hits solid lung tissue that conducts sound more efficiently to the surface.

Increase breath sounds

Characteristics of Normal Breath Sounds

_______ High, Loud, Inspiration

BRONCHIAL (TRACHEAL)

________Moderate, Inspiration = expiration, mixed, located Over major bronchi where fewer alveoli are located: posterior, between scapulae especially on right; anterior, around upper sternum in first and second intercostal spaces A)VESICULAR B)BRONCHOVESICULAR

BRONCHOVESICULAR

_________Low, Soft, Inspiration > expiration, Rustling, like the sound of the wind in the trees,located Over peripheral lung fields where air flows through smaller bronchioles and alveoli A)VESICULAR B)BRONCHOVESICULAR

VESICULAR

Adventitious Sounds

_______These are added sounds that are not normally heard in the lungs. If present, they are heard as being superimposed on the breath sounds. They are caused by moving air colliding with secretions in the tracheobronchial passageways or by the popping open of previously deflated airways. Sources differ as to the classification and nomenclature of these sounds, but crackles (or rales) and wheeze (or rhonchi) arc terms commonly used by most examiners.

Note the presence of any adventitious sounds

Sources differ as to the classification and nomenclature of these sounds, but crackles (or rales) and wheeze (or rhonchi) arc terms commonly used by most examiners. A)assessing any adventitious sounds B)none

One type of adventitious sound, atelectatic crackles, is not pathologic. They are short, popping, crackling sounds that sound like fine crackles but do not last beyond a few breaths. When sections of alveoli are not fully aerated (as in people who are asleep or in older adults), they deflate slightly and accumulate secretions. Crackles are heard when these sections are expanded by a few deep breaths. A)true B)false

One type of adventitious sound, ____________, is not pathologic. They are short, popping, crackling sounds that sound like fine crackles but do not last beyond a few breaths. When sections of alveoli are not fully aerated (as in people who are asleep or in older adults), they deflate slightly and accumulate secretions. Crackles are heard when these sections are expanded by a few deep breaths

atelectatic crackles

When sections of alveoli are not fully aerated as in people who are asleep or in older adults, Crackles are heard when these sections are expanded by a few deep breaths.

atelectatic crackles

Atelectatic crackles are heard only in the periphery, usually in dependent portions of the lungs, and disappear after the first few breaths or after a cough. A)true B)false

In the past, persons were asked to "take a deep breath and blow it out hard" to screen for the presence of wheezing. However, this maneuver is futile because evidence shows wheezing may occur on maximal forced exhalation in healthy people. A)true B)false

During normal tidal flow, high-pitched wheeze occurs with asthma A)true B)false

During normal tidal flow, high-pitched wheeze occurs with ___________

asthma

Voice Sounds

Determine the quality of voice sounds or vocal resonance. The spoken voice can be auscultated over the chest wall just as it can be felt in tactile fremitus described earlier. A)true B)false

Ask the person to repeat a phrase such as "ninety-nine" while you listen over the chest wall. Normal voice transmission is soft, muffled, and indistinct; you can hear sound through the stethoscope but cannot distinguish exactly what is being said. A)true B)false

Pailiology that increases lung density enhances transmission of voice sounds, and you can hear what is being said through the stethoscope A)true B)false

Consolidation or compression of lung tissue will enhance the voice sounds, making the words more distinct. A)true B)false

Consolidation or compression of lung tissue enhances the voice sounds, making the words more distinct. A)true B)false

___________or _________ of lung tissue will enhance the voice sounds, making the words more distinct.

Consolidation or compression

Eliciting the voice sounds is not done routinely. Rather, these are supplemental maneuvers performed if you suspect lung pathology on the basis of earlier data. When they are performed, you are testing for the possible presence of bronchophony, egophony, and whispered pectoriloquy A)true B)false

INSPECT THE ANTERIOR CHEST

Note the shape and configuration of the chest wall. The ribs are sloping downward with symmetric interspaces. The costal angle is within 90 degrees. Development of abdominal muscles is as expected for the person's age, weight, and athletic condition. A)true B)false

Barrel chest has horizontal ribs and costal angle >90 degrees. A)true B)false

Hypertrophy of abdominal muscles occurs in chronic emphysema. A)true B)false

Hypertrophy of abdominal muscles occurs in chronic _________.

emphysema

Note the person's facial expression. The facial expression should be relaxed and benign, indicating an unconscious effort of breathing. A)true B)false

Tense, strained, tired facies accompany COPD A)true B)false

Tense, strained, tired facies accompany ________

COPD

The person with COPD may purse the lips in a whistling position. By exhaling slowly and against a narrow opening, the pressure in the bronchial tree remains positive and fewer airways collapse. A)true B)false

The person with ________ may purse the lips in a whistling position. By exhaling slowly and against a narrow opening, the pressure in the bronchial tree remains positive and fewer airways collapse.

COPD

Cerebral hypoxia may be reflected by excessive drowsiness or by anxiety, restlessness, and irritability. A)true B)false

Cerebral hypoxia may be reflected by drowsiness, restlessness, anxiety, and irritability. A)true B)false

Note skin color and condition. The lips and nail beds are free of cyanosis or unusual pallor. The nails are of normal configuration. Explore any skin lesions. A)true B)false

Clubbing of distal phalanx occurs with chronic respiratory disease. A)true B)false

________of distal phalanx occurs with chronic respiratory disease.

Clubbing

``` Cutaneous angiomas (spider nevi) associated with liver disease or portal hypertension may be evident on the chest. A)true B)false ```

``` Cutaneous angiomas (spider nevi) associated with liver disease , portal hypertension may be evident on the chest. A)true B)false ```

Assess the quality of respirations. Normal relaxed breathing is automatic and effortless, regular and even, and produces no noise. The chest expands symmetrically with each inspiration. Note any localized lag on inspiration. A)true B)false

Noisy breathing occurs with severe asthma or chronic bronchitis A)true B)false

Unequal chest expansion occurs when part of the lung is obstructed or collapsed, as with pneumonia, or when guarding to avoid postoperative incisional pain or pleurisy pain. A)true B)false

Unequal chest expansion occurs when part of the lung is obstructed or collapsed, as with pneumonia, or when guarding to avoid postoperative incisional pain or pleurisy pain A)true B)false

No retraction or bulging of the interspaces should occur on inspiration. A)true B) false

Retraction suggests obstruction of respiratory tract or increased inspiratory effort is needed, as with atelectasis. A)true B)fase

__________ suggests obstruction of respiratory tract or increased inspiratory effort is needed, as with atelectasis

Retraction

Bulging indicates trapped air as in the forced expiration associated with emphysema or asthma. A)true B)false

______indicates trapped air as in the forced expiration associated with emphysema or asthma.

Bulging

Normally, accessory muscles are not used to augment respiratory effort. However, with very heavy exercise, the accessory neck muscles (scalene, sternomastoid, trapezius) are used momentarily to enhance inspiration. A)true B)false

Abnormal finding, would be the Accessory muscles are used in acute airway obstruction and massive atelectasis. A)true B)false

Abnormal finding would be. Rectus abdominis and internal intercostal muscles are used to force expiration in COPD. A)true B)false

The respiratory rate is within normal limits for the person's age, and the pattern of breathing is regular. Occasional sighs normally punctuate breathing A)true B)false

Tachypnea and hyperventilation, bradypnea and hypoventilation, periodic breathing these are all

Abnormal findings

PALPATE THE ANTERIOR CHEST

Palpate symmetric chest expansion. Place your hands on the anterolateral wall with the thumbs along the costal margins and pointing toward the xiphoid process A)true B)false

Abnormally wide costal angle with little inspiratory variation occurs with emphysema. A)true B)false

Ask the person to take a deep breath. Watch your thumbs move apart symmetrically, and note smooth chest expansion with your fingers. Any limitation in thoracic expansion is easier to detect on the anterior chest because greater range of motion exists with breathing here. A)assessing symmetry of the chest expansion B)false

