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Health Assessment > Thorax, Lungs and Respiratory System > Flashcards

Thorax, Lungs and Respiratory System Flashcards

1
Q

history present health status

A
  1. do you have any chronic illnesses? - COPD, CHF, Asthma
  2. Do you have allergies - anaphylaxis
  3. difficulty breathing during daily activities? - SOB dyspnea
  4. difficulty breathing when you sleep? - 3 pillow orthopnea, apnea
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2
Q

paroxisysmal nocturnal dyspnea

A

wake up at night hungry for air - CHF

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3
Q

orthopnea

A

trouble breathing when laying, positional

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4
Q

do you take any medications?

A

immediate:
- albuterold - rescue drug for wheezing
- steroids - maintenance/preventative daily drug
- oxygen is considered a med

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5
Q

pack years

A

smoking

- 3 ppd x 5 years = 15 pack years

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6
Q

family history lung issues

A
  • TB - proximity
  • cancer and cystic fibrosis - genetics
  • emphysema and asthma - smoking
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7
Q

home environment

A
  • air pollution
  • allergens at home, pets
  • type of heating, dust
  • hobbies - wood working, plants, metal
  • exposure to others smoking at home
    2nd hand - other person smokes by you
    3rd hand - smoke lingers in home and car
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8
Q

travel

A

areas within US and other countries have different irritants than in colorado

  • histoplasmosis in southeast and midwest (spores and fungus breathing in)
  • schistosomiasis or severe acute resp syndrome (parasites)
  • SARS in southwest asia, caribbean and asia (viral)
  • histoplasmosis - mississippi
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9
Q

OPQRSTU

A

Pain history checklist
OPQRSTU:
Onset of pain (time, duration)
Palliative factors for pain
Quality of pain (throbbing, stabbing, dull, etc.)
Region of body affected
Severity of pain (usually scale of 1-10)
Timing of pain (after exercise, in evening, etc.)
U: How does it affect ‘U’ in your daily life?
· May wish to expand to OPPQRRSTTUVW, with the extra letters representing:
Provocative factors
Radiation (how does pain spread)
Treatments tried
Deja Vu: Has this happened before?
Worry: What do you think or fear that it is?

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10
Q

sputum

A

clear white - virus
green/yellow - bacteria
rusty/bloody - TB
frothy/pink - heart failure

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11
Q

chest pain with breathing

A

Triage:

  1. MI, Emobolism
  2. pleural friction rub - visceral parietal plura, fluid between pliers and inflammation cases layers to rub together
  3. pulmonary embolism
  4. heart attack
  5. GI and reflux, heart burn
    - punctured lung
    - pulled muscles, fractured ribs
    - anxiety attack - tight crushing in chest
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12
Q

resp - special populations

A

children

  • more than 4-6 colds per year, more than 6 is immune compromised
  • allergies

elderly

  • SOB and fatigue with activities of daily living
  • energy level, effects on ADL
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13
Q

topographic markers, anterior chest wall

A
  • nipples - 5th rib
  • suprasternal notch - top of sternum
  • manubriosternal junction - angle of louie, 2nd rib identification
  • midsternal line - middle of sternum
  • costal angle - bottom of ribs, no more than 90 degrees
  • calvicles - lung tissue above
  • midlcavicular line -
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14
Q

topographic markers, lateral chest wall

A

anterior axillary lines
posterior axillary lines
midaxillary lines

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15
Q

topographic markers, posterior chest wall

A

vertebra prominens: spinous process of C7 is palpable when head is bent forward

vertebral line: line down vert in back

scapular lines: parallel to vertevral line on right and left through scapulas

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16
Q

physical exam, respiratory

A

INSPECT

  • general appearance, posture, breathing effort
  • observe respirations
  • nails, skin, lips: cyanosis, clubbing
  • anterior and posterior thorax

PALPATE

  • trachea, thoracic muscles, expansion of thoracic wall
  • tactile fremitis - vibration over areas of congestion
  • hyperresonance = pregnancy, COPD

PERCUSS
- for tone and diaphragmatic excursion - resonance

AUSCULATATE

  • anterior, posterior and lateral thorax
  • sometimes vocal resonance
17
Q

bronchophony

A

patient’s voice remains loud during ‘99’ even though it should get softer. picks up pneumonia

18
Q

egophony

A

increased resonance of voice sounds heard when auscultating the lungs, often caused by lung consolidation and fibrosis.

