Thorax & lungs: IPPA Flashcards
what IPPA can u expect in px with Pneumonia
Inspection:
* decreased chest expansion expansion on affected side d/t consolidation
Palpation:
* increased tactile fremitus if the bronchus is patent, allowing for sound to be easily transmitted via consolidated lung tissue
* decreased tactile fremitus if the bronchus is obstructed
Percussion:
* dullness over the area of consolidation bc fluid in the lung tissue makes the sound more muffled
Auscultation:
* bronchial breath sounds: louder & have a higher pitch than nml vesicular breath sounds
* crackles which indicate fluid & inflammation in the air sacs
Pneumonia is an infection of the lung parenchyma, the tissue that makes up the lungs
- In pneumonia, the alveoli become filled w/ fluid & inflammatory cells
- this consolidation of the lung tissue prevents the affected portion of the lung from expanding properly
what IPPA can u expect in px with Pneumothorax
Inspection:
* decreased chest expansion on the affected side compared to the unaffected side b/c the collapsed lung is unable to fill with air
Palpation:
* decreased/absent tactile fremitus (vibration when px speaks) bc the collapsed lung isnt moving air
Percussion:
* hyperresonant (booming, hollow) sound on affected side bc the air in the pleural space makes the sound deeper
Auscultate:
* faint/no breath sounds in affected lung bc the lung isnt expanding or contracting properly
Pneumothorax: occurs when air enters the pleural space, the space b/n lung & chest wall. This air pushes on the lung, causing it to collapse
What IPPA can u expect in Atelectasis
Inspection:
* reduced chest expansion on affected side bc that part of the lung isnt expanding
Palpation:
* decreased/absent tactile fremitus bc the collapsed area isnt moving much air
Percussion:
* collapsed part will produce dull (softer, muffled sound) bc there is no air in that part of the lung
Breath sounds:
* decreased/absent
Atlelectasis (part of the lung collapses): a portion of the lung collapses. This can happen bc of:
- a blockage in the airway (mucus)
- pressure on the lung,
- or not enough surfactant (a substance that helps keep air sacs open)
Inspection
what are the normal thoracic shape & configuration?
- spinous process should form a straight line
- thorax symmetrical & elliptical (length is longer than the width) w/ the ribs sloping down at ~45 degrees
- anteroposterior (AP) diameter (front to back) should be less than the transverse (side to side) diameter
Nml adult ratio 0.70-0.75
Inspection
what are the abnormal thoracic shape?
- Skeletal deformities
(e.g., scoliosis, kyphosis) restrict chest expansion. - Increased AP diameter
(barrel chest) indicates COPD (due to lung hyperinflation).
Inspection
normal musculature
- normal neck
- trapezius muscles should be appropriate for age & occupation
Inspection
abnormal musculature
- neck muscle hypertrophy indicates COPD d/t use of accessory muscles for breathing
- abdominal muscle hypertrophy may occur in chronic emphysema
COPD: a long-term lung condition that makes it hard to breathe
- ppl with COPD struggle getting enough air into their lungs, so they use extra (accessory) muscles in their neck & upper body to help with breathing.