Symmetric chest expansion is better for assessing anterior or posterior

A lag in chest expansion occurs with atelectasis, pneumonia, and postoperative guarding. A)true B)false

A palpable grating sensation with breathing indicates pleural friction fremitus. A)abnormal finding in chest expansion B)false

``` Assess tactile (vocal) fremitus. Begin palpating over the lung apices in the supraclavicular areas. Compare vibrations from one side to the other as the person repeats "ninety-nine." Avoid palpating over female breast tissue because breast tissue normally damps the sound. A)true B)false ```

Palpate the anterior chest wall to note any tenderness (normally none is present) and to detect any superficial lumps or masses (again, normally none are present). Note skin mobility and turgor, and note skin temperature and moisture. A)true B)false

If any lumps are found in the breast tissue, refer the man to a specialist. A)true B)false

PERCUSS THE ANTERIOR CHEST

lnterspaces are easier to palpate on the anterior chest than on the back. Do not percuss directly over female breast tissue because this would produce a dull note. Shift the breast tissue over slightly using the edge of your stationary hand. In females with large breasts, percussion may yield little useful data. With all people, use the sequence. A)true B)false

Note the borders of cardiac dullness normally found on the anterior chest and do not confuse these with suspected lung pathology. A)true B)false

In the right hemithorax, the upper border of liver dullness is located in the fifth intercostal space in the right midclavicular line. On the left, tympany is evident over the gastric space. A)true B)false

Lungs are hyperinflated with chronic emphysema, which results in hyperresonance where you would expect cardiac dullness. A)true B)false

Dullness behind the right breast occurs with right middle lobe pneumonia. A)true B)false

AUSCULTATE THE ANTERIOR CHEST

Breath Sounds

Auscultate the lung fields over the anterior chest from the apices in the supraclavicular areas down to the sixth rib. Progress from side to side as you move downward, and listen to one full respiration in each location. Use the sequence indicated for percussion. Do not place your stethoscope directly over the female breast. Displace the breast and listen directly over the chest wall. A)true B)false

Evaluate normal breath sounds, noting any abnormal breath sounds and any adventitious sounds. If the situation warrants, assess the voice sounds on the anterior chest. A)true B)false

Measurement of Pulmonary Function Status

The forced expiratory time is the number of seconds it takes for the person to exhale from total lung capacity to residual volume. It is a screening measure of airflow obstruction. Although the test usually is not performed in the respiratory assessment, it is useful when you wish to screen for pulmonary function. A)true B)false

Ask the person to inhale the deepest breath possible and then to blow it all out hard, as quickly as possible, with the mouth open. Listen with your stethoscope over the sternum. The normal time for full expiration is 4 seconds or less. A)true B)false

A forced expiration of 6 seconds or more occurs with obstructive lung disease. Refer this person for more precise pulmonary function studies. A)true B)false

In an ambulatory care setting, a handheld spirometer measures lung health in chronic conditions such as asthma. Ask the patient to inhale deeply and then to exhale into the spirometer as fast as possible until the most air possible is exhaled. A) true B)false

The forced vital capacity (FVC) is the total volume of air exhaled. The forced expiratory volume in 1 second (FEV1) is the volume exhaled in the first measured second. A normal outcome is a FEV1/FVC ratio of 75% or greater, meaning no significant obstruction of airflow is present. A)true B) false

The forced vital capacity (FVC) is the total volume of air exhaled. A)true B)false

The forced expiratory volume in 1 second (FEV1) is the volume exhaled in the first measured second. A)true B)false

A normal outcome is a FEV1/FVC ratio of 75% or greater, meaning no significant obstruction of airflow is present. A)true B)false

Mild obstruction of airflow is a FEV1/ FCV ratio of 60% to 70%; A)true B)false

moderate obstruction is a measure of 50% to 60%; A)true B)fAlse

severe obstruction is a ratio of less than 50%. A)true B)false

The pulse oximeter is a noninvasive method to assess arterial oxygen saturation (Spo2). A healthy person with no lung disease and no anemia normally has an Spo2 of 97% to 98%. However, every Spo2 result must be evaluated in the context of the person's hemoglobin level, acid-base balance, and ventilatory status. A)true B) false

However, every Spo2 result must be evaluated in the context of the person's hemoglobin level, acid-base balance, and ventilatory status. A)true B) false

The 6-minute distance (6MD) walk is a safer, simple, inexpensive, clinical measure of functional status in aging adults.The 6MD is used as an outcome measure for people in pulmonary rehabilitation because it mirrors conditions that are used in everyday life. A)true B)false

The 6MD is used as an outcome measure for people in pulmonary rehabilitation and aging adult because it mirrors conditions that are used in everyday life. A)true B)false

Locate a flat-surfaced corridor that has little foot traffic, is wide enough to permit comfortable turns, and has a controlled environment. Ensure that the person is wearing comfortable shoes, and equip him or her with a pulse oximeter to monitor oxygen saturation. Ask the person to set his or her own pace to cover as much ground as possible in 6 minutes, and assure the person it is all right to slow down or to stop to rest at any time.

6MD TEST

Use a stopwatch to time the walk. A person who walks >300 meters in 6 minutes is more likely to engage in activities of daily living. A)true B)false

Ask the person to stop the walk if you measure an Spo2 below 85% to 88% or if extreme breathlessness occurs. During a 6MD. A)true B)false

DEVELOPMENTAL COMPETENCE | Infants and Children

To prepare, let the parent hold an infant supported against the chest or shoulder. Ignore the usual sequence of the physical examination; seize the opportunity with a sleeping infant to inspect and then to listen to lung sounds next. This way you can concentrate on the breath sounds before the baby wakes up and possibly cries. A)true B) false

Infant crying does not have to be a problem for you, however, because it actually enhances palpation of tactile fremitus and auscultation of breath sounds. A)true B)false

Offer the stethoscope and let the child handle it. This reduces any fear of the equipment. A)true B)false

Promote the child's participation; school-age children usually are delighted to hear their own breath sounds when you place the stethoscope properly. A)true B)false

While listening to breath sounds, ask the young child to take a deep breath and "blow out" your penlight while you hold the stethoscope with your other hand. Time your letting go of the penlight button so the light goes off after the child blows. Or, ask the child to "pant like a dog" while you auscultate. A)true B)false

The infant has a rounded thorax with an equal AP-to-transverse chest diameter. A)true B)false

By age 6 years, the thorax reaches the adult ratio of 1:2 (AP-to-transverse diameter). A)true B)false

The newborn's chest circumference is 30 to 36 cm and is 2 cm smaller than the head circumference until 2 years of age. A)true B) false

The chest wall is thin with little musculature. The ribs and the xiphoid are prominent; you can see as well as feel the sharp tip of the xiphoid process. The thoracic cage is soft and flexible. A)infant and children B)adult

Note a barrel shape persisting after age 6 years, which may develop with chronic asthma or cystic fibrosis. A)true B)false

barrel shape chest persisting after age 6 years, which may develop with chronic asthma or cystic fibrosis. A)true B)false

In newborn males and females, the breasts may look enlarged by the second or third day from maternal estrogen. Occasionally a white fluid, sometimes referred to by the slang expression "witch's milk," can be expressed. This resolves within a week. A)true B)false

Infant and children up to 6 normally have barrels chest A)true B)false

In some children, "Harrison groove" occurs normally. This is a horizontal groove in the rib cage at the level of the insertion of the diaphragm, extending from the sternum to the midaxillary line. A)true B)false

In some children, ____________" occurs normally. This is a horizontal groove in the rib cage at the level of the insertion of the diaphragm, extending from the sternum to the midaxillary line

"Harrison groove

Harrison groove also occurs with rickets from the pull of the diaphragm on weakened ribs. A)true B)false

The newborn's first respiratory assessment is part of the Apgar scoring system to measure the successful transition to extrauterine life. A)true B) false

The five standard parameters are scored at 1 minute and at 5 minutes after birth. A 1-minute Apgar with a total score of 7 to lO indicates a newborn in good condition, needing only suctioning of the nose and mouth and otherwise routine care. A)true B)false

In the immediate newborn period, depressed respirations are due to maternal drugs, interruption of the uterine blood supply, or obstruction of the tracheobronchial tree with mucus or fluid. A)true, abnormal finding B)false, abnormal finding

A 1-minute Apgar score with a total score of 3 to 6 indicates a moderately depressed newborn needing more resuscitation and subsequent close observation. A)true B)false

A score of 0 to 2 indicates a severely depressed newborn needing full resuscitation, ventilatory assistance, and subsequent intensive care. A)true B)false

The infant breathes through the nose rather than the mouth and is an obligate nose breather until 3 months. Slight flaring of the lower costal margins may occur with respirations, but normally no flaring of the nostrils and no sternal retractions or intercostal retractions occur. A)true B)false

The diaphragm is the newborn's major respiratory muscle. Intercostal muscles are not well developed. Thus you observe the abdomen bulge with each inspiration but see little thoracic expansion. A)true B)false

