Topic 10 Flashcards
Costal cartilages become calcified…
a less mobile thorax.
Aging lung is more rigid structure…
harder to inflate
Changes result in an increase in small airway closure
commonly known as “ate________”
histiologic changes…
-a gradual loss of intra-alveolar septa and a decreased number of alveoli
-increase the older person’s risk of postoperative pulmonary complications.
decreased number of alveoli means…
less surface area is available for gas exchange.
as a result of closing off of a number of airways…
Lung bases become less ventilated
weight changes in the last 3 months may indicate…
pulmoary edema, 3 lbs in a short amound of time is not good.
equpitment for respiratory assessment
-Stethoscope
-Small ruler, marked in centimeters
-Marking pen
-Alcohol wipe
how can a nurse provide respect and comfort during examination of respiratory system
A warm room, a warm diaphragm endpiece, and a private examination time with no interruptions
when should you begin the respiratory examination
just after palpating thyroid gland when you are standing behind person.
-listen to both the front and the back of the individual
where do you perform inspection, palpation, percussion, and auscultation of the thorax
on posterior and lateral thorax, Then move to face person and repeat four maneuvers on anterior chest
Anteroposterior (AP) diameter should be _____ than transverse diameter.
less
symmetric expansion
-Confirm symmetric chest expansion by placing your warmed hands on the posterolateral chest wall with thumbs at the level of T9 or T10.
-Slide your hands medially to pinch up a small fold of skin between your thumbs Ask the person to take a deep breath.
-Your hands serve as mechanical amplifiers; as the person inhales deeply, your thumbs should move apart symmetrically. Note any lag in expansion.
tactile fremitus
Palpable vibrations (normal)
-Sounds generated from larynx are transmitted through LUNG to chest wall, where you feel them as vibrations.
how do you palpate for tactile fremitus
Use palmar base (ball) of fingers or ulnar edge of one hand
-touch person’s chest while he or she repeats words, “ninety-nine” or “blue moon.”
-Start over lung apices and palpate from one side to another
-symmetry is most important; vibrations should feel same on each side.
o-avoid palpating over scapulae because bone damps out sound transmission.
Factors affecting normal intensity of tactile fremitus
o Thickness of chest wall
o Pitch and intensity;
thickness of chest wall and fremitus
-greater over thin wall
-Less over obese or muscular one-dampens vibration (may be herder to hear in athletes due to muscle mass)
o Pitch and intensity and fremitus
§ loud, lowpitched voice generates more fremitus than soft, high-pitched one.
what makes a better conducting medium for sound-increase tactile fremitus.
increase density of lung tissue
what is most important when listening to breath sounds
Side-to-side comparison is most important.
when listening to breath sounds, how should you instruct the batient to breathe?
Instruct person to breathe through mouth, a little bit deeper than usual.
what side of the stethoscope should you use for breath sounds and how do you hold it?
Use flat diaphragm endpiece of stethoscope and hold it firmly on person’s chest wall; listen to at least one full respiration in each location.
what extraneous noises may be confused with lung pathology if not recognized?
o Examiner’s breathing on stethoscope tubing
o Stethoscope tubing bumping together
o Patient shivering
o Patient’s hairy chest; movement of hairs under stethoscope sounds like crackles (rales)
o Rustling of paper gown or paper drapes
how can u minimize noise on a hairy chest with a stethoscope?
minimize this by pressing harder or by wetting the hair with damp cloth.
While standing behind person, listen to following lung areas:
o Posterior from apices at C7 to bases around T10
o Laterally from axilla down to seventh or eighth rib
what three types of normal breath sounds should you expect to hear in adult and older child.
-Bronchial
-Bronchovesicular
-Vesicular
bronchial breath sounds
loud, high-pitched, hollow sounds
Where are bronchial breath sounds heard?
trachea and larynx
bronchovesicular breath sounds
medium-pitched and quieter sounds
where are bronchovesticular breath sounds heard?
Over major bronchi where fewer alveoli are located: posterior, between scapulae especially on right; anterior, around upper sternum in 1st and 2nd intercostal spaces
vesicular breath sounds
soft, fine, breezy, low-pitched sounds
where are vesicular breath sounds heard?
Over the peripheral lung fields
adventitious sounds
Added sounds that are not normally heard in lungs
adventitious sounds are caused by
moving air colliding with secretions in tracheobronchial passageways or by popping open of previously deflated airways
adventitious sounds:classification and nomenclature of these sounds
crackles (or rales) and wheeze (or rhonchi) are terms commonly used by most examiners.