- over time, bc these neck muscles are used sm, they get larger & stronger = muscle hypertrophy
Chronic emphysema: a type of COPD where the lungs **lose their elasticity, making it hard to exhale completely **
- ppl with emphysema often use their abdominal muscles more than normal to help force air out of their lungs, bc their lung fuction is reduced
Inspection
normal posture
a relaxed posture is normal
Inspection
abnormal posture
tripod position (leaning forward w/ hands braced) suggests COPD or respiratory distress
- COPD & respiratory distress makes it hard for someone to breathe normally. They have to work harder to get enough air in & out of their lungs
- tripod position helps expand the chest more, allowing the lungs to take in more air
- bracing the hands on the knees or another surface helps stabalize the body, making it easier for the person to use their accessory muscles (neck, shoulder, chest muscles) to breathe more efficiently
Inspection
normal respirations
- nml breathing is automatic, effortless, & symmetrical chest mvmt
- occasional sighs are nml
Inspection
abnormal respirations
- tachypnea, bradypnea
- hyperventilation, hypoventation
- Cheyne-stokes
- Bios respirations
= indicate abnormal breathing - Use of accessory muscles (scalene, sternomastoid)
= indicate diff breathing
Cheyne-Stokes breathing: this is a pattern where a px’s breaths change b/n deep, fast breaths & periods of no breathing (apnea)
- the body is struggling to control breathing, so u get these up and downs in the breathing patterns
- seen in serious heart conditions, brain injuries, or in the end stages of life
Biots respirations: this is an irregular breathing pattern that includes nml breaths followed by periods of apnea (no breathing)
- seen in ppl with brain damage, esp in the area that controls breathing (head trauma, strokes)
- diff than Cheyne-stokes bc the breathes are irregular & unpredictable, rather than cycling between deep & shallow
Inspection
Nml chest expansion
symmetrical
Inspection
Abnormal chest expansion
asymmetrical chest expansion which may suggest:
- pneumonia:
- atelectasis:
- pneumothorax:
Inspection
retractions/bulging
nml: no retractions/bulging of the interspaces
retractions indicate diff breathing
- airway obstruction
- atelectasis
- pneumonia
- pneumothorax
- respiratory distress
bulging indicate trapped air
- emphysema , COPD
Retractions: occur when the spaces b/n ribs (interspaces) or other muscles in the chest *pull in *deeply as a person breathes bc the body is working hard to get air into the lungs
- airway obstruction: something blocking the airways, making it harder to breathe
- atelectasis: part of the lung has collapsed, & the body struggles to bring in enough air
- pneumonia: parts of the lungs are fuld w/ fluid & inflamed, which makes it harder for the lungs to expand & take in enough air. This extra effort to breathe can cause muscles b/n the ribs to pull in (retractions) as the body tries to compensate for the reduced O2 exchange
- pneumothorax: air enters the space b/n the lungs & chest wall = lung to collapse.
Bulging: happens when the spaces b/n the ribs push outward instead of pulling in, indicating trapped air in the lungs, making the chest expand more than nml
- emphysema/COPD: a chronic lung disease where the lungs become overinflated bc air gets trapped in the lungs. This leads to hyperinflation of the lungs, which can cause bulding of interspaces as the chest expands more than normal. The trapped air makes it diff for the lungs to empty fully, leading to this outward pressure
- asthma: during an asthma attack, air can get trapped in the lungs, causing the chest to bulge
Inspection
nml skin condition & color
- skin color should match genetic background
- lips & nail beds should be pink
Inspection
abnormal skin condition & color
- cynosis
- pallor
- clubbing of fingertips (COPD, chronic hypoxia)
Inspection
nml facial expression
relaxed, neutral
Inspection
abnormal facial expression
- tense/strained face
- pused lips breathing (COPD)
Inspection
nml consciousness
alert & cooperative
Inspection
abnormal consciousness
- altered mental state (drowsy, restless) could indicate **cerebral hypoxia **
Palpation
How do you assess symmetric chest expansion posteriorly
Posterior:
- Place hands sideways on the posterolateral chest wall with thumbs meeting at T9 or T10.
- Slide hands medially to pinch a small fold of skin between thumbs.
- Ask the patient to take a deep breath and observe for symmetrical movement of thumbs.
Palpation
how do u assess symmetric chest expansion anteriorly?
Anterior:
* Place hands on the anterolateral wall with thumbs along the costal margins pointing toward the xiphoid process.
* Ask the patient to take a deep breath and observe for the outward movement of hands
Palpation
What are normal findings when palpating for symmetrical chest expansion?
The examiner should observe symmetrical expansion of the chest
Palpation
What does unequal chest expansion indicate?
