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
