Week #3-Concept Review Flashcards
Respiratory System & Axilla
What is the functional unit of the lungs?
The Alveoli
What are the true ribs?
1 to 7th ribs
What are the false ribs and why are they called false ribs?
8th, 9th, and 10th ribs, because they are not connected to the sternum. They are connected to the cartilage of the 7th rib.
What are the floating ribs, where are they seen, and what are they connected to?
The 11th and 12th rib, they cannot be seen anteriorly, and are connected to the vertebra of the back.
Where do you find the “Angle of Louie”?
Articulated between the manubrium and the body of the sternum, in line with the 2nd rib
What is the initial step in respiration assessments and in any assessment?
Inspection
What are the sequence of assessment techniques in respiratory assessments?
1) Inspection
2) Palpation
3) Auscultations- is the last assessment technique
4) Percussion (optional)
What is the technique for percussing the lungs and what are the normal sounds called?
Indirect percussion & Resonant Sounds
What do the resonant sounds of the lungs sound like?
long, low-pitched, hollow sounds
On percussion, what sounds will be heard when air is trapped in the lungs?
Hyperresonant sounds
What is the technique used to assess bronchophony, egophony, and whispered pectoriloquy? What should you ask the patient to say during auscultation?
Auscultation for voice sounds assessed on the posterior thorax; bronchophony *99, egophony *E, whispered pectoriloquy *123.
What technique is used to assess tactile fremitus?
Palpation
What four things cause increased tactile fremitus?
(hint: FIFT)
1) fluid in the lungs
2) fibrosis
3) tumor
4) infection
What five things cause a decrease in tactile fremitus?
(Hint C-POTS)
1) soft voice
2) Thick chest muscles
3) Obesity
4) COPD
5) Pleural effusion
What technique is used to assess diaphragmatic excursion?
Percussion
What are normal diaphragmatic excursions? What can they go up to in fit individuals?
Normal= 3-5 cm
In a well fit individual= 7-8 cm
What are decreased diaphragmatic excursions, and what does this mean?
Decreased diaphragmatic excursions= less than 3 cm
This means the lungs are not fully expanding.
What can cause the lungs to not fully expand (4)?
Emphysema, atelectasis, respiratory depression, and pneumonia
What can asymmetric diaphragmatic excursion indicate?
Paralysis or pleural effusion of the higher side of the chest
What are the normal sounds when assessing for bronchophony on auscultation?
Muffled sounds
While auscultating bronchophony, when the lungs are filled with fluid (as in bilateral pneumonia), what are expected sounds?
Sounds are loud and clear
What are normal sounds when assessing for egophony?
“eeeeeee”
What auscultated sounds are present when assessing for whispered pectoriloquy when lungs are filled with fluid, as in bilateral pneumonia?
Sounds are loud and clear
What are normal sounds when assessing for whispered pectoriloquy?
Faint, muffled, and almost indistinguishable
What are Rhonchi Sibilant or Wheezing sounds? What patient may have them?
Continuously high pitched adventitious breath sounds, expected abnormal findings on auscultation with asthmatic patients.
What are Rhonchi Sonorous sounds? Which patient’s may have them?
continuous low pitched, snoring and rattling adventitious breath sounds. Common in clients with COPD, Pneumonia, Chronic Bronchitis, and Cystic Fibrosis
What adventitious breath sounds characterize blocked air flow?
High pitched and continuous upon auscultation.
What adventitious sound will you hear in clients with Lobar Pneumonia?
Crackles
What are pleural friction rub lung sounds?
Adventitious lung sounds heard outside the airway, rubbing and dry sounds.
Adventitious sounds heard upon auscultation when alveoli are filled with fluid.
A low pitch that has a loud, moist, and bubbly quality
What sounds are heard during the auscultation of atelectisis?
Decreased breath sounds at the lower lobes of the lungs.
What are the causes of atelectasis?
Prolonged bedrest of a post-op client, ineffective coughing, or hypoventilation
Describe external respiration.
Exchange of O2 and carbon dioxide at the alveoli level of the lungs.
Describe internal respiration.
Exchange of O2 and carbon dioxide at the cellular level of the lungs
What are the two phases of respiration?
1) Active phase- Inspiration
2) Passive phase- expiration
Describe Eupnea (Normal Breathing)
R.R.E.U. R.
Regular, Rhythmic, even, unlabored, 12-20X per minute at rest in adults
What is eupnea with the occasional sigh considered?
It is still considered normal breathing
What will frequent sighs result in?
Hyperventilation
Describe Choanal Atresia.
A congenital defect wherein there is membrane obstructing the nasal passages of a newborn. Must be managed right away because it can lead to respiratory failure.
Describe tachypnea.
A RR over 20 times per minute that is rapid and deep
Describe Bradypnea.
RR less than 12 times per minute, slow but regular.
What is the normal respiration rate of a newborn>
Ranges from 40-80 X/ minute & irregular
Describe hypoventialtion.
