THORAX & LUNGS(GAS EXCHANGE) - ABNORMAL

Question 1

COPD

Answer 1

chronic inflammatory lung disease that causes obstructed airflow from the lungs.

Emphysema and chronic bronchitis are the two main conditions that make up COPD.

COPD as a preventable and treatable disease associated with airflow limitation that is not fully reversible

Question 2

airflow limitation is usually progressive and associated with inflammatory responses of the lungs to irritants from inhaled particles and gases, usually from cigarette smoke.

Answer 2

COPD

Question 3

RISK ASSESSMENT COPD

Answer 3

Cigarette smoke exposure (smoking cigarettes or exposure to secondhand smoke), pipe smoking, cigar smoking, marijuana smoking
Occupational exposure to dust and chemicals
Age of 35 to 40 years and above
Rarely, genetics (one genetic variation)

Question 4

LUNG CANCER

Answer 4

is the leading cause of cancer deaths in the United States (and worldwide), and causes more deaths than breast, colorectal, and prostate cancers combined.
. More men and women are affected, and more blacks than whites are affected, especially black males. Age is a major factor

60 years or older.

Question 5

RISK ASSESSMENT LUNG CANCER

Answer 5

Smoking tobacco and breathing secondhand tobacco smoke
Exposure to asbestos, radon, arsenic, diesel exhaust, some forms of silica and chromium and other substances, in the home or at work
Personal history of radiation exposure
Personal or family history of lung cancer
Diet (much research being done now, but evidence that smokers who take beta-carotene supplements are at greater risk for lung cancer)

Question 6

Nasal flaring is seen with labored respirations (especially in small children) and is indicative of

Answer 6

Hypoxia

Question 7

Pursed lip breathing may be seen in

Answer 7

asthma, emphysema, or CHF as a physiologic response to help slow down expiration and keep alveoli open longer.

Question 8

Ruddy to purple complexion may be seen in clients with

Answer 8

COPD or CHF as a result of polycythemia.

Question 9

Cyanosis may be seen if client is

Answer 9

cold or hypoxic.

Question 10

Cyanosis - Dark skin

Answer 10

Dark skin appears blue, dull, and lifeless in the same areas

Question 11

normal findings:
general inspection
breathing, lips/face, nails

Answer 11

Nasal flaring is not observed.

Normally the diaphragm and the external intercostal muscles do most of the work of breathing

client has evenly colored skin tone, without unusual or prominent discoloration.

Pink tones should be seen in the nailbeds. There is normally a 160-degree angle

Question 12

Pale or cyanotic nails may indicate

Answer 12

hypoixa

Question 13

(180-degree angle) in nail

Answer 13

Early clubbing

Question 14

(greater than a 180-degree angle) can occur from hypoxia.

Answer 14

Late clubbing

Question 15

Spinous processes that deviate laterally in the thoracic area may indicate

Answer 15

scoliosis

Question 16

Inspect configuration - abnormal

Answer 16

Spinal configurations may have respiratory implications

Question 17

Inspect configuration - normal finding

Answer 17

ratio of anteroposterior to transverse diameter is 1:2.

Question 18

Ribs appearing horizontal at an angle greater than 45 degrees with the spinal column
(1 to 1) ratio between the anteroposterior and transverse diameter

Answer 18

barrel chest - Abnormal configuration

Question 19

barrel chest is commonly the result of emphysema due to

Answer 19

hyperinflation of the lungs.

Question 20

Trapezius, or shoulder, muscles are used to facilitate inspiration in cases of

Answer 20

acute and chronic airway obstruction or atelectasis

Question 21

Kyphosis (an increased curve of the thoracic spine) is common in

Answer 21

older clients

Question 22

tripod position - abnormal

Answer 22

Client leans forward and uses arms to support weight and lift chest to increase breathing capacity

Question 23

When inspecting pt. positioning - Pain over the intercostal spaces may be from

Answer 23

inflamed pleurae

Question 24

When inspecting pt. positioning - normal findings

Answer 24

should be sitting up and relaxed, breathing easily with arms at sides or in lap.

client does not use accessory (trapezius/shoulder) muscles to assist breathing.

Question 25

when palpating tenderness and sensation - abnormal

Answer 25

Muscle soreness from exercise or the excessive work of breathing COPD

Question 26

when palpating tenderness and sensation - normal

Answer 26

Client reports no tenderness, pain, or unusual sensations. Temperature should be equal bilaterally.

