Thorax & Lungs- Ch. 18 Flashcards
Structure and function
- ventilation
- regulate acid/base balance of blood
- regulate O2/CO2
- always listen to lung and heart sounds
Subjective data: health history questions
Cough
SOB
Chest pain while breathing
History of respiratory infections: pneumonia, TB, copd, lung surgery
Smoking history
Environmental exposure: work hazards
Self control behaviors: x-Ray, vaccines(pneumonia), TB, exercise, dental hygiene
Subjective-cough
Cough?: productive? What are you coughing up? Sputum?
Subjective- shortness of breath
activity, laying, sitting, how long?
COPD-has SOB very easily when doing simple things
*proximal nocturnal dyspnea- sob at night, CHF, pulmonary edema
Subjective: Chest pain when breathing
pneumonia, bronchitis- painful to palpate, jpainful to breathe in,
- muscle pain-reproducible
- chest pain cardiac related is non reproducible(angina)
Subjective- smoking history
Usually always have chronic adventitious sounds-crackles
Objective data: the physical exam
Prep: good positioning decreases position changes/⬇️SOB
Draping-support modesty
Inspect 👀
-posterior thorax
Thoracic cage- shape and configuration, position, skin color, spinal alignment (scoliosis, kyphosis), tripod position (copd)
Palpate ✋🏻
-posterior
-symmetrical expansion (chest expansion)- place thumbs at T9-10 and watch for hands to rise symmetrically
Tactile fremitus: sound/vibration generates thru the larynx-patent bronchi-chest wall. Place palms beginning with Apices (c7)
“99, blue moon”
* is it symmetrical ??
What would cause ⬆️ fremitus?
Pneumonia
What would cause ⬇️ tactile fremitus?
Obstruction, pneumothorax, emphysema, asthma
Anteroposterior-Transverse diameter
Front to back of thoracic cage
Transverse is 2x the size of ant/post
Normal 1:2*
Percussion 👆🏻
Posterior thorax
Begin with Apices (c7), listen and compare to other side (RtoL), is it symmetrical?
- L to R-compare
- resonance should be heard over lungs during percussion
- bone sounds flat
- organ sounds dull
Pleural friction fremitus
Inflammation in lung tissue
-sounds like “sand paper”
Auscultation 👂🏻
Listen for breath sounds in all fields
Posterior thorax
1) bronchovesicular sounds
2) vesicular sounds
Apices- will sound diminished
Feel for 1st intercostal
Bronchovesicular sounds
-Posterior
On sides of spine
⬆️-moderate pitch
Heard on inspiration and expiration
Vesicular sounds
-posterior
Along medial scapular border and down and around Ribs
⬇️ pitch
Heard on inspiration more than ex.
Adventitious sounds: any sound that is abnormal (not suppose to be heard in the lungs)
1- crackles: “rales”, snap, crackle, pop, when alveoli are not fully inflated with air * heard on inspiration
2- wheeze: “rhonchi”, heard mainly over explorations, asthma, emphysema
3- stridor: sounds like a wheeze buy more coarse, affiliated with allergic response, airway pushing air thru a constructed tube “snore”
Anterior thorax
👀 Inspect
Check skin, posture, LOC, quality of respirations (rr), intercostal spaces, accessory muscles (abdomen)?
*pigeon chest: indebted ant wall
Anterior thorax
Palpate ✋🏻
Completed posteriorly
Palpate for the ❤️
Sitting in upright position
Anterior thorax
Percussion 👆🏻
Resonance heard over lungs
We percuss posteriorly
Anterior thorax
👂🏻 Auscultation
*use diaphragm
Listen for breath sounds, adventitious sounds, 1 full cycle (in and out), listen L to R then compare
Anterior thorax
3 auscultation areas
1) Bronchial (tracheal): ⬆️ pitch, inspiration
2) bronchovesicular-⬆️ pitch, inspiration and expiration
3) vesicular- ⬇️ pitch, inspiration
Measurement of pulmonary function status:
Forced expiratory time
Pulse Ox
6- minute distance walk