(hint: S.I.S.)
RR below 12 per minute, slow, irregular, and shallow
Describe Cheyne-Stokes Respirations.
Periods of apnea but regular, common in elderly dying patient
Describe Biots/ Ataxic respirations.
Periods of apnea with irregular pattern observed in brain damaged patients.
What is obstructive breathing and what patients may experience this?
Prolonged expiration; observed in patients with COPD, Asthma, and Chronic Bronchitis
Describe stridor.
Adventitious breath sounds heard without a stethoscope indicating an upper airway obstruction. Also known as an ominous sign.
What do loud and scratchy breath sounds indicate?
These are adventitious sounds that indicate pleurisy caused by inflammation of the pleura.
When using a spirometer what will you advise to the client?
Secure lips around the mouthpiece & and take a deep breath in.
Describe elliptical.
Normal chest configuration for adults- lateral diameter is 2:1 with the anteroposterior diameter of the chest.
Describe a barrel chest.
A normal configuration in an infant’s chest- rounded. Also, common in elderly and an unexpected finding for COPD patients.
Describe Scoliosis.
Lateral deviation of the spinous process.
Describe Kyphosis.
Exaggerated curvature of the thoracic vertebrae-elderly.
Describe Lordosis.
Exaggerated curvature of the lumbar vertebrae- pregnant women
Describe Pectus Excavatum or Funnel Chest
Congenital deformity wherein there is depression of the sternum and adjacent cartilage compressing the heart and lungs. Cardiac murmurs may be heard in severe cases surgery in indicated.
Describe Pectus Carinatum or Pigeon Chest
A congenital deformity forward displacement of the sternum with depression of the adjacent cartilage.
What causes clubbing of the fingers?
Chronic smoking, hypoxia, and poor tissue perfusion.
How can clubbing of the fingers be assessed?
The nail angle of the client is over 160 degrees (normal is 160 degrees) when dorsal aspects of the fingers are brought together to create a mirror image with a diamond space observed between fingers.
What is an early sign of hypoxia?
Altered level of consciousness
What are late signs of hypoxia (6)?
(hint: B.C.D.D.R.S.)
restlessness, stupor, dyspnea, decreased respirations, bradycardia, cyanosis
What is the most important question to ask a patient with Rhinitis?
History of allergies
What are the normal findings on transillumination of the sinus?
“Red Glow”
What is the indication of an absent red glow during transillumination?
When sinuses will not transilluminate red glow, the sinuses are filled with fluid.
How should a patient with the complaint of a sinus headache be assessed?
Assess by transillumination of the sinus or direct percussion of the sinuses.
What are the two assessment techniques of the breast?
Inspection and palpation
What structures of the breast are responsible for milk production.
Acini Cells
Describe Supernumerary Nipples.
A minor congenital malformation that consist of additional nipples which occurs along the breast line from the armpit to the groin. this is usually misdiagnosed as mole (s).
Breast cancer facts.
The occurrence of breast cancer in men is less than 1 % that is why it is easily ignored. Early detection of breast cancer has a higher rate of cure.
Where are most breast tumors located?
In the upper outer quadrant of the breast.
When should an SBE (self breast examination) be performed
-For elderly advise to perform of same day at the same time every month.
-For female still menstruating- Advise to perform 3-5 days after menstruation when hormones are more stable.
What is fibroadenoma?
A well defined breast tumor with no tenderness or discharge, most common in adolescent girls 15 years old to women up to 35 years old.
Describe Intraductal Papilloma.
The most common cause of benign nipple discharge ( serous or bloody) in post-menopausal female.
What is Peau D’Orange
Orange peel appearance on the skin of the breast, a sign of breast cancer or cancer.
When there is a change in the consistency of the breast lump, what must be performed?
It must be further evaluated by a physician.
What are examples of “expected variation on breast”?
1) Flat nipples since puberty
2) Veins on the breast since puberty
What are examples of “expected findings of clients with Asthma”?
1) Rhonchi Sibilant
2) Chronic Hyperactive Bronchospasms
What are examples of “expected variations of COPD”?
1) Barrel Chest
2) Clubbing of the fingers
3) O2 Sat 90% or less
What is the sequence for a breast examination?
1) Inspection
2) Palpation
What is the location, ratio of inspiration: expiration, and quality for the tracheal sound?
Over the trachea, inspiration less than expiration, harsh and high-pitched
What is the location, ratio of inspiration: expiration, and quality for the bronchial sound?
Next to the trachea, superior to each clavicle, and in the first intercostal space. Inspiration less than expiration, loud and high-pitched.
What is the location, ratio of inspiration: expiration, and quality for the bronchovesicular sound?
Over major bronchi, in second and third intercostal space, between the scapula. Inspiration is equal to expiration, medium loudness, medium pitched.
What is the location, ratio of inspiration: expiration of the vesicular lung sounds.
The remainder of the lungs, inspiration is greater than expiration, soft and low pitched