Question 27

can be palpated if air escapes from the lung or other airways into the subcutaneous tissue, as occurs after an open thoracic injury, around a chest tube, or tracheostomy.

Answer 27

Crepitus

Question 28

what is Crepitus

Answer 28

grating sound or sensation produced by friction between bone and cartilage

Question 29

Unequal fremitus is usually the result of

Answer 29

consolidation (which increases fremitus) or bronchial obstruction, air trapping in emphysema, pleural effusion, or pneumothorax

Question 30

Diminished fremitus even with a loud spoken voice may indicate an obstruction of the

Answer 30

tracheobronchial tree

Question 31

Unequal chest expansion can occur with severe

Answer 31

atelectasis, pneumonia, chest trauma, or pneumothorax

Question 32

what is atelectasis

Answer 32

collapse or incomplete expansion

Question 33

Decreased chest excursion at the base of the lungs is characteristic of

Answer 33

COPD

Question 34

calcification of the costal cartilages and loss of the accessory musculature, the older client’s thoracic expansion may be (increase or decreased?)

Answer 34

decreased, but should still be symmetric.

Question 35

cases of trapped air such as in emphysema or pneumothorax, what should be elicited

Answer 35

Hyperresonance

Question 36

Normal findings percussion over lung

Answer 36

Resonance is the percussion tone elicited over normal lung tissue

Question 37

Normal findings percussion for diaphragmatic excursion

Answer 37

Excursion should be equal bilaterally and measure 3–5 cm in adults.

Question 38

how to percussing diaphragmatic excursion

Answer 38

Ask the client to exhale forcefully and hold the breath. Beginning at the scapular line (T7), percuss the intercostal spaces of the right posterior chest wall.

Question 39

What tone would you hear when fluid or solid tissue replaces air in the lung or occupies the pleural space, such as in lobar pneumonia, pleural effusion, or tumor.

Answer 39

Dullness

Question 40

Uneven excursion may be seen with

Answer 40

inflammation from unilateral pneumonia, damage to the phrenic nerve, or splenomegaly.

Question 41

Diminished or absent breath sounds often indicate that little or no air is moving in or out of the lung area being auscultated. This may indicate

Answer 41

obstruction within the lungs as a result of secretions, mucus plug, or a foreign object. OR abnormalities of the pleural space such as pleural thickening, pleural effusion, or pneumothorax

Question 42

In cases of emphysema,

Answer 42

hyperinflated nature of the lungs, together with a loss of elasticity of lung tissue, may result in diminished inspiratory breath sounds.

Question 43

Increased (louder) breath sounds often occur when

Answer 43

consolidation or compression results in a denser lung area that enhances the transmission of sound.

Question 44

Three types of normal breath sounds may be auscultated

Answer 44

bronchial, bronchovesicular, and vesicular Sometimes breath sounds may be hard to hear with obese or heavily muscled clients

Question 45

Auscultate for adventitious sounds - abnormal

Answer 45

Adventitious lung sounds, such as crackles (formerly called rales) and wheezes (formerly called rhonchi)

Question 46

Auscultate for adventitious sounds - normal

Answer 46

No adventitious sounds, such as crackles (discrete and discontinuous sounds) or wheezes (musical and continuous), are auscultated.

Question 47

If you hear an abnormal sound during auscultation, what should you do

Answer 47

have the client cough, then listen again and note any change. Coughing may clear the lungs.

Question 48

Labored and noisy breathing is often seen with

Answer 48

asthma or chronic bronchitis.

Question 49

abnormal breathing patterns include

Answer 49

- tachypnea, - bradypnea, - hyperventilation, - hypoventilation, - Cheyne–Stokes respiration, - Biot respiration.

