Thorax, Lungs and Respiratory System

Question 1

history present health status

Answer 1

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

Question 2

paroxisysmal nocturnal dyspnea

Answer 2

wake up at night hungry for air - CHF

Question 3

orthopnea

Answer 3

trouble breathing when laying, positional

Question 4

do you take any medications?

Answer 4

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

Question 5

pack years

Answer 5

smoking

- 3 ppd x 5 years = 15 pack years

Question 6

family history lung issues

Answer 6

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

Question 7

home environment

Answer 7

• 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

Question 8

travel

Answer 8

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

Question 9

OPQRSTU

Answer 9

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?

Question 10

sputum

Answer 10

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

Question 11

chest pain with breathing

Answer 11

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

Question 12

resp - special populations

Answer 12

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

Question 13

topographic markers, anterior chest wall

Answer 13

• 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 -

Question 14

topographic markers, lateral chest wall

Answer 14

anterior axillary lines
posterior axillary lines
midaxillary lines

Question 15

topographic markers, posterior chest wall

Answer 15

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

Question 16

physical exam, respiratory

Answer 16

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

Question 17

bronchophony

Answer 17

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

Question 18

egophony

Answer 18

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

Question 19

whispered pectorilouqy

Answer 19

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

Question 20

INSPECT

Answer 20

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

Question 21

Respirations - rate, breathing patterns

Answer 21

• 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

Question 22

clubbing

Answer 22

6 months - 1 year after hypoxia

Question 23

unequal posterior chest expansion

Answer 23

pneumonia atatlectasis

Question 24

tactile femitis

Answer 24

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

Question 25

normal lung sounds

Answer 25

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

Question 26

abnormal lung sounds

Answer 26

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

Question 27

Adventitious lung sounds

Answer 27

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

Question 28

special populations, infants and children

Answer 28

- hyperresonance normal over lungs - 1:1 chest ratio - fine crackles normal in immediate newborn

Question 29

special population, older adults

Answer 29

fatigue quickly | kyphosis, lordosis

Question 30

special populations, pregnant women

Answer 30

- wider thoracic cage - wider costal angle - deeper respriations = more estrogen, relaxes muscles, sideways lungs

Question 31

atelectasis

Answer 31

- 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

Question 32

pneumonia

Answer 32

- 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

Question 33

bronchitis

Answer 33

- 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

Question 34

COPD

Answer 34

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

Question 35

astham, RAD (reactive airway disease)

Answer 35

- 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

Question 36

pleural effusion

Answer 36

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

Question 37

pneumothorax

Answer 37

- 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

Question 38

Tuberculosis

Answer 38

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

Question 39

lung cancer

Answer 39

- 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