diaphragm is the newborn's major respiratory muscle. Intercostal muscles are not well developed. Thus you observe the abdomen bulge with each inspiration but see little thoracic expansion. A)true B)false

Marked retractions of sternum and intercostal muscles indicate increased inspiratory effort, as in atelectasis, pneumonia, asthma, and acute airway obstruction. A)abnormal finding in an infant or child B)false

Count the respiratory rate for 1 full minute. Normal rates for the newborn are 30 to 40 breaths per minute but may spike up to 60 per minute. Obtain the most accurate respiratory rate by counting when the infant is asleep, because infants reach rapid rates with very little excitation when awake. A)ture B)false

Normal rates for the newborn are 30-40 breaths per minute but may spike up to 60 per minute. most accurate respiratory rate by counting when the infant is asleep, because infants reach rapid rates with very little excitation when awake. A)true B)false

The infants respiratory pattern may be irregular when extremes in room temperature occur or with feeding or sleeping. A)true B)false

Brief periods of apnea less than 10-15 seconds are common. This periodic breathing is more common in premature infants. A)true B)false

Rapid respiratory rates accompany pneumonia, fever, pain, heart disease, and anemia. A)true B)false

In an infant, tachypnea of 50 to 100 per minute during sleep may be an early sign of heart failure. A)true B)false

Palpate symmetric chest expansion by encircling the infant's thorax with both hands. Further palpation should yield no lumps, masses, or crepitus, although you may feel the costochondral junctions in some normal infants. A)true B)false

costochondral junctions in some normal infants.are palatable A)true B)false

Asymmetric of infant chest expansion occurs with diaphragmatic hernia or pneumothorax. A)true B)false

Crepitus is palpable around a fractured clavicle, which may occur with difficult forceps delivery. A)true B)false

Percussion is of limited usefulness in the newborn and especially in the premature newborn because the adult's fingers are too large in relation to the tiny chest. The percussion note of hyperresonance occurs normally in the infant and young child because of the relatively thin chest wall. Anything less than hyperresonance would have the same clinical significance as dullness in the adult. If measured, diaphragmatic excursion measures about one to two rib interspaces in children. A)true B)false

Auscultation normally yields bronchovesicular breath sounds in the peripheral lung fields of the infant and young child up to age 5 to 6 years. Their relatively thin chest walls with underdeveloped musculature do not damp off the sound as do the thicker walls of adults, so breath sounds are louder and harsher. A)true B)false

Auscultation normally yields bronchovesicular breath sounds in the peripheral lung fields of the infant and young child up to age 5 to 6 years. thin chest walls with underdeveloped musculature do not damp off the sound, so breath sounds are louder and harsher. A)true B)false

Diminished breath sounds occur with pneumonia, atelectasis, pleural effusion, or pneumothorax. A)abnormal finding in infant and children B)normal finding

Fine crackles are the adventitious sounds commonly heard in the immediate newborn period from opening of the airways and clearing of fluid. Because the newborn's chest wall is so thin, transmission of sounds is enhanced and sound is heard easily all over the chest, making localization of breath sounds a problem. A)true B)false

Persistent fine crackles that are scattered over the chest occur with pneumonia, bronchiolitis, or atelectasis. A)abnormal finding for infant and children B)normal finding

Even bowel sounds are easily heard in the chest. Try using the smaller pediatric diaphragm endpiece, or place the bell over the infant's interspaces and not over the ribs. Use the pediatric diaphragm on an older infant or toddler. A)true B)false

Crackles only in upper lung fields occur with cystic fibrosis; crackles only in lower lung fields occur with heart failure. A)abnormal finding in infant and children B)normal finding in infant and children

Crackles only in upper lung fields occur with cystic fibrosis; A)abnormal finding in infant and children B)normal finding in infant and children

crackles only in lower lung fields occur with heart failure. A)abnormal finding in infant and children B)normal finding in infant and children

Expiratory wheezing occurs with lower airway obstruction (e.g., asthma or bronchiolitis). When unilateral, it may be foreign body aspiration. A)abnormal finding in infant or children B)normal finding in infant or children

Persistent peristaltic sounds with diminished breath sounds on the same side may indicate diaphragmatic hernia. A)abnormal finding in infant or children B)normal finding in infant or children

Stridor is a high-pitched inspiratory crowing sound heard without the stethoscope, occurring with upper airway obstruction (e.g., croup, foreign body aspiration, or acute epiglottitis). A)abnormal finding in infant or children B)normal finding in infant or children

DEVELOPMENTAL COMPETENCE | The Pregnant Woman

The thoracic cage may appear wider and the costal angle may feel wider than in the nonpregnant state. Respirations may be deeper, although this can be quantified only with pulmonary function tests. A)pregnant woman B)aging adult

In a pregnant woman, The thoracic cage may appear wider and the costal angle may feel wider than in the nonpregnant state. Respirations may be deeper, although this can be quantified only with pulmonary function tests. A)true B)false

DEVELOPMENTAL COMPETENCE | The Aging Adult

The chest cage commonly shows an increased anteroposterior diameter, giving a round barrel shape, and kyphosis or an outward curvature of the thoracic spine A)aging adult B) infant

Aging adult, barrel chest, kyphosis and increase in thoracic curvature A)true B)false

The person compensates by holding the head extended and tilted back.in kyphosis A)aging adult B)infant

You may palpate marked bony prominences because of decreased subcutaneous fat. A)aging adult B)infant

Chest expansion may be somewhat decreased with the older person, although it still should be symmetric. The costal cartilages become calcified with aging, resulting in a less mobile thorax. A)true B)false

The older person may fatigue easily, especially during auscultation when deep mouth breathing is required. Take care that this person does not hyperventilate and become dizzy. Allow brief rest periods or quiet breathing. If the person does feel faint, holding the breath for a few seconds will restore equilibrium. A)aging adult B)infant

If the person does feel faint, holding the breath for a few seconds will restore equilibrium. A) aging adult B)infant

DEVELOPMENTAL COMPETENCE | The Acutely Ill Person

Ask a second examiner to hold the person's arms and to support him or her in the upright position. If no one else is available, you need to roll the person from side to side, examining the uppermost half of the thorax. This obviously prevents you from comparing findings from one side to another. A)true B)false

Also, side flexion of the trunk alters percussion findings because the ribs of the upward side may flex closer together. A)true B)false

side flexion of the trunk alters percussion findings A)true B)false

PROMOTING A HEALTHY LIFESTYLE: ENVIRONMENTAL TOBACCO SMOKE (ETS) Secondhand Smoke- There Is No Risk-Free Level of Exposure!

Secondhand smoke, also referred to as environmental tobacco smoke (ETS), is a mixture of sidestream and mainstream smoke. A)true B)false

Sidestream smoke is the smoke given off at the burning end of a tobacco product, whereas mainstream smoke is the smoke exhaled from the individual smoking the tobacco product A)true B)false

increases an adult's risk for cancer and heart disease. A)true B)false

Cotinine levels are consistently higher in African Americans than in whites and Mexican Americans. A)true B)false

ABNORMAL FINDINGS ---·

Configurations of the Thorax

The thorax has an elliptical shape with an anteroposteriorto-transverse diameter of 1:2 or 5 :7. This is

Normal Adult (for Comparison)

Note equal anteroposterior-to-transverse diameter and that ribs are horizontal instead of the normal downward slope. This is associated with normal aging and also with chronic emphysema and asthma as a result of hyperinflation of lungs. A)Barrel Chest B)Pectus Excavatum

A markedly sunken sternum and adjacent cartilages (also called funnel breast). Depression begins at second intercostal space, becoming depressed most at junction of xiphoid with body of sternum. More noticeable on inspiration. Congenital, usually not symptomatic. When severe, sternal depression may cause embarrassment and a negative self-concept. Surgery may be indicated. A)Pectus Excavatum B)Pectus Carinatum

A forward protrusion of the sternum, with ribs sloping back at either side and vertical depressions along costochondral junctions (pigeon breast). Less common than pectus excavatum, this minor deformity requires no treatment. If severe, surgery may be indicated. A) Pectus Carinatum B)pectus exactum

A lateral S-shaped curvature of the thoracic and lumbar spine, usually with involved vertebrae rotation. Note unequal shoulder and scapular height and unequal hip levels, rib interspaces Aared on convex side. More prevalent in adolescent age-groups, especially girls. Mild deformities are asymptomatic. If severe (>45 degrees) deviation is present, __________ may reduce lung volume and then person is at risk for impaired cardiopulmonary function. Primary impairment is cosmetic deformity, negatively affecting self-image. Refer early for treatment, often surgery. A)Scoliosis B)kyphosis

An exaggerated posterior curvature of the thoracic spine (humpback) that causes significant back pain and limited mobility. Severe deformities impair cardiopulmonary function. If the neck muscles are strong, compensation occurs by hyperextension of head to maintain level of vision. A)Kyphosis B)scoliosis

___________has been associated with aging, especially the familiar "dowager's hump" of postmenopausal osteoporotic women. However, it is common well before menopause. It is related to physical fitness; women with adequate exercise habits are less likely to have kyphosis.

Kyphosis

Respiratory Patterns*

