THORAX & LUNGS(GAS EXCHANGE) - ABNORMAL Flashcards
COPD
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
airflow limitation is usually progressive and associated with inflammatory responses of the lungs to irritants from inhaled particles and gases, usually from cigarette smoke.
COPD
RISK ASSESSMENT COPD
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)
LUNG CANCER
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.
RISK ASSESSMENT LUNG CANCER
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)
Nasal flaring is seen with labored respirations (especially in small children) and is indicative of
Hypoxia
Pursed lip breathing may be seen in
asthma, emphysema, or CHF as a physiologic response to help slow down expiration and keep alveoli open longer.
Ruddy to purple complexion may be seen in clients with
COPD or CHF as a result of polycythemia.
Cyanosis may be seen if client is
cold or hypoxic.
Cyanosis - Dark skin
Dark skin appears blue, dull, and lifeless in the same areas
normal findings:
general inspection
breathing, lips/face, nails
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
Pale or cyanotic nails may indicate
hypoixa
(180-degree angle) in nail
Early clubbing
(greater than a 180-degree angle) can occur from hypoxia.
Late clubbing
Spinous processes that deviate laterally in the thoracic area may indicate
scoliosis
Inspect configuration - abnormal
Spinal configurations may have respiratory implications
Inspect configuration - normal finding
ratio of anteroposterior to transverse diameter is 1:2.
Ribs appearing horizontal at an angle greater than 45 degrees with the spinal column
(1 to 1) ratio between the anteroposterior and transverse diameter
barrel chest - Abnormal configuration
barrel chest is commonly the result of emphysema due to
hyperinflation of the lungs.
Trapezius, or shoulder, muscles are used to facilitate inspiration in cases of
acute and chronic airway obstruction or atelectasis
Kyphosis (an increased curve of the thoracic spine) is common in
older clients
tripod position - abnormal
Client leans forward and uses arms to support weight and lift chest to increase breathing capacity
When inspecting pt. positioning - Pain over the intercostal spaces may be from
inflamed pleurae
When inspecting pt. positioning - normal findings
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.
when palpating tenderness and sensation - abnormal
Muscle soreness from exercise or the excessive work of breathing COPD
when palpating tenderness and sensation - normal
Client reports no tenderness, pain, or unusual sensations. Temperature should be equal bilaterally.
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.
Crepitus
what is Crepitus
grating sound or sensation produced by friction between bone and cartilage
Unequal fremitus is usually the result of
consolidation (which increases fremitus) or bronchial obstruction, air trapping in emphysema, pleural effusion, or pneumothorax
Diminished fremitus even with a loud spoken voice may indicate an obstruction of the
tracheobronchial tree
Unequal chest expansion can occur with severe
atelectasis, pneumonia, chest trauma, or pneumothorax
what is atelectasis
collapse or incomplete expansion
Decreased chest excursion at the base of the lungs is characteristic of
COPD
calcification of the costal cartilages and loss of the accessory musculature, the older client’s thoracic expansion may be (increase or decreased?)
decreased, but should still be symmetric.
cases of trapped air such as in emphysema or pneumothorax, what should be elicited
Hyperresonance
Normal findings percussion over lung
Resonance is the percussion tone elicited over normal lung tissue
Normal findings percussion for diaphragmatic excursion
Excursion should be equal bilaterally and measure 3–5 cm in adults.
how to percussing diaphragmatic excursion
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.
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.
Dullness
Uneven excursion may be seen with
inflammation from unilateral pneumonia, damage to the phrenic nerve, or splenomegaly.
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
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
In cases of emphysema,
hyperinflated nature of the lungs, together with a loss of elasticity of lung tissue, may result in diminished inspiratory breath sounds.
Increased (louder) breath sounds often occur when
consolidation or compression results in a denser lung area that enhances the transmission of sound.
Three types of normal breath sounds may be auscultated
bronchial, bronchovesicular, and vesicular
Sometimes breath sounds may be hard to hear with obese or heavily muscled clients
Auscultate for adventitious sounds - abnormal
Adventitious lung sounds, such as crackles (formerly called rales) and wheezes (formerly called rhonchi)
Auscultate for adventitious sounds - normal
No adventitious sounds, such as crackles (discrete and discontinuous sounds) or wheezes (musical and continuous), are auscultated.