19
Q

whispered pectorilouqy

A

refers to an increased loudness of whispering noted during auscultation with a stethoscope on the lung fields on a patient’s torso
- lung consolidation

20
Q

INSPECT

A
  • general appearance, posture, breathing effort (accessory muscles)
  • shape and configuration of chest wall ( barrel chest)
  • postioning for breathing (tripod)
  • skin color - blue, pallor
21
Q

Respirations - rate, breathing patterns

A
  • eupnea - normal within 12-20 reps per min
  • bradypnea - slow breathing, 5 per min
  • tachypnea - more than 20 breaths per min
  • hypervent - faster and deeper, increase co2, increased acidic blood
  • kussmal resp - fast, very deep, resp/metabolic acidosis, diabetic acidosis
  • biot - sick or dying
  • chayne stokes
22
Q

clubbing

A

6 months - 1 year after hypoxia

23
Q

unequal posterior chest expansion

A

pneumonia atatlectasis

24
Q

tactile femitis

A

palpate and do “99” test, vibration

  • decreased: any obstruction
  • increased: compression or consolidation of lung tissue ( only big changes, not small areas of pneumonia or anything like that)
  • rhonchal: thick broncial secretions
  • pleural friction: inflammation of pleura
  • crepitus: course, crackling sensation palpable over the skin surface, emphysema, after open thoracic surgery
25
Q

normal lung sounds

A

BRONCHIAL: high pitch, loud, louder during expiration, found in trachea and larynx

BRONCHIOVESICULAR: moderate pitch, insirpation and expiration equally, over major bronchi where fewer alveoli are located

VESICULAR: low pitch, soft, greater during inspiration, peripheral lung field where air flows through smaller bronchioles and alveoli

26
Q

abnormal lung sounds

A

DECREASED SOUNDS: obstruction in bronchial tree, emphysema loss of elasticity
INCREASED: consolidation or compression

27
Q

Adventitious lung sounds

A

CRACKLES: discontinuous, high pitched, short crackling, pooping sounds heard during inspiration

PLEURAL FRICTION RUB: course and low pitched, two pieces of leather being rubbed together, inspiratory and expiratory

WHEEZE: high pitched, muscle, squeaking, may occur in both inspiration and expiration.

STRIDOR: high pitched, monophonic, inspiratory, crowing, louder in neck than chest wall

28
Q

special populations, infants and children

A
  • hyperresonance normal over lungs
  • 1:1 chest ratio
  • fine crackles normal in immediate newborn
29
Q

special population, older adults

A

fatigue quickly

kyphosis, lordosis

30
Q

special populations, pregnant women

A
  • wider thoracic cage
  • wider costal angle
  • deeper respriations = more estrogen, relaxes muscles, sideways lungs
31
Q

atelectasis

A
  • collapse of alveoli
  • lung collapes
  • hear no air movement
  • external pressure by fluid, tumor or ari in pleural space that COMPRESSES alveoli OR obstuction by secretions ABSORPTION
32
Q

pneumonia

A
  • consolidation: things come together in an area of the lung
  • posterior: lower lobes
  • Anterior: upper lobes
  • virus or bacteria, aspiration
    VIRAL pneumonia: nonproductive cough, clear sputum
    BACTERIA pneumonia: produtive cough, white/yellow/green sputum
  • crackles and wheezes
33
Q

bronchitis

A
  • hyper secretion of mucous by goblet cells or trachea and bronchi resulting in productive cough
  • caused by cigarette, pollution or infection
  • productive cough, mucous, dyspnea
  • crackles, wheeze
34
Q

COPD

A

emphysema = distraction of alveolar walls that causes abnormal enlargement of air spaces (hyper inflated lung)
- diminished breath sounds, wheezing or crackles, decreased tactile emits, hyper resonant tones

35
Q

astham, RAD (reactive airway disease)

A
  • hyperreactive airway disease
  • bronchoconstriction
  • airway obstruction
  • inflammation
  • increased resp rate with prolonged expiration
  • audible wheezes
  • dyspnea
  • tachycardia
  • anxious appearance
  • possible use of accessory muscles
  • cough
  • decreased tactile fremitus
36
Q

pleural effusion

A

accumulation of serous fluid in pleural space between visceral and parietal pleura

  • decreased or absent tactile fremitius
  • full or flat percussion
  • absent breath sounds or decreased
37
Q

pneumothorax

A
  • air in pleural spaces
  • closed - spontaneous, traumatic, iatrogenic
  • open - penetration of chest
  • tension - air leaks into pleura and cannot escape
  • SOB, anxious, resp distress, cyanosis, dypnea, tachypnea, hyper resonance, tracheal displacement if severe
  • space fills with air and blood and makes it harder and harder to breath in
38
Q

Tuberculosis

A
  • bacteria enteres lungs, brain, muscles
  • enlarged lymph nodes
  • blood-tinged sputum
  • hard to treat - daily meds for 6 months
  • fatigue, anorexia, weight loss
39
Q

lung cancer

A
  • uncontrollable growth of anapestic cells in lungs
  • tobacco, asbestos, ionizing raditation, other inhalants cause it
  • first symptom is persistent cough
  • weight loss, congestion, wheezing,
  • percussion normal

Health Assessment (8 decks)

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