``` Rate-10 to 20 breaths per minute Depth-500 to 800 mL Pattern-even The ratio of pulse to respirations is fairly constant, about 4:1. Both values increase as a normal response to exercise, fear, or fever. Depth-air moving in and out with each respiration. This what finding of respirations ```

Normal Adult (for Comparison)

Depth-500 to 800 mL The ratio of pulse to respirations is fairly constant, about 4:1. Both values increase as a normal response to exercise, fear, or fever. A)true for normal respiration B)false

``` 'Assess the (1) rate, (2) depth (tidal volume), and (3) pattern. All for respirations A)true B)false ```

Occasional sighs punctuate the normal breathing pattern and are purposeful to expand alveoli. Frequent sighs may indicate emotional dysfunction. Frequent sighs also may lead to hyperventilation and dizziness. A) Sigh B)tachypena

Rapid, shallow breathing. Increased rate, >24 per minute. This is a normal response to fever, fear, or exercise. Rate also increases with respiratory insufficiency, pneumonia, alkalosis, pleurisy, and lesions in the pons.

Tachypnea

Increase in both rate and depth. Normally occurs with extreme exertion, fear, or anxiety. Also occurs with diabetic ketoacidosis (Kussmaul respirations), hepatic coma, salicylate overdose (producing a respiratory alkalosis to compensate for the metabolic acidosis), lesions of the midbrain, and alteration in blood gas concentration (either an increase in C02 or a decrease in oxygen). _____________ blows off C02, causing a decreased level in the blood (alkalosis). A)Hyperventilation B)tachypena C)hypoventilation

Slow breathing. A decreased but regular rate (

Bradypnea

An irregular shallow pattern caused by an overdose of narcotics or anesthetics. May also occur with prolonged bedrest or conscious splinting of the chest to avoid respiratory pain. A) Hypoventilation B)hyperventilation

A cycle in which respirations gradually wax and wane in a regular pattern, increasing in rate and depth and then decreasing. The breathing periods last 30 to 45 seconds, with periods of apnea (20 seconds) alternating the cycle. The most common cause is severe heart failure; other causes are renal failure, meningitis, drug overdose, and increased intracranial pressure. Occurs normally in infants and aging persons during sleep. A) Cheyne-Stokes Respiration B)Bradypena

Occurs normally in infants and aging persons during sleep. A) Cheyne-Stokes Respiration B)Bradypena

Similar to Cheyne-Stokes respiration, except that the pattern is irregular. A series of normal respirations (three to four) is followed by a period of apnea. The cycle length is variable, lasting anywhere from 10 seconds to 1 minute. Seen with head trauma, brain abscess, heat stroke, spinal meningitis, and encephalitis A)Biot's Respiration B)tachypena C)both a and b

Normal inspiration and prolonged expiration to overcome increased airway resistance. In a person with chronic obstructive lung disease, any situation calling for increased heart rate (exercise) may lead to dyspneic episode (air trapping), because then the person does not have enough time for full expiration. A)Chronic Obstructive Breathing B)tachypena

Abnormal Tactile Fremitus

_________Tactile Fremitus Occurs with conditions that increase the density of lung tissue, thereby making a better conducting medium for vibrations (e.g., compression or consolidation [pneumonia]). There must be a patent bronchus and consolidation must extend to lung surface for increased fremitus to be apparent.

Increased

____________Tactile Fremitus Occurs when anything obstructs transmission of vibrations (e.g., an obstructed bronchus, pleural effusion or thickening, pneumothorax, and emphysema). Any barrier that gets in the way of the sound and your palpating hand decreases fremitus.

Decreased

Decrease Tactile Fremitus Occurs when an obstructed bronchus, pleural effusion or thickening, pneumothorax, and emphysema. A)true B)false

compression or consolidation [pneumonia]. also there must be a patent bronchus and consolidation must extend to lung surface for increased fremitus to be apparent. A)true B)false

________Fremitus Vibration felt when inhaled air passes through thick secretions in the larger bronchi. This may decrease somewhat by coughing. A)Rhonchal B)increase C)decrease

_________ Produced when inflammation of the parietal or visceral pleura causes a decrease in the normal lubricating fluid. Then the opposing surfaces make a coarse grating sound when rubbed together during breathing. Although this sound is best detected by auscultation, it may sometimes be palpable and feels like two pieces of leather grating together. It is synchronous with respiratory excursion. Also called a palpable friction rub. A)Pleural Friction Fremitus B)fremitusitis

Adventitious Lung Sounds

Discontinuous Sounds are discrete, crackling sounds. A)true B)false

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 A)Crackles-fine (formerly called rales) B)Crackles-coarse (Coarse rales)

Late inspiratory crackles occur with restrictive disease: pneumonia, heart failure, and interstitial fibrosis A)Crackles-coarse (coarse rales) B)Crackles-fine (formerly called rales)

Early inspiratory crackles occur with obstructive disease: chronic bronchitis, asthma, and emphysema A)Crackles-coarse (coarse rales) B)Crackles-fine (formerly called rales)

Posturally induced crackles (PICs) are fine crackles that appear with a change from sitting to the supine position or with a change from supine to supine with legs elevated A)Crackles-coarse (coarse rales) B)Crackles-fine (formerly called rales)

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 Clinical ex;Pulmonary edema, pneumonia, pulmonary fibrosis, and the terminally ill who have a depressed cough reflex A)Crackles-coarse (coarse rales) B)Atelectatic crackles (atelectatic rales)

Sounds like fine crackles but do not last and are not pathologic; disappear after the first few breaths; heard in axillae and bases (usually dependent) of lungs. Clinical ex;In aging adults, in bedridden persons, or in persons just aroused from sleep A)Atelectatic crackles (atelectatic rales) B)Pleural friction rub

A very superficial sound that is coarse and low pitched; it has a grating quality as if two pieces o f leather are being rubbed together; sounds just like crackles, but close to the ear; sounds louder if you push the stethoscope harder onto the chest wall; sound is inspiratory and expiratory Clinical ex;Pleuritis, accompanied by pain with breathing (rub disappears after a few days if pleural fluid accumulates and separates pleurae) A)Pleural friction rub B)Wheeze-high-pitched (sibilant)

Adventitious Lung Sounds-cont'd

Continuous Sounds are connected, musical sounds. A)true B)false

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. Clinical ex;Diffuse airway obstruction from acute asthma or chronic emphysema A)Wheeze-high-pitched (sibilant) B)Wheeze-low-pitched (sonorous rho nchi )

