Thorax, Lungs and Respiratory System Flashcards
history present health status
- do you have any chronic illnesses? - COPD, CHF, Asthma
- Do you have allergies - anaphylaxis
- difficulty breathing during daily activities? - SOB dyspnea
- difficulty breathing when you sleep? - 3 pillow orthopnea, apnea
paroxisysmal nocturnal dyspnea
wake up at night hungry for air - CHF
orthopnea
trouble breathing when laying, positional
do you take any medications?
immediate:
- albuterold - rescue drug for wheezing
- steroids - maintenance/preventative daily drug
- oxygen is considered a med
pack years
smoking
- 3 ppd x 5 years = 15 pack years
family history lung issues
- TB - proximity
- cancer and cystic fibrosis - genetics
- emphysema and asthma - smoking
home environment
- 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
travel
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
OPQRSTU
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?
sputum
clear white - virus
green/yellow - bacteria
rusty/bloody - TB
frothy/pink - heart failure
chest pain with breathing
Triage:
- MI, Emobolism
- pleural friction rub - visceral parietal plura, fluid between pliers and inflammation cases layers to rub together
- pulmonary embolism
- heart attack
- GI and reflux, heart burn
- punctured lung
- pulled muscles, fractured ribs
- anxiety attack - tight crushing in chest
resp - special populations
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
topographic markers, anterior chest wall
- 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 -
topographic markers, lateral chest wall
anterior axillary lines
posterior axillary lines
midaxillary lines
topographic markers, posterior chest wall
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
physical exam, respiratory
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
bronchophony
patient’s voice remains loud during ‘99’ even though it should get softer. picks up pneumonia
egophony
increased resonance of voice sounds heard when auscultating the lungs, often caused by lung consolidation and fibrosis.
whispered pectorilouqy
refers to an increased loudness of whispering noted during auscultation with a stethoscope on the lung fields on a patient’s torso
- lung consolidation
INSPECT
- general appearance, posture, breathing effort (accessory muscles)
- shape and configuration of chest wall ( barrel chest)
- postioning for breathing (tripod)
- skin color - blue, pallor
Respirations - rate, breathing patterns
- 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
clubbing
6 months - 1 year after hypoxia
unequal posterior chest expansion
pneumonia atatlectasis
tactile femitis
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
normal lung sounds
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
abnormal lung sounds
DECREASED SOUNDS: obstruction in bronchial tree, emphysema loss of elasticity
INCREASED: consolidation or compression
Adventitious lung sounds
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
special populations, infants and children
- hyperresonance normal over lungs
- 1:1 chest ratio
- fine crackles normal in immediate newborn
special population, older adults
fatigue quickly
kyphosis, lordosis
special populations, pregnant women
- wider thoracic cage
- wider costal angle
- deeper respriations = more estrogen, relaxes muscles, sideways lungs
atelectasis
- 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
pneumonia
- 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
bronchitis
- 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
COPD
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
astham, RAD (reactive airway disease)
- 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
pleural effusion
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
pneumothorax
- 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
Tuberculosis
- bacteria enteres lungs, brain, muscles
- enlarged lymph nodes
- blood-tinged sputum
- hard to treat - daily meds for 6 months
- fatigue, anorexia, weight loss
lung cancer
- 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
