Thorax & Lungs Flashcards
Thorax and Lungs
,
STRUCTURE AND FUNCTION
,
POSITION AND SURFACE LANDMARKS
,
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
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.
a musculotendinous septum that separates the thoracic cavity from the abdomen.
diaphragm,
a musculotendinous septum that separates the thoracic cavity from the abdomen.
The first seven ribs attach directly to the sternum via their costal cartilages;
A)true
B)false
A
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
A
ribs 11 and 12 are “floating,” with free palpable tips.
A)true
B)false
A
The costochondral junctions are the points at which the ribs join their cartilages. They are not palpable.
A)true
B)false
A
Anterior Thoracic landmarks
,
__________. Feel this hollow U-shaped depression just above the sternum, in between the clavicles.
Suprasternal Notch
. 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
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
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
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
A
The angle of Louis is a useful place to start counting ribs, when localizing an respiratory finding horizontally.
A)true
B)false
A
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
A
_________ 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
Division into two branches
A)bifurcation
B)spinal
A
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.
If costal angle increase beyond 90degrees than patient might have
Emphysema
It’s okay if sternal angle a little less than 90.
A)true
B)false
A
Posterior Thoracic landmarks
,
________. 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
A
Use reference lines to pinpoint vertical findings
A)true
B)false
A
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
A
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
A
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
A
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
A
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
A
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
A
The visceral pleura lines the outside of the lungs, dipping down into the fissures.
A)true
B)false
A
parietal pleura lining the inside of the chest wall and diaphragm.
A)true
B)false
A
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
A
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
A
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
A
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
A
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
A
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
A
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
A
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
A
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
A
Supplying oxygen to the blood and eliminating carbon dioxide, respirations maintain ph balance
A)true
B)false
A
hypoventilation (slow, shallow breathing) causes carbon dioxide to build up in the blood.
A)true
B)false
A
_____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
A
________ (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
A
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__________ (pons and medulla).
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
A
The normal stimulus to breathe for most of us is an increase of carbon dioxide in the blood, or hypercapnia.
A)true
B)false
A
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
A decrease of oxygen in the blood (hypoxemia) also increases respirations but is less effective than hypercapnia.
A)true
B)false
A
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
A
Respiration is the physical act of breathing;
A)true
B)false
A
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
A
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
A
___________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
A
Positive pressure is on explorations
A)true
B)false
A
Inspiration diaphragm is descend and flatten
A)true
B)false
A
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
A
During the first 5 weeks of fetal life, the primitive lung bud emerges
A)true
B)false
A
Fetal life by 16 weeks, the conducting airways reach the same number as in the adult;
A)true
B)false
A
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
A
by birth, the lungs have 70 million primitive alveoli ready to start the job of respiration.
A)true
B)false
A
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
A
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
A
respiratory system alone does not function until birth.
A)true
B)false
A
When the cord is cut, blood is cut off from the placenta and it gushes into the pulmonary circulation.
A)true
B)false
A
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
A
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
A
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
A
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
A
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
A
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
A
Prenatal exposure causes chronic hypoxia and low birth weight.
A)true, for smoking
B)false
A
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
A
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
A
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
A
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
A
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
A
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
A
The total circumference of the chest cage increases by 6 cm during pregnancy
A)true
B)false
A
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
A
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
A
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
A
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
A
Early pregnancy as the need to breath. pregnant women may interpret dyspnea although, structurally, nothing is wrong.
A)true
B)false
A
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
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
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
A
In all, the aging lung is a more rigid structure that is harder to inflate.
A)true
B)false
A
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
A
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
A
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
A
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
A
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
A
The histologic changes also increase the older person’s risk for postoperative pulmonary complications.
A)true
B)false
A
histologic changes increase the older person’s risk for postoperative pulmonary complications.
A)true
B)false
A
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
A
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
A
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
A
Groups at increased risk include African Americans who reside in inner cities and premature or low-birth-weight infants.
A)asthma
B)herpes
A
Asthma prevalence is highest among African American and American Indian adults; it is lowest among Asian and Hispanic adults.
A)true
B)false
A
African Americans, Hispanics, and especially American Indians experience more than do whites or Asians.
A)asthma
B)false
A
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
A
Extrinsic/allergic asthma involves a complex interaction between genetic susceptibility and environmental factors.
A)true
B)false
A
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
A
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
A
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
A
Acute cough lasts less than 2 or 3 weeks;
A)true
B)false
A
chronic cough lasts over 2 months.