Low-pitched; monophonic single note, musical snoring, moaning sounds; they are heard throughout the cycle, although they are more prominent on expiration; may clear somewhat by coughing Clinical ex;Bronchitis, single bronchus obstruction from airway tumor A)Wheeze-low-pitched (sonorous rhonchi ) B)Stridor

High-pitched, monophonic, inspiratory, crowing sound, louder in neck than over chest wall Clinical ex;Croup and acute epiglottitis in children, and foreign inhalation, obstructed airway m pay be life-threatening A)Stridor B)Wheeze-low-pitched (sonorous rhonchi )

ABNORMAL FINDINGS FOR | ADVANCED PRACTICE

Voice Sounds

Ask the person to repeat " ninety- nine" while you listen with the stethoscope over the chest wall; listen especially if you suspect pathology A)Bronchophony B)Egophony

Normal voice transmission is soft, muffled, and indistinct; you can hear sound through the stethoscope but cannot distinguish exactly what is being said. A)Bronchophony B)egochony

Pathology that increases lung density will enhance transmission of voice sounds; you auscultate a clear " ninety-nine" The words are more distinct than normal and sound close to your ear A)abnormal Bronchophony B)Egophony

(Greek: " the voice of a goat") Auscultate the chest whi le the person phonates a long "ee-ee-ee-ee" sound A)Egophony B)Whispered Pectoriloquy

Normally, you should hear "eeeeeeee" through your stethoscope A)Egophony B)Whispered Pectoriloquy

Over area of consolidation or compression, the spoken "eeee" sound changes to a bleating long "aaaaa" sound. A)Egophony B)Whispered Pectoriloquy

Ask the person to whisper a phrase like " one-two-three" as you auscultate A)Whispered Pectoriloquy B)pain

The no rmal response is faint, muffled, and almost inaudible A)Whispered Pectoriloquy B)false

With only small amounts of consolidation, the whispered voice is transmitted very clearly and distinctly, although still somewhat faint; it sounds as if the person is whispering right into your stethoscope, " one-two-three" A)abnormal Whispered Pectoriloquy B)abnormal Egophony

Assessment of Common | Respiratory Conditions

Inspection: Anteroposterior

Normal Lung (for comparison)

Condition Collapsed shrunken section of alveoli or an entire lung as a result of (1) airway obstruction (e.g., the bronchus is completely blocked by thick exudate, aspirated foreign body, or tumor), the alveolar air beyond it is gradually absorbed by the pulmonary capillaries, and the alveolar walls cave in; (2) compression o n the lung; and (3) lack of surfactant (hyaline membrane disease).

Atelectasis (Collapse)

Inspection: Cough Lag on expansion on affected side. Increased respiratory rate and pulse. Possible cyanosis. Palpation: Chest expansion decreased on affected side. Tactile fremitus decreased or absent over area. With large collapse, tracheal shift toward affected side. Percussion: Dull over area (remainder of thorax sometimes may have hyperresonant note) Auscultation: Breath sounds decreased vesicular or absent over area. Voice sounds variable, usually decreased or absent over affected area. Adventitious Sounds: None if bronchus is obstructed. Occasional fine crackles if bronchus is patent. A)Atelectasis (Collapse) B)none

Condition Infection in lung parenchyma leaves alveolar membrane edematous and porous, so red blood cells (RBCs) and white blood cells (WBCs) pass from blood to alveoli. Alveoli progressively fill up (become consolidated) with bacteria, solid cellular debris, fluid, and blood cells, which replace alveolar air. This decreases surface area of the respiratory membrane, causing hypoxemia. A)lobar Pneumonia B)pneonia

Inspection: Increased respiratory rate. Guarding and lag on expansion on affected side. Children-sternal retraction, nasal flaring. Palpation: Chest expansion decreased on affected side. Tactile fremitus increased if bronchus patent, decreased if bronchus obstructed. Percussion: Dull over lobar pneumonia. Auscultation: Breath sou nds louder with patent bronchus, as if co ming directly from larynx. Voice sounds have increased clarity; bronchophony, egophony, whispered pectoriloquy present. Children-diminished breath sounds may occur early in pneumonia. Adventitious Sounds: Crackles, fine to medium. A)lobar Pneumonia B)brochlitits

Condition Proliferation of mucus glands in the passageways, resulting in excessive mucus secretion. Inflammation of bronchi with partial obstruction of bronchi by secretions or constrictions. Sections of lu ng di stal to obstruction may be deflated. Bronchitis may be acute or chronic with recurrent productive cough. Chronic bronchitis is usually caused by cigarette smoking. A)Bronchitis B)lobar Pneumonia

Inspection: Hacking, rasping cough productive of thick mucoid sputum. Chronic-dyspnea, fatigue, cyanosis, possible clubbing of fingers. Palpation: Tactile frem itus normal. Percussion: Resonant. Auscultation: Normal vesicular. Voice sounds normal. Chronic-prolonged expiration. Adventitious Sounds: Crackles over deflated areas. May have wheeze. A)Bronchitis B)Emphysema

Condition Caused by destruction of pulmonary connective tissue (elastin, collagen); characterized by permanent enlargement of air sacs distal to terminal bronchioles and rupture of interalveolar walls. This increases airway resistance, especially on expiration-producing a hyperinflated lung and an increase in lung volume. Cigarette smoking accounts for 80% to 90% of cases of _______. A)Emphysema B)Asthma (Reactive Airway Disease)

Inspection: Increased anteroposterior diameter. Barrel chest. Use of accessory muscles to aid respiration. Tripod position. Shortness of breath, especially on exertion. Respiratory distress. Tachypnea. Palpation: Decreased tactile fremitus and chest expansion. Percussion: Hyperresonant. Decreased diaphragmatic excursion. Auscultation: Decreased b rea th sounds. May have prolonged expiration. Muffled heart sounds resulting from overdistention of lungs. Adventitious Sounds: Usually none; occasionally, wheeze. A)Emphysema B)Asthma (Reactive Airway Disease)

Condition An allergic hypersensitivity to certain inhaled allergens (pollen), irritants (tobacco, ozone), microbes, stress, or exercise that produces a complex response characterized by bronchospasm and inflammation, edema in walls of bronchioles, and secretion of highly viscous mucus into ai rways. These factors greatly increase airway resistance, especially duri ng expiratio n, and prod uce the symptoms of wheezing, dyspnea, and chest tightness. A)emphysema B)Asthma (Reactive Airway Disease)

Inspection: During severe attack: increased respiratory rate, shortness of breath with audible wheeze, use of accessory neck muscles, cyanosis, apprehension, retraction of intercostal spaces. Expiration labored, prolonged. When chronic, may have barrel chest. Palpation: Tactile fremitus decreased, tachycardia. Percussion: Resonant. May be hyperresonan t if chronic. Auscultation: Diminished air movement. Breath sounds decreased, with prolonged expiration. Voice sounds decreased. Adventitious Sounds: Bilateral wheezing on expiration, sometimes inspiratory and expiratory wheezing. A)emphysema B)asthma