Atelectatic crackles
a type of adventitious sound, is not pathologic; short, popping, crackling sounds that sound like fine crackles but do not last beyond a few breaths
wheezes
Rhonchi
crackles
rales
Where are atelectatic crackles heard?
heard in the periphery only, and disappear after first few breaths or after a cough
While ausculating voice sounds, Ask person to repeat what phrase while you listen over chest wall?
“ninety-nine”
what do you normally hear while ausculating voice sounds
Normal voice transmission is soft, muffled, and indistinct; you can hear sound through stethoscope but cannot distinguish exactly what is being said.
when ausculatating breath sounds, Progress from side to side as you move downward, and…
listen to one full respiration in each location.
Auscultate lung fields over the
anterior chest from apices in supraclavicular areas down to sixth rib.
A healthy person with no lung disease and no anemia normally has an SpO2 of
97% to 98%.
>95% is good
what is a safer, simple, inexpensive, clinical measure of functional status in aging adults.
The 6-minute walk test (6 MWT)- checks if they are havinf SOB, whats their pulse ox?
developmental competence of againg adult
o round barrel shape, and kyphosis or an outward curvature of thoracic spine.
o Chest expansion may be somewhat decreased, although still symmetric.
o Tend to tire easily during auscultation when deep mouth breathing is required
thoracic diameter and barrel chest
shows an increased anteroposterior diameter
developmental competence of acutely ill patient
-Use of a second examiner to assist the patient in terms of positional changes
-If no one is available, examiner may roll patient from side to side to facilitate change of position.
-If rolling technique is used, this may interfere with bilateral assessments of inspection and percussion.
crepitus
crackling, crinkling, grating feeling under the skin (Rice crispies)
Barrel chest
a condition characterized by increased anterior-posterior chest diameter caused by increased functional residual capacity due to air trapping from small airway collapse. A barrel chest is frequently seen in patients with chronic obstructive diseases, such as chronic bronchitis and emphysema.
thorax and lung exam: inspection
o Thoracic cage, respirations, skin color, and condition
o Person’s facial expression, and LOC
thorax and lung exam: palpation
o Confirm symmetric expansion and tactile fremitus.
o Detection of any lumps, masses, or tenderness
thorax and lung exam: auscultation
o Assess breath sounds, and note any abnormal/adventitious breath sounds.
Pectus excavatum
sunken sternum and adjacent cartilages
Pectus carinatum
a chest that protrudes like the keel of a ship
Scoliosis
abnormal lateral curvature of the spine
Kyphosis
hunchback
Sigh
o Occasional sighs punctuate the normal breathing pattern and are purposeful to expand alveoli. Frequent signs may indicate emotional dysfunction and also may lead to hyperventilation and dizziness.
Tachypnea
o Rapid, shallow breathing. Increase rate.
Bradypnea
o Slow breathing. A decreased but regular rate .
Hyperventilation
o Increase both rate and depth. Blows off CO2, causing decrease in the blood
Hypoventilation
ventilation of the lungs that does not fulfill the body’s gas exchange needs; An irregular shallow pattern
Cheyne-Stokes respiration
o A cycle in which respirations gradually wax and wane in a regular pattern, increasing in rate and depth and then decreasing. The breathing periods last 30 to 45 seconds, with periods of apnea (20 seconds) alternating the cycle
Biot’s respiration
o Similar to Cheyne-Stokes respiration, except that the pattern is irregular. A series of normal respirations (3 to 4) is followed by a period of apnea. The cycle length is variable, lasting anywhere from 10 seconds to 1 minute.
Chronic obstructive breathing
normal inspiration and prolonged expiration to overcome increased airway resistance
Discontinuous sounds
o Crackles—fine
o Crackles—course
o Atelectatic crackles
o Pleural friction rub
Crackles—fine
Discontinuous, high-pitched, short, crackling, popping sounds heard during inspiration that are not cleared by coughing.
Crackles—coarse
Loud, low-pitch bubbling and gurgling sounds that start in early inspiration and may be present in expiration.
Pleural friction rub
A very superficial sound that is coarse and low pitched; it has a grating quality as if two pieces of leather are being rubbed together. Sound is inspiratory and expiratory.
Wheeze—sibilant
High-pitched, musical squeaking sounds that sound polyphonic. Predominant in expiration but can occur in both
Wheeze—sonorous rhonchi
Low-pitched; monophonic, single note, musical snoring, moaning sounds. Heard throughout the cycle, although they are more prominent on expiration.
Stridor
High-pitched, monophonic, inspiratory, crowing sound; louder in neck (pharynx/larnx) than over chest wall.
