Week 3 Respiratory and Breast Flashcards
T/F High pitched noise louder during inspiration indicating partial obstruction is called what?
stridor
T/F Bronchovesicular sounds are heard in the second and third intercostal space in the interscapular area?
True
Breathing pattern of extreme rate and depth assess for DKA
Kussmaul
Shape ssociated with COPD
Barrel chest
All are normal breath sounds except what?
rhonchi
70-year old complaining of fever and confusion can mean what?
Pneumonia
Decreased wall expansion on one side means what respiratory disease?
pneumothorax
Normal sounds percussion on lung fields
Resonance
Decreased oxygenation of blood cells mean what?
hypoxemia
Which side of the body has three lobes in the lungs?
Right, and the left only has two
What is the order in which the chest is assessed?
Inspection, palpation, auscultation
What are you assessing at in the anterior part of the chest?
Color, symmetry, clavicles, chest wall itself
What does unlevel shoulders mean?
Pneumothorax or collapsed lung
What is the proportion of the diameter of the chest?
The lateral diameter is larger than the anteroposterior diameter of the chest
What a normal chest proportion
L to A/P 2:1
What kind of chest proportion would a barrel chest patient have?
L to A/P 1:1
What is pectus carinatum? Aka? Cures?
Pigeon chest is when the sternum protrudes outward and this is congenital and will require surgery to correct.
What is pectus excavatum? Aka?
Funnel chest is a congenital deformity where the sternum is going inward and chest compression may interfere with respiration and cause murmurs
What does the respiratory pattern of kussmaul look like?
Rapid and deep, so fast and goes up and down. Labored.
How early do you check for scoliosis?
11-12 y.o.
What is a lateral curvature and rotation of the thoracic and lumbar spine?
scoliosis
What does someone with kyphosis look like?
A hunchback because there is a curvature of the thoracic spine
What causes kyphosis? And what complications are there?
Old age and causes decreases lung expansion and increase in cardiac problems
What causes lordosis and what is it?
Lower back curves forward toward the pelvis too much when the belly is big like in pregnant women and toddlers
At what point does scoliosis affect the lungs?
When greater than 45 degrees
A curve in the middle or lumbar area, it can be what?
scoliosis
What type of palpation do you use for the chest wall?
Indirect palpation to assess for vibrations
What is tactile fremitus?
When the back is palpated, the back is felt for vibrations
What is diaphragmatic excursion and how is it performed?
You are looking for even expansion of the lungs while you place your hand in a “w” formation at the base of the ribs and feel the patient breathing
Where are tracheal sounds heard? What is the quality?
Over the trachea, harsh, high pitched
Where are bronchial sounds heard? What is the quality?
Next to the trachea, superior to each clavicle and in the first intercostal space, loud, high pitched
Where are bronchovesicular sounds heard? What is the quality?
Over major bronchi in the 2nd and 3rd intercostal spaces between the scapulae, and medium loudness, medium pitch
Where are vesicular sounds heard? What is the quality?
Remainder of lungs, soft low pitched
What breath sounds have inspiration less than expiration?
Tracheal and bronchial
What lung sound would expiration be greater than inspiration?
Tracheal and Bronchial
What lung sound would expiration be equal to inspiration?
Bronchovesicular
What would you hear with atelectasis and what does it indicate?
Silence from a collapsed alveoli
Where in the airway would cause stridor?
Inspiration in the upper airway aka croup
What causes rhonchi and when is it heard? Aka
Wheezes or sibilant (hissing) is heard upon expiration and inspiration and is high pitched, and continuous and with a blocked airflow in asthma
What causes rales and when is it heard? Aka
Crackles are ear at the end of inspiration and high pitched, and with collapsed or fluid filled alveoli
What might cause a friction rub?
Inhalation/exhalation and pleural inflammation
What would you hear with consolidation?
Muffled sounds in the lower lobes normally, but with consolidation, the sound in lower lobes are louder than normal
What is consolidation caused by?
Fluid filled lungs tissue, usually filled with air
What is normal bronchophony?
Sound from the top is less muffled because of the bigger airway
What is abnormal bronchophony?
“99” Sound sounds the same in upper and lower lobes because there is fluid in the lungs
What is normal egophony? What sound do you use?
Use “eee” and it would be more distinct on the top than the bottom because the sound gets more muffled toward the bottom
What is abnormal egophony? What sound do you use?
Patient says “eee”, but it sounds like “aahh” so there might be consolidation
What is whispered pectoriloquy? What sound do you use?
Whispered “99” and the sound up top sounds more clear than the bottom
What is abnormal whispered pectoriloquy?
Sounds the same throughout all lung fields, which might mean consolidation throughout
What is the normal sound for indirect percussion of the chest?
resonance
What might an elderly patient with respiratory distress have?
ALOC
If a patient has a hemothorax, what might the patient have and what do you do with it?
Chest tube, and don’t empty it, but just measure it.
What is a hemothorax
Blood in the lungs
What does the breast area consist of?
Areola, adipose tissue, nipple, Montgomery glands, and tail of spence (goes under the axillae)
Where do tumors usually like to hang out?
Upper outside in the tail of spence
How are the breasts divided?
In four quadrants
How would the patient be positioned for a breast exam?
Hands over head
Hands on hips
Leaning forward
What do you look for in an initial breast assessment?
Color, symmetry, similar, uncracked, no discharge nipples, dimpling
Breast assessment cancer assessment
Lumps- inspect and palpate for lumps, and masses
Mammary changes- inspect and palpate for dimpling, tenderness, abnormal contours
Nipple changes- inspect and palpate for retraction, lesions, and discharge
Other symptoms- check size, symmetry, appearance of skin, direction of pointing rashes, and ulceration
Patient risk factors- family history
What is the order of assessment techniques?
Inspect and palpate
In what direction should you exam the breast
Start at the axillary and move toward the nipple
When is the best time to do a self- breast exam?
5-7 days after menses in the shower
What should an abnormal breast lump feel like?
Hard and fixed, and initially not painful
What might the skin look like with cancer?
Dimpling
What kind of discharge might be present with breast cancer?
bloody
What is the benign breast problem called and what does it feel like?
After the menses, the breasts are tender and the lump is moveable and can be taken care of with compresses and low sodium diet
What causes gynecomastia?
Males with extra breast tissues and an excess of hormones
What is it called if someone has an extra nipple?
Supernumerary nipple
What can cause peau d’ orange?
Inflamed blocked mammary nipple
What causes Paget’s disease and what does it look like?
Nipple’s areola is deformed and the areola have irregular borders and causes by condition associated with breast cancer
What is Stage one of breast development?
Preadolescent- only the nipple raised above the level of the breast
What is the budding stage?
Stage two where the areola increased in diameter and surrounding area slightly elevated
When would the breast and areola be enlarged, No contour separation.
stage three
What stage do you have an areola that forms a secondary elevation above that of the breast in half of girls?
Stage four
What Tanner stage would you find the areola usually part of the general breast contour and is strongly pigmented?
Stage five
What breath sound has inspiration less than expiration?
Tracheal and bronchial
Which breath sound has inspiration equal to expiration?
Bronchovesicular
Which breath sound has expiration greater than inspiration?
Bronchial and tracheal