Condition Collection of excess fluid in the intrapleural space, with compression of overlying lung tissue. Effusion may contain watery capillary fluid (transudative), protein (exudative), purulent matter (empyemic), blood (hemothorax), or milky lymphatic fluid (chylothorax). Gravity settles fluid in dependent areas of thorax. Presence of fluid subdues all lung sounds. A)Pleural Effusion (Fluid) or Thickening B)Heart Failure

Inspection: Increased respirations, dyspnea; may have dry cough, tachycardia, cyanosis, abdominal distention. Palpation: Tactile fremitus decreased or absent. Tracheal shift away from affected side. Chest expansion decreased on affected side. Percussion: Dull to flat. No diaphragmatic excursion on affected side. Auscultation: Breath sounds decreased or absent. Voice sounds decreased or absent. When remainder of lung is compressed near the effusion, may have bronchial breath sounds over the compression along with bronchophony, egophony, whispered pectoriloquy. Adventitious Sounds: None. A)Pleural Effusion (Fluid) or Thickening B)heart failure

Condition Pump failure with increasing pressure of cardiac overload causes pulmo nary congestion or an increased amount of blood present in pulmonary capillaries. Dependent air sacs are deflated. Pulmonary capillaries engorged. Bronchial mucosa may be swollen. A)Heart Failure B)emphysema

Inspection: Increased respiratory rate, shortness of breath on exertion, orthopnea, paroxysmal nocturnal dyspnea, nocturia, ankle edema, pallor in light-skinned people. Palpation: Skin moist, clammy. Tactile fremitus normal. Percussion: Resonant. Auscultation: Normal vesicular. Heart sounds include s3 gallop. Adventitious Sounds: Crackles at lung bases. A)heart failure B)emphysema

Condition Free air in pleural space causes partial or complete lung collapse. Air in pleural space neutralizes the usual negative pressure present; thus lung collapses. Usually unilateral. ___________ can be (1) spontaneous (air enters pleural space through rupture in lung wall, (2) traumatic (air enters through opening or injury in chest wall), or (3) tension (trapped air in pleural space increases, compressing lung and shifting mediastinum to t he unaffected side). A)Pneumothorax B)Pneumocystis jiroveci (P. carinii) Pneumonia

Inspection: Unequal chest expansion. If large, tachypnea, cyanosis, apprehension, bulging in interspaces. Palpation: Tactile fremitus decreased or absent. Tracheal shift to opposite side (unaffected side). Chest expansion decreased on affected side. Tachycardia, decreased BP. Percussion: Hyperresonant. Decreased diaphragmatic excursion. Auscultation: Breath sounds decreased or absent. Voice sounds decreased or absent. Adventitious Sounds: None. A)Pneumothorax B)Pneumocystis jiroveci (P. carinii) Pneumonia

Condition This virulent form of pneumonia is a protozoal infection associated with AIDS. The parasite P. jiroveci (P. cnrillii) is common in the United States and harm less to most people, except to the immunocompromised , in whom a diffuse interstitial pneumonitis ensues. Cysts containing the organism and macrophages form in alveolar spaces, alveolar walls thicken, and the disease spreads to bilateral interstitial infiltrates of foamy, protein-rich fluid. A)Pneumocystis jiroveci (P. carinii) Pneumonia B)heart disease

Inspection: Anxiety, shortness of breath, dyspnea on exertion, malaise are common; also tachypnea; fever; a dry, nonproductive cough; intercostal retractions in children; cyanosis. Palpation: Decreased chest expansion. Percussion: Dull over areas of diffuse infiltrate. Auscultation: Breath sounds may be diminished. Adventitious Sounds: Crackles may be present but often are absent. A)Pneumocystis jiroveci (P. carinii) Pneumonia B)TB

Condition Inhalation of tubercle bacilli into the alveolar wall starts: (1) Initial complex is acute inflammatory response-macrophages engulf bacilli but do not kill them. Tubercle forms around bacilli. (2) Scar tissue forms, lesion calcifies and shows on x-ray. (3) Reactivation of previously healed lesion. Dormant bacilli now multiply, producing necrosis, cavitation, and caseous lung tissue (cheeselike). (4) Extensive destruction as lesion erodes into bronchus, forming air-filled cavity. Apex usually has the most damage. A)Tuberculosis B)emphysema

Subjective Initially asymptomatic, showing as positive skin test or on x-ray film. Progressive tuberculosis involves weight loss, anorexia, easy fatigability, low-grade afternoon fevers, night sweats. May have pleural effusion , recurrent lower respiratory infections. A)TB B)emphysema

Inspection: Cough initially nonproductive, later productive of purulent, yellow-green sputum, may be blood tinged. Dyspnea, orthopnea, fatigue, weakness. Palpation: Skin moist at night from night sweats. Percussion: Resonant initially. Dull over any effusion. Auscultation: Normal or decreased vesicular breath sounds. Adventitious Sounds: Crackles over upper lobes common, persist following full expiration and cough. A)TB B)emphysema

Condition Undissolved materials (e.g., thrombus or air bubbles, fat globules) originating in legs or pelvis detach and travel through venous system returning blood to right heart and lodge to occlude pulmonary vessels. Over 95% arise from deep vein thrombi in lower legs as a result of stasis of blood, vessel injury, or hypercoagulability. Pulmonary occlusion results in ischemia of downstream lung tissue, increased pulmonary artery pressure, decreased cardiac output, and hypoxia. Rarely, a saddle embolus in bifurcation of pulmonary arteries leads to sudden death from hypoxia. More often, small to medium pulmonary branches occlude, leading to dyspnea. These may resolve by fibrolytic activity. A)Pulmonary Embolism B)TB

Subjective: Chest pain, worse on deep inspiration, dyspnea. Inspection: Apprehensive, restless, anxiety, mental status changes, cyanosis, tachypnea, cough, hemoptysis, Pao 2

Condition An acute pulmonary insult (trauma, gastric acid aspiration, shock, sepsis) damages alveolar capillary membrane, leading to increased permeability of pulmonary capillaries and alveolar epithelium and to pulmonary edema. Gross examination (autopsy) would show dark red, firm, airless tissue, with some alveoli collapsed, and hyaline membranes lining the d iste nded alveoli. A)Acute Respiratory Distress Syndrome (ARDS) B)TB

Subjective: Acute onset of dyspnea, apprehension. Inspection: Restlessness; disorientation; rapid, shallow breathing; productive cough, thin, frothy sputum; retractions of intercostal spaces and stern um. Decreased Pao 2, blood gases show respiratory alkalosis, x- ray films show diffuse pulmonary infiltrates; a late sign is cyanosis. Palpation: Hypotension. Auscultation: Tachycardia. Adventitious Sounds: Crackles, rhonchi. A)Acute Respiratory Distress Syndrome (ARDS) B)TB

Summary Checklist: Thorax and Lung Examination