If you hear an abnormal sound during auscultation, what should you do
have the client cough, then listen again and note any change. Coughing may clear the lungs.
Labored and noisy breathing is often seen with
asthma or chronic bronchitis.
abnormal breathing patterns include
- tachypnea,
- bradypnea,
- hyperventilation,
- hypoventilation,
- Cheyne–Stokes respiration,
- Biot respiration.
Cheyne–Stokes
-respiration,
Regular pattern characterized by alternating periods of deep, rapid breathing followed by periods of apnea
-Biot respiration
irregular pattern characterized by varying depth and rate of respirations followed by periods of apnea
Normal respiration patterns
12- 20 breaths per min
Tachypnea
more than 24 breaths/min and shallow
occur with respiratory insufficiency, alkalosis, pneumonia, or pleurisy
bradynea
less than 10 breaths/min
occur with medication-induced depression of the respiratory center, diabetic coma, neurologic damage
hyperventilation
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
Kussmaul
Rapid, deep, labored
A type of hyperventilation associated with diabetic ketoacidosis
hypoventilaion
decreased rate and decreased depth - irrgeluar pattern
associated with overdose of narcotics or anesthetics
ataxix
Significant disorganization with irregular and varying depths of respiration
A more extreme expression of Biot respirations indicating respiratory compromise
air trapping
increasing diffculty in getting breath out
chronic obstructive pulmonary disease, air is trapped in the lungs during forced expiration
what respiration pattern-
May be a normal response to fever, anxiety, or exercise
Tachypnea
what respiration pattern-May be normal in well-conditioned athletes.
Bradynea
Auscultate voice sounds-
Ask the client to repeat the phrase “ninety-nine” while you auscultate the chest wall.
Bronchophony
Auscultate voice sounds- Ask the client to repeat the letter “E” while you listen over the chest wall.
Egophony
Auscultate voice sounds- Ask the client to whisper the phrase “one–two–three” while you auscultate the chest wall.
Whispered pectoriloquy
Bronchophony normal sound
Voice transmission is soft, muffled, and indistinct.
sound of the voice may be heard but phrase cannot be distinguished
Egophony normal findings
transmission will be soft and muffled but the letter “E” should be distinguishable.
Whispered pectoriloquy normal findings
Transmission of sound is very faint and muffled. It may be inaudible.
Bronchophony abnormal
words are easily understood and louder over areas of increased density
may indicate consolidation from pneumonia, atelectasis, or tumor.
Egophony abnormal
, the sound is louder and sounds like “A.”
Whispered pectoriloquy: abnormal
sound is transmitted clearly and distinctly. In such areas, it sounds as if the client is whispering directly into the stethoscope.
Pectus excavatum
markedly sunken sternum and adjacent cartilages (often referred to as funnel chest).
is a forward protrusion of the sternum causing the adjacent ribs to slope backward (often referred to as pigeon chest)
Pectus carinatum
The sternum and ribs may be more prominent in
older client because of loss of subcutaneous fat.
Retraction of the intercostal spaces indicates an increased
inspiratory effort.
. Bulging of the intercostal spaces indicates
trapped air such as in emphysema or asthma.
Abnormal palpation over thorax
Tenderness over thoracic muscles can result from exercising (e.g., pushups) especially in a previously sedentary client
When you assess for fremitus on the female client, avoid palpating what
the breast. Breast tissue dampens the vibrations.
TRUE OR FALSE
listen through clothing or other materials when auscultating
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.
Bronchial normal breath sounds
pitch quality amplitude duration location
high harsh-hollow loud short inspiration, long expiration 1:2 Trachea & thorax
Bronchovesicular
normal breath sounds
pitch quality amplitude duration location
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
vesicular
normal breath sounds
pitch quality amplitude duration location
Low breezy soft long inspiration, short expiration Peripheral lung fields
