Term
| Anterior Thoracic Landmarks |
|
Definition
Anterior thoracic landmarks:
-Suprasternal Notch
-Sternum
-Sternal Angle: "angle of louis" continuous with the second rib, useful place to start counting ribs. Each intercostal space is numbered by the rib above it.
-angle of louis also marks the site of tracheal bifurcation into the right and left main bronchi; it corresponds with the upper border f the atria of the heart, and i lies above the fourth thoracic vertebra on the back
-costal angle |
|
|
Term
| Posterior Thoracic Landmarks |
|
Definition
Posterior Thoracic Landmarks:
-Vertebra Prominens: most prominent bony spur protruding at the base of the neck. spinous process of C7. if two bumps seem equally prominent, the upper one is C7 and the lower one is T1
-Spinous process: note that spinous processes align with their same numbered ribs only down to T4. after T4 the spinous process angle downward from their vertebral body and overlie the vertebral body and rib below.
-Inferior border of the scapula: lower tip is usually at the seventh or eight rib
-twelfth rib- palpate midway between the spine and the person;s side to identify its free tip. |
|
|
Term
|
Definition
Reference Lines:
-Midsternal
-Midclavicular
-Vertebral
-Scapular
-Anterior Axillary
-Posterior Axillary
-Mid Axillary |
|
|
Term
|
Definition
| Mediastinum: is the middle section of the thoracic cavity containing the esophagus, trachea, heart and great vessels. the right and left pleural cavities, on either side of the mediastinum contain the lungs. |
|
|
Term
|
Definition
Lung Borders:
-Apex, or highest point of lung tissue is 3 or 4 cm above the inner third of the clavicles.
-Base or lower border, rests on the diaphragm at about the 6th rib in the midclavicular line. Laterally, lung tissue extends from the apex of the axilla down to the seventh or eight rib. posteriorly, the location of C7 marks the Apex of lung tissue, and T10 usually corresponds tot he base. deep inspiration expands the lungs, and their lower border drops to the level of T12. |
|
|
Term
Lobes
Anterior
Posterior
Lateral |
|
Definition
Right lung has three lobes and the left lung has two lobes.
separated by fissures that run obliquely through the chest.
Anterior: the oblique (the major or diagonal) fissure crosses the fifth rib in the midaxillary line and terminates at the sixth rib in the midaxillary line and terminates at the sixth rib in the midclavicular line. the right lung also ontaints the horizontal minor) fissure, which divides the right upper and middle lobes. this fissure extends from the fifth rib in the right midaxillary line to the third intercostal space or fourth rib at the right sternal border.
Posterior: chest is almsot all lower lobe. upper lobes occupy from T1-T3 or T4. at this level the lower lobes begin, and the inferior border reaches down tot he level of T10 on expiration and T12 on inspiration.-the right middle lobe does not project onto the posterior chest at all.
Lateral: lung tissue extends from the axilla down to teh seventh or eight rib. right upper lobe extends formt he apex of axilla down to the horizontal fizzier at the 5th rib. the right middle lobe extends from the horizontal fissure down and forward to the 6th rib at the midclavicular line. the right lower lobe continues from the 5th rib to the 8th rib in the midaxillary line.
Left lung- only two lobes separated by oblique fissure. left upper lobe from apex of axilla down to 5th rib at midaxillary line. left lower lobe continues down tot he 8th rib in the midaxillary line. |
|
|
Term
|
Definition
Pleurae- are thin slippery serous membranes that form an envelope between the lungs and the chest wall.
visceral pleura line the outside of the lungs, dipping down into the fissures. It it continuous with the parietal pleura lining the inside of the chest wall and diaphragm
-the inside of the envelope, the pleural cavity, is a potential soace filled with only a few milliliters of lubricating fluid. It normally has a vacuum, or negative pressure, which holds the lungs tightly against teh chest wall.
Pleaurae extend to about 3m below the level of the lungs, forming the costodiaphragmatic recess. this si a potential space; when it abnormally fills with air or fluid, it compromises lung expansion |
|
|
Term
|
Definition
Trachea lies anterior to the esophagus and is 10-11 cm long in an adult. begins at the level of cricoid cartilage and bifurcates jsut below the sternal angle into right and left main bronchi. posterior;y bifurcates at T4 or T5. right main bronchus is shorter, wider and more vertical then the left main bronchus.
