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NSG 200 > THORAX & LUNGS(GAS EXCHANGE) - ABNORMAL > Flashcards

THORAX & LUNGS(GAS EXCHANGE) - ABNORMAL Flashcards

1
Q

COPD

A

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

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2
Q

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

A

COPD

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3
Q

RISK ASSESSMENT COPD

A

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)

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4
Q

LUNG CANCER

A

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.

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5
Q

RISK ASSESSMENT LUNG CANCER

A

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)

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6
Q

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

A

Hypoxia

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7
Q

Pursed lip breathing may be seen in

A

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

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8
Q

Ruddy to purple complexion may be seen in clients with

A

COPD or CHF as a result of polycythemia.

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9
Q

Cyanosis may be seen if client is

A

cold or hypoxic.

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10
Q

Cyanosis - Dark skin

A

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

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11
Q

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

A

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

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12
Q

Pale or cyanotic nails may indicate

A

hypoixa

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13
Q

(180-degree angle) in nail

A

Early clubbing

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14
Q

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

A

Late clubbing

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15
Q

Spinous processes that deviate laterally in the thoracic area may indicate

A

scoliosis

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16
Q

Inspect configuration - abnormal

A

Spinal configurations may have respiratory implications

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17
Q

Inspect configuration - normal finding

A

ratio of anteroposterior to transverse diameter is 1:2.

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18
Q

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

A

barrel chest - Abnormal configuration

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19
Q

barrel chest is commonly the result of emphysema due to

A

hyperinflation of the lungs.

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20
Q

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

A

acute and chronic airway obstruction or atelectasis

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21
Q

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

A

older clients

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22
Q

tripod position - abnormal

A

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

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23
Q

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

A

inflamed pleurae

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24
Q

When inspecting pt. positioning - normal findings

A

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.

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25
Q

when palpating tenderness and sensation - abnormal

A

Muscle soreness from exercise or the excessive work of breathing COPD

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26
Q

when palpating tenderness and sensation - normal

A

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

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27
Q

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.

A

Crepitus

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28
Q

what is Crepitus

A

grating sound or sensation produced by friction between bone and cartilage

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29
Q

Unequal fremitus is usually the result of

A

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

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30
Q

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

A

tracheobronchial tree

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31
Q

Unequal chest expansion can occur with severe

A

atelectasis, pneumonia, chest trauma, or pneumothorax

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32
Q

what is atelectasis

A

collapse or incomplete expansion

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33
Q

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

A

COPD

34
Q

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

A

decreased, but should still be symmetric.

35
Q

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

A

Hyperresonance

36
Q

Normal findings percussion over lung

A

Resonance is the percussion tone elicited over normal lung tissue

37
Q

Normal findings percussion for diaphragmatic excursion

A

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

38
Q

how to percussing diaphragmatic excursion

A

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.

39
Q

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.

A

Dullness

40
Q

Uneven excursion may be seen with

A

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

41
Q

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

A

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

42
Q

In cases of emphysema,

A

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

43
Q

Increased (louder) breath sounds often occur when

A

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

44
Q

Three types of normal breath sounds may be auscultated

A

bronchial, bronchovesicular, and vesicular

Sometimes breath sounds may be hard to hear with obese or heavily muscled clients

45
Q

Auscultate for adventitious sounds - abnormal

A

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

46
Q

Auscultate for adventitious sounds - normal

A

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

47
Q

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

A

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

48
Q

Labored and noisy breathing is often seen with

A

asthma or chronic bronchitis.

49
Q

abnormal breathing patterns include

A
  • tachypnea,
  • bradypnea,
  • hyperventilation,
  • hypoventilation,
  • Cheyne–Stokes respiration,
  • Biot respiration.
50
Q

Cheyne–Stokes

-respiration,

A

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

51
Q

-Biot respiration

A

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

52
Q

Normal respiration patterns

A

12- 20 breaths per min

53
Q

Tachypnea

A

more than 24 breaths/min and shallow

occur with respiratory insufficiency, alkalosis, pneumonia, or pleurisy

54
Q

bradynea

A

less than 10 breaths/min

occur with medication-induced depression of the respiratory center, diabetic coma, neurologic damage

55
Q

hyperventilation

A

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

56
Q

Kussmaul

A

Rapid, deep, labored

A type of hyperventilation associated with diabetic ketoacidosis

57
Q

hypoventilaion

A

decreased rate and decreased depth - irrgeluar pattern

associated with overdose of narcotics or anesthetics

58
Q

ataxix

A

Significant disorganization with irregular and varying depths of respiration

A more extreme expression of Biot respirations indicating respiratory compromise

59
Q

air trapping

A

increasing diffculty in getting breath out

chronic obstructive pulmonary disease, air is trapped in the lungs during forced expiration

60
Q

what respiration pattern-

May be a normal response to fever, anxiety, or exercise

A

Tachypnea

61
Q

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

A

Bradynea

62
Q

Auscultate voice sounds-

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

A

Bronchophony

63
Q

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

A

Egophony

64
Q

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

A

Whispered pectoriloquy

65
Q

Bronchophony normal sound

A

Voice transmission is soft, muffled, and indistinct.

sound of the voice may be heard but phrase cannot be distinguished

66
Q

Egophony normal findings

A

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

67
Q

Whispered pectoriloquy normal findings

A

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

68
Q

Bronchophony abnormal

A

words are easily understood and louder over areas of increased density

may indicate consolidation from pneumonia, atelectasis, or tumor.

69
Q

Egophony abnormal

A

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

70
Q

Whispered pectoriloquy: abnormal

A

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

71
Q

Pectus excavatum

A

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

72
Q

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

A

Pectus carinatum

73
Q

The sternum and ribs may be more prominent in

A

older client because of loss of subcutaneous fat.

74
Q

Retraction of the intercostal spaces indicates an increased

A

inspiratory effort.

75
Q

. Bulging of the intercostal spaces indicates

A

trapped air such as in emphysema or asthma.

76
Q

Abnormal palpation over thorax

A

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

77
Q

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

A

the breast. Breast tissue dampens the vibrations.

78
Q

TRUE OR FALSE

listen through clothing or other materials when auscultating

A

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.

79
Q

Bronchial normal breath sounds

pitch 
quality
amplitude
duration
location
A 
high
harsh-hollow
loud
short inspiration, long expiration 1:2
Trachea & thorax
80
Q

Bronchovesicular
normal breath sounds

pitch 
quality
amplitude
duration
location
A

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

81
Q

vesicular

normal breath sounds

pitch 
quality
amplitude
duration
location
A 
Low
breezy 
soft
long inspiration, short expiration
Peripheral lung fields

NSG 200 (11 decks)

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