A)true
B)false
A
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
A
Conditions with characteristic timing of cough:
,
continuous throughout day- acute illness (e.g., respiratory infection);
A)true
B)false
A
coughing in afternoon/evening-may reflect exposure to irritants at work
A)true
B)false
A
night postnasal drip, indicates sinusitis;
A)true
B)false
A
early morning coughing indicates -chronic bronchial inflammation of smokers.
A)true
B)false
A
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
A
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
C
Some conditions have characteristic sputum production:
,
white or dear mucoid indicates colds, bronchitis, viral infections;
A) true
B)false
A
yellow or green-bacterial infections;
A)true
B)false
A
rust colored-tuberculosis, pneumococcal pneumonia;
A)true
B)false
A
pink, frothypulmonary edema, some sympathomimetic medications have a side effect of pinktinged mucus.
A)true
B)false
A
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
A
Some conditions have a characteristic cough: mycoplasma pneumonia-hacking;
A)true
B)false
A
Some conditions have a characteristic cough; early heart failure-dry;
A)true
B)false
A
Some conditions have a characteristic cough; croup-barking; colds, bronchitis, pneumonia-congested.
A)true
B)false
A
Does the cough seem to come with anything: activity, position (lying), fever, congestion, talking, anxiety?
A)assessing cough
B)none
A
Does activity make it better or worse?
A)assessing cough
B)none
A
What treatment have you tried? Prescription or over-the-counter medications, vaporizer, rest, position change?
A)Assess the effectiveness of coping strategies
B)none
A
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
A
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
A
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
A
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
A
_______________ 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
A
Or cough, chest pain, or bluish color around lips or nails? Wheezing sound?
A)I’m assessing for Cyanosis which signals hypoxia.
B)none
A
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
C
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
A
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
A
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
A
Chest pain of thoracic origin occurs with muscle soreness from coughing
A)true
B)false
A
Chest pain of thoracic origin occurs from inflammation of pleura overlying pneumonia.
A)true
B)false
A
Distinguish this from chest pain of cardiac origin or from heartburn of stomach acid.
A)true
B)false
A
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
A
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
A
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
A
Any family history of allergies, tuberculosis, or asthma?
A)Assess possible risk factors
B)false
A
SMOKING HISTORY
A
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
A
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
A
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
A
Farmers may be at risk for grain inhalation, pesticide inhalation.
A)assessing people who are affected by environmental factors
B)false
A
People in the rural Midwest have a risk for histoplasmosis exposure;
A)assessing people who are affected by environmental factors
B)false
A
those in the Southwest and Mexico have a risk for coccidioidomycosis.
A)assessing people who are affected by environmental factors
B)false
A
Coal miners have a risk for pneumoconiosis.
A)assessing people who are affected by environmental factors
B)false
A
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
A
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
A
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
A
specific symptoms to note that may signal breathing problems would be coughing, and shortness of breath.
A) true
B)false.
A
Some gases produce specific symptoms of breathing problems : carbon monoxide-dizziness, headache, fatigue
A)true
B)false
A
Some gases produce specific symptoms of breathing problems; sulfur dioxide-cough, congestion.
A)true
B)false
A
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
A
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
A
Limit of 4 to 6 uncomplicated upper respiratory infections per year is expected in early childhood.
A)true
B)false
A
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
A
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
A
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
A
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
A
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)
A
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
A
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
C
__________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
A
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
A
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
A
In aging adults Activities may decrease do to increasing shortness of breath or pain.
A)true
B)false
A
Do you have any chest pain with breathing?
A)Some older adults feel pleuritic pain less intensely than younger adults.
B)false
A
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
A
In aging adult a Precisely localized sharp pain (points to it with one finger)-consider fractured rib or muscle injury.
A)true
B)false
A
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
A
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
A
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
A
Perform the inspection, palpation, percussion, and auscultation on the posterior and lateral thorax.
A)true
B)false
A
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
A
EQUIPMENT NEEDED
,
Stethoscope Small ruler, marked in centimeters Marking pen Alcohol wipe A)true B)false
A
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
A
Abnormal finding is Skeletal deformities which may limit thoracic cage excursion: scoliosis, kyphosis.
A)true
B)false
A
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
A
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
A
AP = transverse diameter, or “barrel chest.” .occurs in chronic emphysema from hyperinflation of the lungs
A) true
B)false
A
The neck muscles and trapezius muscles should be developed normally for age and occupation.
A)true
B)false
A
Neck muscles are hypertrophied in COPD from aiding in forced respirations.
A)abnormal findings
B)normal findings
A
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
A
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
A
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
A
Cyanosis occurs with tissue hypoxia.
A) true
B)false
A
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
A
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
A
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
A
Pain accompanies deep breathing when the pleurae are inflamed.
A)true
B)false
A
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
A
._________ 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
A