-trachea and bronchi transport gases between the environment and the lung parenchyma. they are dead space, filled with air but not available for gas exchange. 150 m in adult. bronchial tree also protects alveoli from small particulate matter in the inhale air. bronchi lined with goblet cells, secrete mucus and entrap the particle. lined with cilia, sweep particles upward to be swallowed or expelled. |
|
|
Term
|
Definition
| Acinus: is a functional respiratory unit that consists of the bronchioles, alveolar ducts, alveolar sacs and the alveoli. gaseous exchange occurs across the respiratory membrane in the alveolar duct and in millions of alveoli. Alveoli are clustered around each alveolar duct. this created millions of interalveolar septa (walls) that increase tremendously the working space available for gas exchange. |
|
|
Term
|
Definition
| Hypercapnia- the normal stimulus to breathe for most ppl is the increase of CO2 in the blood |
|
|
Term
|
Definition
| hypoxemia: a decrease of O2 in the blood also increases respirations but is less effective than hypercapnia |
|
|
Term
|
Definition
| Surfactant-a t 32 weeks the complex lipid substance needed for sustained inflation of the air sacs, is present in adequate amounts. |
|
|
Term
|
Definition
Subjective Data:
1. Cough
2. Shortness of Breath
3. Chest pain with breathing
4. HIstory of respiratory infections
5. Smoking history
6. Environmental exposure
7. Self-care behaviors |
|
|
Term
Characteristic timing of cough
characteristic sounds |
|
Definition
Cough Timing:;
1. continuous through out the day - acute illness
2. afternoon/evening-may reflect exposure to irritants at work
3. night- post nasal drip
4. early morning- chronic bronchial inflammation of smokers
Cough Sounds:
1. hacking- mycoplasm pneumoniae
2. dry- early heart failure
3. croup-barking
4.congested- colds, bronchitis, pneumonia |
|
|
Term
|
Definition
Hemoptysis: characteristic sputum produciton1. white or clear mucoid- colds, bronchitis, viral infections
2. yellow/green- bacterial infections
3. rust colored-TB, pneumococcal pneumonia
4. pink, frothy- pumonary edema, some sympathomimetic meds have this side effect. |
|
|
Term
|
Definition
| SOB: determine how much activity precipitates the shortness of breath-state specific number of blocks walked or stairs |
|
|
Term
|
Definition
| Orthopnea- difficulty breathing when supine |
|
|
Term
| Paroxysmal Nocturnal Dyspnea |
|
Definition
| Paroxysmal Nocturnal Dyspnea- is awakening from sleep with SOB and needing to be upright to achieve comfort. may be accompanies by diaphoresis and cyanosis signaling hypoxia. |
|
|
Term
| Chest pain with breathing |
|
Definition
Chest pain with breathing:
chest pain of thoracic origin occurs with muscle soreness from coughing or from inflammation of pleura overlying pneumonia. distinguish this from chest pain of cardiac origin or heartburn from stomach. |
|
|
Term
| History of respiratory infections |
|
Definition
| History of respiratory infections: breathing trouble, lung disease. consider sequelae after these conditions |
|
|
Term
|
Definition
| history of smoking: state number of packs per day and the number of eyars smoked. assess smoking behavior, ways to modify daily smoking activities, identify triggers how to manage withdrawal. |
|
|
Term
environmental exposure
self care |
|
Definition
environmental conditions: pollution exposure. pesticides, coal, dust, asbestos, radon
assess self care-masks
general symptoms: cough SOB
carbon monoxide-dizziness, headache, fatigue
sulfur dioxide- cough, congestion |
|
|
Term
Self-care behaviors
precise localized sharp pain |
|
Definition
Self care behaviors- vaccines, chest x-rays, immunizations
precisely localized sharp pain (points with one finger)- consider fractured rib or muscle injury. |
|
|
Term
Inspect the posterior chest:
-Thoracic cage |
|
Definition
inspect the posterior chest:
Thoracic cage: note the shape and configuration of the chest wall. should be a straight line thorax symmetrical, elliptical shape, ribs about 45 degrees relative to the spine. anteroposterior diameter should be less than the transverse diameter 1:2 to 5:7
Abnormal findings: skeletal deformities may limit thoracic cage excursions: scoliosis and kyphosis
AP= transverse diameter or "barrel chest". Ribds are horiontal, chest appears as if help in continuous inspiration, occurs in emphysema.
note the position the person takes to breath- should be relaxed posture and be able to support own weight comfortably
Abnormal findings:
neck muscles are hypertrophied in COPD from aiding in forced respirations. Pt with COPD often sit in tripod position
Assess the skin color and conditions: color should be consistent. no cyanosis or pallor. note any lesions, inquire about nevus on back
Abnormal findings: cyanosis occurs with tissue hypoxia |
|
|
Term
Palpate the posterior chest:
-symmetric expansion |
|
Definition
Symmetric expansion: confirm by placing your warmed hands on he posterolateral chest wall with thumbs at level of T9 or T10. pt inhales deeply, thumbs should move apart symmetrically
Abnormal findings: unequal chest expansion occurs with marked atelectasis, lobar pneumonia, pleural effusion, with thoracic trauma ie fractured ribs or pneumothorax. pain accompanies deep breathing when pleurae are inflamed |
|
|
Term
Palpating posterior chest:
-Tactile fremitus
-rationale
-procedure
-factors affecting intensity |
|
Definition
Tactile Fremitus: (aka vocal fremitus) Fremitus is palpable vibration. note any areas of abnormal fremitus. sound is conducted better through uniformly dense structure (not like porous flexible structure of normal lung). Conditions (usually abnormal) that increase density of lung tissue make better sound conducting medium for sound vibrations and increase tactile fremitus.