Question 50

Cheyne–Stokes | -respiration,

Answer 50

Regular pattern characterized by alternating periods of deep, rapid breathing followed by periods of apnea

Question 51

-Biot respiration

Answer 51

irregular pattern characterized by varying depth and rate of respirations followed by periods of apnea

Question 52

Normal respiration patterns

Answer 52

12- 20 breaths per min

Question 53

Tachypnea

Answer 53

more than 24 breaths/min and shallow occur with respiratory insufficiency, alkalosis, pneumonia, or pleurisy

Question 54

bradynea

Answer 54

less than 10 breaths/min occur with medication-induced depression of the respiratory center, diabetic coma, neurologic damage

Question 55

hyperventilation

Answer 55

increased rate and increased depth occurs with extreme exercise, fear, or anxiety. Also, disorders of the central nervous system, an overdose of the drug salicylate, or severe anxiety

Question 56

Kussmaul

Answer 56

Rapid, deep, labored A type of hyperventilation associated with diabetic ketoacidosis

Question 57

hypoventilaion

Answer 57

decreased rate and decreased depth - irrgeluar pattern associated with overdose of narcotics or anesthetics

Question 58

ataxix

Answer 58

Significant disorganization with irregular and varying depths of respiration A more extreme expression of Biot respirations indicating respiratory compromise

Question 59

air trapping

Answer 59

increasing diffculty in getting breath out chronic obstructive pulmonary disease, air is trapped in the lungs during forced expiration

Question 60

what respiration pattern- | May be a normal response to fever, anxiety, or exercise

Answer 60

Tachypnea

Question 61

what respiration pattern-May be normal in well-conditioned athletes.

Answer 61

Bradynea

Question 62

Auscultate voice sounds- | Ask the client to repeat the phrase “ninety-nine” while you auscultate the chest wall.

Answer 62

Bronchophony

Question 63

Auscultate voice sounds- Ask the client to repeat the letter “E” while you listen over the chest wall.

Answer 63

Egophony

Question 64

Auscultate voice sounds- Ask the client to whisper the phrase “one–two–three” while you auscultate the chest wall.

Answer 64

Whispered pectoriloquy

Question 65

Bronchophony normal sound

Answer 65

Voice transmission is soft, muffled, and indistinct. | sound of the voice may be heard but phrase cannot be distinguished

Question 66

Egophony normal findings

Answer 66

transmission will be soft and muffled but the letter “E” should be distinguishable.

Question 67

Whispered pectoriloquy normal findings

Answer 67

Transmission of sound is very faint and muffled. It may be inaudible.

Question 68

Bronchophony abnormal

Answer 68

words are easily understood and louder over areas of increased density may indicate consolidation from pneumonia, atelectasis, or tumor.

Question 69

Egophony abnormal

Answer 69

, the sound is louder and sounds like “A.”

Question 70

Whispered pectoriloquy: abnormal

Answer 70

sound is transmitted clearly and distinctly. In such areas, it sounds as if the client is whispering directly into the stethoscope.

Question 71

Pectus excavatum

Answer 71

markedly sunken sternum and adjacent cartilages (often referred to as funnel chest).

Question 72

is a forward protrusion of the sternum causing the adjacent ribs to slope backward (often referred to as pigeon chest)

Answer 72

Pectus carinatum

Question 73

The sternum and ribs may be more prominent in

Answer 73

older client because of loss of subcutaneous fat.

Question 74

Retraction of the intercostal spaces indicates an increased

Answer 74

inspiratory effort.

Question 75

. Bulging of the intercostal spaces indicates

Answer 75

trapped air such as in emphysema or asthma.

Question 76

Abnormal palpation over thorax

Answer 76

Tenderness over thoracic muscles can result from exercising (e.g., pushups) especially in a previously sedentary client

Question 77

When you assess for fremitus on the female client, avoid palpating what

Answer 77

the breast. Breast tissue dampens the vibrations.

Question 78

TRUE OR FALSE | listen through clothing or other materials when auscultating

Answer 78

False do not attempt to listen through clothing or other materials. However, if the client has a large amount of hair on the chest and/or back, listening through a thin T-shirt can decrease extraneous sounds that may be misinterpreted as crackles.

Question 79

Bronchial normal breath sounds ``` pitch quality amplitude duration location ```

Answer 79

``` high harsh-hollow loud short inspiration, long expiration 1:2 Trachea & thorax ```

Question 80

Bronchovesicular normal breath sounds ``` pitch quality amplitude duration location ```

Answer 80

moderate mixed moderate same inspiration & expiration 2:2 major bronchi—posterior: between the scapulae; anterior: around the upper sternum in the first and second intercostal spaces

Question 81

vesicular normal breath sounds ``` pitch quality amplitude duration location ```

Answer 81

``` Low breezy soft long inspiration, short expiration Peripheral lung fields ```