``` 1. Inspection Thoracic cage Respirations Skin color and condition Person's position Facial expression Level of consciousness 2. Palpation Confirm symmetric expansion Tactile fremitus Detect any lumps, masses, tenderness 3. Percussion Percuss over lung fields Estimate diaphragmatic excursion 4. Auscultation Assess normal breath sounds Note any abnormal breath sounds lf abnormal breath sounds present, perform bronchophony, whispered pectoriloquy, egophony Note any adventitious sounds ```

Assess the level of consciousness. The level of consciousness should be alert and cooperative. A)true B)false

EXTRA INFORMATION

``` The thoracic cage is defined by all the following except the: A)sternum B)ribs C)costochondral junction D)diaphragm ```

A patient has a nursing diagnosis of gas exchange related to alveolar–capillary membrane changes. What interventions are appropriate in this situation? Select all that apply. ``` Select all that apply: A Reduce fever B Increase fluids C Administer oxygen D Use an incentive spirometer E Facilitate deep breathing ```

c d e

A patient has a nursing diagnosis of ineffective airway clearance related to fatigue and inability to cough effectively as evidenced by respiratory rate and dyspnea. What outcome would be appropriate for this patient? Choose one of the following A Breath sounds return to baseline within 1 week B Teach the patient cough and deep breathing techniques to perform every 2 hours C The patient demonstrated accurate cough and deep breathing techniques D The patient increases force and depth of breath to clear secretions

There are significant differences in the chest volumes of Caucasians, African Americans, and Hispanics. There are no differences in the chest volume between Caucasians and Asians. ``` Choose one of the following A True B False ```

A 66-year-old woman is brought to the ED by her daughter. The patient is cyanotic; her pulse is 117 beats/min, respirations 36 breaths/min, blood pressure 110/64, and O2 saturation 82%. What is the first nursing action? ``` Choose one of the following A Start an 18-gauge IV B Leave the patient and daughter so as not to overexcite them C Call a Code D Administer O2 ```

When caring for a patient with chronic shortness of breath, fatigue is an issue. How might the nurse limit fatigue and still gather assessment information needed for daily care? Choose one of the following A Use more than one nurse to gather assessment data B Cluster care during times when the patient is more rested C Use shorter assessments D Spread care throughout the shift to allow rest periods

The thoracic cavity contains which of the following organs? Select all that apply. ``` Select all that apply: A Stomach B Pancreas C Lungs D Heart E Most of the esophagus ```

C d e

A 78-year-old man comes to the clinic. He is pale and diaphoretic. He has smoked for 40 years. His respiratory rate is 30 breaths/min, and he has coarse crackles in all fields. Why is this patient at increased risk for pneumonia? Select all that apply. Select all that apply: A At great risk for "stiff lungs," which are harder to ventilate, because of his age B Pooling of secretions because of decreased function of the cilia C Increased risk for COPD because of years of smoking D Decreased ability to cough up secretions because of weakened chest muscles

A B C D

A 26-year-old woman comes to the clinic and states, "I have a bad cold and am having trouble breathing." The nurse checks her breath sounds and hears bilateral fine crackles at the base. Of what is this finding indicative? ``` Choose one of the following A Fluid in the bronchus B No fluid present C Fluid in the bronchioles D Fluid in the alveoli ```

Pneumonia does not always cause pain on respiration nor does asthma. A)true B)false

A patient who just underwent hip replacement surgery reports pain at a 10 on a scale of 0 to 10 and receives 4 mg of morphine. A nurse on the orthopedic unit enters the patient's room and finds that the patient has a respiratory rate of 7 breaths/min. The patient is groggy and hard to arouse. What could be contributing to the patient's findings? ``` Choose one of the following A Opiates, which may cause hyperventilation B Nothing, this is normal following surgery C Opiates, which may cause hypoventilation D Anesthesia, from surgery that morning ```

A high-pitched crowing sound from the upper airway results from tracheal or laryngeal spasm and is called what? ``` Choose one of the following A Crackles B Rales C Wheezes D Stridor ```

A patient in the ED tells the nurse that she is having difficulty breathing at rest. What term would the nurse use in documenting this finding? ``` Choose one of the following A Anxiety B Tachypnea C Dyspnea D Shortness of breath ```

A patient reports sharp and stabbing chest pain that worsens with deep breathing and coughing. A cardiac cause to this pain is ruled out. The description of the pain is consistent with what respiratory condition? ``` Choose one of the following A Pleurisy B Pneumonia C Rales D Asthma ```

Pleurisy can follow inflammation of the parietal pleura. Patients usually describe such pain as sharp or stabbing, worsening with deep breathing or coughing. A)true B)false

Rales are a breath sound, not a respiratory condition. A)true B)false

A nurse in the operating room has a patient who just underwent gastric bypass surgery and weighs 243 kilograms. Upon extubation, the patient's oxygen saturation drops to 84% and the patient has difficulty catching her breath. What could be causing these problems? Choose one of the following A Obesity, which can limit chest wall expansion and compromise breathing B A progressive loss of muscle function C Pain, which is inhibiting the patient's ability to breathe D Anesthesia, which is causing the patient to be more sleepy than usual

Rhonchi (also called coarse wheezes or gurgles) are lower pitched and louder sounds resulting from secretions moving around during inhalation or exhalation. They commonly accompany pneumonia. A) true B)false

The patient denies chest pain or discomfort, dyspnea, orthopnea, paroxysmal noctural dyspnea, cough, mucus, wheezing or tightness in chest, and decrease in functional ability. This documentation is a correct representation of normal respiratory subjective data. ``` Choose one of the following A True B False ```

A nurse is receiving report from the night shift about four patients. Which patient would the nurse see first? Choose one of the following A A 23-year-old woman who had a mountain biking accident in which she suffered a neck fracture and now has numbness and tingling in her right arm B A 64-year-old man with COPD who is short of breath and has a respiratory rate of 32 breaths/min C A 29-year-old woman with a history of drug abuse and a heart rate of 124 beats/min D A 57-year-old woman who had surgery yesterday for a small bowel obstruction with possible wound dehiscence

What are the signs of hypoxia, which is a medical emergency? Select all that apply. ``` Select all that apply: A Retractions B Increased level of consciousness C O2 saturation of 90% D Cyanosis E Use of accessory muscles to breathe F Respiratory rate > 30 ```

A. D E F

The upper division of the respiratory tract is where oxygenation and ventilation occur. ``` Choose one of the following A True B False ```

The _________ is formed by the right and left costal margins where they meet at the xiphoid process. It is usually 90 degrees or less.

costal angle

An acinus is a functional respiratory unit and consists of the bronchioles and alveoli. A)true B)false

An acinus is a functional respiratory unit that consists of bronchioles and alveoli. A)true B)false

Anterior to the chest The base of the lungs, or lower border, rests on the diaphragm. A)true B)false

Posteriorly, the location of the seventh cervical vertebra (C7) marks the apex of lung tissue and TI0 usually corresponds to the base of the lung. A)true B)false

The incidence of tuberculosis (TB) is higher in those who have recently immigrated to the United States from countries with a high endemic rate of TB including Mexico, the Philippines, Vietnam, India, and China. A)true B)false

With COPD, a tripod position is performed by the patient. A)true B)false

Symmetric Expansion,placing your warmed hands on the posterolateral chest wall with thumbs at the level of T9 or T I0. A)true B)false

Unequal chest expansion occurs with atelectasis, pneumonia, thoracic trauma,and pneumothorax. A)true B)false

Pain accompanies deep breathing when the pleurae are inflamed. A)true B)false

Decreased fremitus occurs when anything obstructs transmission of vibrations. A)true B)false

Decreased fremitus occurs with obstructed bronchus, pleural effusions, pneumothorax, emphysema. A)true B)false

fremitus is most prominent between the scapulae and around the sternum, sites where the major bronchi arc closest to the chest wall. A)true B)false

Increased fremitus occurs with compression or consolidation of lung tissue, ex:lobar pneumonia. A)true B)false

Resonance predominates in healthy lung tissue in the adult A)true B)false

Hyperresonance is found when too much air is present, as in emphysema or pneumothorax. A)true B)false

A dull note signals abnormal density in the lungs, as with pneumonia, pleural effusion, atelectasis, or tumor. A)true B)false