Unequal chest expansion indicates issues like
1. atelectasis
2. pneumonia
3. pleural effusion
4. pneumothorax
5. or postoperative guarding.
Palpation
How do you palpate for tactile fremitus?
- Use the palmar base or ulnar edge of your hand to palpate while the patient says “ninety-nine.”
- Start at the lung apices and compare side-to-side
Palpation
What are the normal findings when assessing for tactile fremitus?
- Vibrations should feel the same in corresponding areas on each side.
- Fremitus is most prominent between the scapulae and around the sternum, decreasing as you move down the chest
Palpation
What does decreased tactile fremitus suggest?
Decreased tactile fremitus suggests an
1. obstructed bronchus
2. pleural effusion
3. pneumothorax
4. or emphysema.
Palpation
What does increased tactile fremitus indicate?
Increased tactile fremitus indicates compression or consolidation of lung tissue, such as in lobar pneumonia
Palpation
What is rhonchal fremitus?
Rhonchal fremitus is a palpable vibration felt with thick bronchial secretions.
Palpation
What is pleural friction fremitus?
Pleural friction fremitus is a palpable grating sensation with breathing, indicating pleural inflammation
Palpation
How should the examiner palpate for lumps, masses, or tenderness?
The examiner should gently palpate the entire chest wall, including the anterior chest wall and supraclavicular areas.
Palpation
What are the normal findings when palpating the chest wall for lumps, masses, or tenderness?
The chest wall should be free of lumps, masses, or tenderness.
Palpation
What are abnormal findings when palpating the chest wall for lumps, masses, or tenderness?
Note any palpable masses, tenderness, or crepitus (a coarse, crackling sensation).
* Crepitus indicates subcutaneous emphysema.
Percussion
How does the examiner percuss the lung fields?
Percuss in the intercostal spaces, comparing side-to-side, starting at the apices and moving down the chest.
* Avoid the scapulae and ribs.
Percussion
What is the normal percussion note over the lung fields?
Resonance is the predominant percussion note, a low-pitched, clear, hollow sound.
Palpation
What does hyperresonance upon percussion of the lung fields suggest?
Hyperresonance, a lower-pitched, booming sound, suggests air trapping, as seen in
* emphysema
* or pneumothorax.
Percussion
What does dullness upon percussion of the lung fields indicate?
Dullness, a soft, muffled thud, indicates abnormal density in the lungs, such as
* pneumonia
* pleural effusion
* atelectasis
* or tumor
Auscultation
What is the technique for auscultating breath sounds?
- Listen with the diaphragm of the stethoscope to one full respiration in each location, comparing side-to-side.
- Instruct the patient to breathe deeply through their mouth
Auscultation
What are the three normal breath sounds?
1) Bronchial: High-pitched, loud, with expiration longer than inspiration
* heard over the trachea and larynx.
2) Bronchovesicular: Moderate pitch and amplitude; inspiration and expiration are equal
* heard over major bronchi.
3) Vesicular: Low-pitched, soft, with inspiration longer than expiration
* heard over peripheral lung fields.
Auscultation
What might decreased or absent breath sounds indicate?
Decreased or absent breath sounds may indicate an
* obstructed bronchus
* emphysema
* or pleural effusion.
Auscultation
What do increased breath sounds suggest?
Increased breath sounds, sounds that are louder than expected for their location, such as bronchial sounds heard over the peripheral lung fields, suggest
* consolidation
* or compression.
Auscultation
How do you auscultate for adventitious sounds?
Listen for added sounds that are not normal breath sounds.
* Describe their timing (inspiratory vs. expiratory), loudness, pitch, and location.
Auscultation
What are fine crackles?
Fine crackles (rales) are high-pitched, short, crackling sounds heard during inspiration
Auscultation
What are coarse crackles?
Coarse crackles (rales) are loud, low-pitched bubbling and gurgling sounds, most prominent during inspiration.
Auscultation
What are atelectatic crackles?
Atelectatic crackles are short, popping sounds that disappear after a few breaths;
* they are not pathologic.
