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Health Assessment- NUR 202 > Thorax & Lungs- Ch. 18 > Flashcards

Thorax & Lungs- Ch. 18 Flashcards

1
Q

Structure and function

A
  • ventilation
  • regulate acid/base balance of blood
  • regulate O2/CO2
  • always listen to lung and heart sounds
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2
Q

Subjective data: health history questions

A

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

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3
Q

Subjective-cough

A

Cough?: productive? What are you coughing up? Sputum?

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4
Q

Subjective- shortness of breath

A

activity, laying, sitting, how long?
COPD-has SOB very easily when doing simple things
*proximal nocturnal dyspnea- sob at night, CHF, pulmonary edema

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5
Q

Subjective: Chest pain when breathing

A

pneumonia, bronchitis- painful to palpate, jpainful to breathe in,

  • muscle pain-reproducible
  • chest pain cardiac related is non reproducible(angina)
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6
Q

Subjective- smoking history

A

Usually always have chronic adventitious sounds-crackles

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7
Q

Objective data: the physical exam

A

Prep: good positioning decreases position changes/⬇️SOB

Draping-support modesty

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8
Q

Inspect 👀

-posterior thorax

A

Thoracic cage- shape and configuration, position, skin color, spinal alignment (scoliosis, kyphosis), tripod position (copd)

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9
Q

Palpate ✋🏻

-posterior

A

-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 ??

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10
Q

What would cause ⬆️ fremitus?

A

Pneumonia

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11
Q

What would cause ⬇️ tactile fremitus?

A

Obstruction, pneumothorax, emphysema, asthma

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12
Q

Anteroposterior-Transverse diameter

A

Front to back of thoracic cage
Transverse is 2x the size of ant/post

Normal 1:2*

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13
Q

Percussion 👆🏻

Posterior thorax

A

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
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14
Q

Pleural friction fremitus

A

Inflammation in lung tissue

-sounds like “sand paper”

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15
Q

Auscultation 👂🏻
Listen for breath sounds in all fields
Posterior thorax

A

1) bronchovesicular sounds
2) vesicular sounds

Apices- will sound diminished
Feel for 1st intercostal

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16
Q

Bronchovesicular sounds

-Posterior

A

On sides of spine
⬆️-moderate pitch
Heard on inspiration and expiration

17
Q

Vesicular sounds

-posterior

A

Along medial scapular border and down and around Ribs
⬇️ pitch
Heard on inspiration more than ex.

18
Q

Adventitious sounds: any sound that is abnormal (not suppose to be heard in the lungs)

A

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”

19
Q

Anterior thorax

👀 Inspect

A

Check skin, posture, LOC, quality of respirations (rr), intercostal spaces, accessory muscles (abdomen)?
*pigeon chest: indebted ant wall

20
Q

Anterior thorax

Palpate ✋🏻

A

Completed posteriorly
Palpate for the ❤️
Sitting in upright position

21
Q

Anterior thorax

Percussion 👆🏻

A

Resonance heard over lungs

We percuss posteriorly

22
Q

Anterior thorax

👂🏻 Auscultation

A

*use diaphragm

Listen for breath sounds, adventitious sounds, 1 full cycle (in and out), listen L to R then compare

23
Q

Anterior thorax

3 auscultation areas

A

1) Bronchial (tracheal): ⬆️ pitch, inspiration
2) bronchovesicular-⬆️ pitch, inspiration and expiration
3) vesicular- ⬇️ pitch, inspiration

24
Q

Measurement of pulmonary function status:

A

Forced expiratory time
Pulse Ox
6- minute distance walk

25
Q

Abnormal shapes of the thorax

A

barrel chest- A=P
pectus excavatum- inverted anterior chest wall
Pectus carinatum- protrusion of chest outward “pigeon chest”
Congenital
scoliosis, kyphosis

26
Q

Common respiratory conditions

A 
Lobar pneumonia 
CHF 
ARDS
Emphysema 
Asthma
27
Q

Sputum

A

Pink/frothy r/t pulmonary edema (life threatening)
Bloody sputum-hemoptysis
-viral infection: clear/white
-bacterial: yellow/green/rust

28
Q

Anatomy

A

Posterior: vetebral prominens (sp of C7), sp of T3, clavicle, scapula (inferior angle), 12th rib

Anterior: suprasternal notch, manubrium of sternum, sternum, manubriosternal angle (angle of Louis), costal angle

29
Q

Reference lines

Anterior

A

Mid sternal line: ⬇️ middle of sternum (angina pain)

Mid clavicar line: bisects each clavicle halfway between sternoclavicular and acromian joints

30
Q

Reference lines

Posterior

A

Scapular line: extends thru the inferior angle of the scapula/arms at sides of body

Vetebral line: follows the spine

31
Q

Lobes of the lungs

A

Right lung: 3 lobes (upper, middle, lower)
Ant-all
Post-mostly lower
Lat-all3

Left lung: 2 lobes (upper, lower)
Ant- both
Post- mostly lower
Lat-both

32
Q

Reference lines

Lateral

A

Anterior axillary: extends ⬇️ from anterior axillary folds where the pec major inserts

Mid-axillary line: line extends ⬇️ from the apex of the axilla and lies between and parallel to the other 2

Posterior axillary line: line extends down from the posterior fold where the latissimus dorsi inserts

33
Q

Lobes of lung

Anterior

A

Right- U-M-L

Left- U-L

34
Q

Lobes of lung

Posterior

A

Right- U-L

Left- U-L

35
Q

Lobes of the lung

Lateral

A

Right: U-M-L
Left: U-L

36
Q

When we listen to lungs posteriorly which lobes do we listen to most of the time??

A

Lower lobes

37
Q

Tactile fremitus would be increased when…?

A

The patient has an advanced case of pneumonia

38
Q

Tactile fremitus would be decreased when…?

A

The patient has pleural effusion and when the patient has a blocker bronchus

39
Q

True statement about percussion?

A

Percussion is helpful only in identifying surface alterations of lung tissue

Health Assessment- NUR 202 (11 decks)

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