A dull note signals abnormal density in the lungs ex:pneumonia, pleural effusion, atelectasis, and tumor. A)true B)false

Diaphragmatic Excursion. Percuss to map out the lower lung border, both in expiration and inspiration. Measure the difference. A)true B)false

An abnormally high level of dullness on the chest wall, as well as absence of excursion, occurs with pleural effusion and atelectasis of the lower lobes. A)true B)false

An abnormal high level of dullness on the chest wall in a Diaphragmatic Excursion. Test would be pleural effusion or atelectasis of the lower lobes. A)true B)false

Decreased or absent breath sounds occur: A)bronchial tree is obstructed by secretions, mucous plug, or a foreign body. B)In emphysema C)When anything obstructs transmission of sound, such as pleurisy, pleural thickening, pneumothorax, pleural effusion. D)all the above

_________ These are abnormal sounds caused by the collision of moving air with secretions in the tracheobronchial passageways or by the popping open of a previously deflated airway.

adventitious sounds.

Crackles (or rales) occur with pneumonia and pulmonary edema. A)true B)false

wheezes (or rhonchi) occur with asthma and emphysema. A)true B)false

Hypertrophy of abdominal muscles occurs with chronic emphysema. A)true B)false

Tense, strained, tired facies accompanies COPD. A)true B)false

Level of Consciousness. Abnormal finding would be,Cerebral hypoxia presents with excessive drowsiness or by anxiety, restlessness, and irritability. A)true B)false

Noisy breathing occurs with severe asthma or chronic bronchitis. A)true B)false

Unequal chest expansion occurs when part of the lung is obstructed or collapsed,pneumonia, or with guarding to avoid postoperative incisional pain, and the pain of pleurisy. A)true B)false

The rectus abdominis and internal intercostal muscles are used to force expiration in COPD. A)true B)false

Lungs are hyperinflated with chronic emphysema, resulting in hyperresonance where cardiac dullness would be expected. A)true B)false

Infants and Children

Rapid respiratory rates accompany pneumonia, fever, pain, heart disease, and anemia. A)infant and children B)aging adult

In an infant, tachypnea of 50 to 100 breaths per minute during sleep may be an early sign of congestive heart failure. A)true B)false

The respiration pattern may be irregular when there are extremes in room temperature or with feeding or sleeping. A)true B)false

Auscultation normally yields bronchovesicular breath sounds in the peripheral lung fields in the infant and young child up to age 5 or 6 years, because of the relatively thin chest wall with underdeveloped musculature. A)true B)false

Diminished breath sounds occur with pneumonia, atelectasis, pleural effusion, or pneumothorax. A)infant and children B)false

Fine crackles are the adventitious sounds commonly heard in the immediate newborn period and arc due to opening of the airways and clearing of fluid A)true B)false

Crackles only in upper lung fields occur with cystic fibrosis; crackles only in lower lung fields occur with heart failure. A)true B)false

Expiratory wheezing occurs with asthma or bronchiolitis. A)true B)false

Persistent peristaltic sounds with diminished breath sounds on the same side may indicate diaphragmatic hernia. A) true B) false

Stridor is a high-pitched inspiratory crowing sound heard without the stethoscope that occurs with croup, acute epiglottitis, or foreign body aspiration A)true B)false

_______is a high-pitched inspiratory crowing sound heard without the stethoscope that occurs with croup, acute epiglottitis, or foreign body aspiration

Stridor

The Pregnant Woman

The thoracic cage may appear wider and the costal angle may feel wider than in the nonpregnant state. Respirations may be deeper. A)true B)false

Surfactant: A fluid secreted by the cells of the alveoli (the tiny air sacs in the lungs) that serves to reduce the surface tension of pulmonary fluids; surfactant contributes to the elastic properties of pulmonary tissue. A)true B)false

Harrison's groove a horizontal groove along the lower border of the thorax corresponding to the costal insertion of the diaphragm; seen in advanced rickets in children. A)true B)false

Harrison's groove, also known as Harrison's sulcus, is a horizontal groove along the lower border of the thorax corresponding to the costal insertion of the diaphragm; It is usually caused by chronic asthma or obstructive respiratory disease. It may also appear in rickets. A)true B)false

the nurse assess a patient who has a costal angle greater than 90 degrees. what is the most likely cause of this finding? A)COPD B)pneumothroax

the nurse percusses a patient chest and feels dullness. the nurse suspect which diagnosis? A)pneumonia B)emphysema

a nurse hears inspiratory and expiratory wheezes bilaterally. what is the meaning of this finding. A)narrowed airways B)consolidation in alveoli

the examiner notes a diaphragmatic excursive of 4 cm on the right side and 8 cm on the left side. what do these finding mean? A)the patient may have a pleural effusion B)none

a pneumothorax will be evidenced by decreased lung sounds and changes in percussion tone on the affected side A)true B)False

muffled voice sounds and symmetric tactile fremitus, symmetric chest, resonant percussion tones, expansion muffled voice sounds. A)normal assessment finding. B)abnormal assessment finding.

functional units of the lungs:thin walled chambers surrounded by networks of capillaries that are the site of respiratory exchange of carbon dioxide and oxygen A)Alveoli B)Apena

Cessation of breathing A)apena B)bronchophony

the spoken voice sound heard through the stethoscope, which sounds soft, muffled and indistinct over normal lung tissue. A)bronchophony B)bronchovesicular

the normal breath sound heard over major bronchi, characterized by moderate pitch and an equal duration of inspiration and expiration. A)bronchovesicular B)COPD

a functional category of abnormal respiratory conditions, characterized by airflow obstruction(emphysema, chronic bronchitis) A)COPD B)consolidation

the soildication of portions of the lung tissue as it fills up with infectious exudate as in pneumonia A)consolidation B)crackles

(rales) abnormal, discontinuous, adventitious lung sounds heard on inspirations A)Crackles B)creptious

coarse, crackling sensations palpable over the skin when air abnormally escapes from the lung and enters the subcutaneous tissue A)crepitus B) dead space

passageway that transport air but are not available for gaseous exchange (trachea,bronchi) A)dead space B)fissure

the narrow crack dividing the lobes of the lungs A)fissure B)friction rub

a coarse, grating, adventitious lung sound heard when the pleurae are inflamed A)friction rub B)kussmual respirations

a type of hyperventilation that occurs with diabetic ketoacidosis A)kussmal respiration B)PND

sudden awakening from sleeping with SOB A)paroxysmal noctural dyspena B)rhonic

abnormal fluid between the layers of the pleura A)pleural effusions B)Rhonchi

low pitched,musical,snoring, adventitious lung sound caused by airflow obstruction from secretions A)rhonchi B)vescular

the soft, low pitched, normal breath sounds heard over peripheral lung fields. A)Vesicular B)wheeze

high-piitched, musical, squeaking, adventitious sound. A)wheeze B)back

the manubriosternal angle is also called ____________

angle of louis

the angle of louis, it is useful place to start when counting ribs because it is continuous with the 2nd ribs A)true B)false

absence of diaphragmatic excursion occurs with A)plerural effusion or atelectasis of the lower lobes B)asthma

auscultation of the breath sounds is an important component of respiratory assessment select the most accurate description of this part of the examination. A)hold the diaphragm of the stethoscope against the chest wall;listen to one full respiration in each location, being sure to do side to side comparison. B)flaase

select the best description of bronchovesicular breath sounds: A)moderate pitched, inspiration equal to respirations B)high-pitched

after examining a patient, you make the following notation:increased respiratory rate, chest exxpansion decreased on left side, dull percussion over left lower lobe, breath soouds louder with fine crackles over left lower lobe. these findings are consistent with a diagnosis of. A)labor pneummoia B)pleuraal effusion

upon examining a patient nails, you note that the angle of the nail base is >160 degrees and that the nail base feels spongy to palpation.these finding are consistent with. A)chronic congenital heart disease and COPD B)atelectasis

upon examination of a patient, you note a coarse, low-pitched sound during both inspiration and expiration.this patient complains of pain with breathing.these finding are consistent with? A)pleural friction rub B)palpate the chest symmetrically

when examine for tactile fremitus, it is important to. A)palpate the chest symmetrically B)arterial oxygen

the pulse oximeter measures A)arterial oxygen saturation B)observations

a pleural friction rub is best detected by A)auscultation B)palpation

apex of the lung is 3-4 cm above the inner third of the clavicles A)true B)false

base of the lung rest on the diaphragm A)True B)False

lateral left lung, sixth rib, midclavicular line A)true B)false

lateral right: fifth intercostal. A)true B)false

posterior apex of the lung C7? A)true B)false