Auscultation
What are the characteristics of a high-pitched wheeze?
High-pitched wheezes (rhonchi) are high-pitched, musical squeaking sounds, predominantly during expiration.
Auscultation
What are the characteristics of a low-pitched wheeze?
Low-pitched wheezes (rhonchi) are low-pitched, monophonic, musical snoring or moaning sounds, more prominent on expiration.
Auscultation
What is a pleural friction rub?
A pleural friction rub is a coarse, grating sound heard during both inspiration and expiration.
Auscultation
What is stridor?
Stridor is a high-pitched, monophonic, inspiratory crowing sound
* suggesting upper airway obstruction
Auscultation
What is the technique for assessing voice sounds?
Auscultate the chest while the patient speaks or whispers. These are supplemental maneuvers used when lung pathology is suspected.
Auscultation
what is bronchophony
Bronchophony is increased clarity and loudness of spoken words.
Auscultation
What is egophony?
Egophony is when the spoken “eeeee” sound changes to a bleating “aaaa” sound.
Auscultation
What is whispered pectoriloquy?
Whispered pectoriloquy is when whispered words are heard clearly and distinctly
Aging Adult
How should the examiner adjust the pacing of the assessment for the aging adult?
Allow rest periods during the examination to prevent fatigue and hyperventilation.
Aging
What are some age-related changes to be aware of when assessing the aging adult?
Be aware of the
1. increased AP diameter and
2. potential for decreased chest expansion in older adults.
Acutely ill
What is an important consideration for positioning an acutely ill patient?
Ensure the patient is adequately supported, possibly with the help of a second examiner, especially if they are unable to sit upright.
Acutely ill
How should the examiner adapt the examination for an acutely ill patient who cannot be positioned upright?
If the patient cannot be positioned upright, roll them side to side to examine the accessible lung fields.
* Recognize that this limits side-to-side comparison and may affect percussion findings.
Fine crackles
“Faint crackles follow faint conditions”
Fine crackles are soft, crackling, or popping sounds (sound u hear when u rub ur hair b/n fingers) close to ur ear.
- airways are blocked or inflames (asthma, chronic bronchitis)
- stiff (pneumonia, HF)
Think of these crackles as faint, high-pitched sounds that happen when air bumps into closed airways and makes them pop open.
Imagine it like tiny bubbles bursting in your lungs when you breathe in.
Coarse crackles
coarse crackles crush cleaning
are bigger, louder, and sound like bubbling or gurgling.
Imagine someone blowing air through a straw into a thick milkshake. These sounds are like air trying to push through mucus or fluids in the lungs.
Sibilant Wheezes
Squeeze That Sibilant Sound”
- Squeeze: Air is squeezed through tiny, narrow passages, like air being forced through a pinched straw.
- Sibilant Sound: The sound is high-pitched and musical, like a squeak or whistle.
- You hear it mostly when someone is breathing out, and it’s common in asthma or emphysema.
It’s like a whistle from someone’s lungs—air is getting squeezed through narrow or tight airways, making that high-pitched, musical sound.
atelectatic crackes
“A-telect-quickly crackles
sound like fine crackles but disappear fast after a few deep breaths
- they happen bc parts of ur lungs haven’t fully expanded (like after being in bed too long) and when u take a deep breath these areas open up quickly
Sonorous Rhonchi
“Low and Slow Rhonchi”
- Low: These sounds are deeper and lower-pitched, like a rumbling or snoring.
- Slow Rhonchi: You’ll hear them more on the way out when someone breathes out, and sometimes they’ll go away for a little while after coughing.
Pleural Friction Rub
“leather rubs the pleura”
- Leather: Imagine the sound of two pieces of stiff leather rubbing together. This is what pleural friction rub sounds like.
- It happens when the linings of the lungs (the pleura) get inflamed and lose their smooth, lubricated surface, causing a rough, rubbing sound when the person breathes.