-palpate entire chest wall: note any areas of tenderness, skin temperature and moisture, to detect any superficial umps or masses, and t explore any lesions noted on inspection.
-using ball of hand touch person's chest while he repeats words "99'. these are resonant phrases that generate strong vibration. start over the lung apices and palpate from one side to another
1 1
2 2
3 3
4 4
5 5
vibrations should feel the same in corresponding area on each side, accept just between the scapulae, fremitus should feel stronger on the right side bc its closer to bronchial bifurcation. avoid scapulae.
Factors affecting normal intensity of tactile fremitus:
-relative location of bronchi to the chest wall: most prominent between scapulae and sound sternum, normally decreases as progress down
- thickness of chest wall
-pitch and intensity: loud, low pitch voice generated mroe fremitus than soft, high pitched one |
|
|
Term
Tactile Fremitus:
-Abnormal findings (5) |
|
Definition
Tactile Fremitus:
Abnormal findings-
Decreased Fremitus: occurs when anything obstructs transmission of vibrations. any barrier between sound and palpating hand will decrease fremitus.
(e.g. obstructed bronchitus, pleural effusion or thickening, pneumothorax, or emphysema)
Increased Fremitus: occurs with compression or consolidation of lung tissue. Only gross changes increase fremitus. present only when the bronchus is patent and when consolidation extends to the lung surface. small areas do not significantly affect fremitus
Rhonchal Fremitus: is palpable with thick bronchial secretions
Pleural Friction Fremitus: is palpable with inflammation of the pleura
Crepitus: is a coarse, crackling sensation palpable over the skin surface. it occurs in subcutaneous emphysema when air escapes from the lung and enters the subQ tissue, as after open thoracic injury or surgery |
|
|
Term
Percussing the posterior chest
lung fields |
|
Definition
Percussing the posterior chest:
Lung fields: determine the predominant note over the lung fields, Start at the apices and percuss the band of normally resonant tissue across the tops of both shoulders. percussing in the interspaces, make a side to side comparison all the way down the lung region. percuss at 5 cm intervals. avoid the damping effect of the scapulae and ribs
Percussion sets into motion only the outer 5-7 cm of tissue. it will not penetrate to reveal any change in density deeper than that. also, an abnormal finding must b 2-3 cm wide to yield an abnormal percussion note. lesions smaller than that are not detectable by percussion. |
|
|
Term
Resonance:
-abnormal resonance |
|
Definition
Resonance: is the low pitched, clear hollow sound that predominates in healthy lung tissue in the adult. resonance is relative. resonance note amy be modified in the athlete with a heavily muscular chest wall and in the heavily obese adult in whom subQ fat produces scattered dullness.
Abnormal Resonance:
Hyperresonance- is a lower pitched, booming sound found when too much air is present.
ie. emphysema or pneumothorax
Dull note- a dull note, soft muffled thud, signals abnormal density in the lungs, as with pneumonia, pleural effusion, atelectasis or tumor. |
|
|
Term
| Auscultate Posterior Chest |
|
Definition
| Auscultate posterior chest wall: passage of air through tracheobronchial tree creates a characteristic set of noises. may be modified by obstruction within the respiratory passageways or by changes in the lung parenchyma, the pleura or the chest wall. |
|
|
Term
Breath sounds
normal
abnormal |
|
Definition
breath sounds: person is sitting, leaning forward slightly with arms resting comfortably across lap. instruct to breathe through mouth. be careful to monitor the breathing throughout the examination and offer times for the person to rest and breathe normally.
-use flat diaphragm end piece and hold it firmly on chest wall. listen o at least one full respiration in each location. Side by side comparison is most important. do not confuse extraneous noises with pathology.
-while standing behind the person listen to the following lung areas- posterior form the apices at C7 to the bases (around T10), and laterally from the axilla down to the seventh or eighth rib.
Normal: 3 types of sounds
bronchial, vesicular and bronchovesicular
Abnormal breath sounds: crackles (fine, coarse, atelectatic), wheeze, stridor, pleural friction rub, discontinuous sounds |
|
|
Term
Normal Sounds:
Bronchial (aka Tracheal) |
|
Definition
Normal Bronchial sounds
Pitch: High
Amplitude: Loud
Duration: inspirationQuality: harsh, hollow tubular
Normal Location: trachea and larynx |
|
|
Term
Normal Breath sounds
Bronchovesicular |
|
Definition
Normal Bronchovesicular sounds
Pitch: moderate
Amplitude: moderate
Duration: Inspiration = Expiration
Quality: mixed
Normal location: over major bronchi:
posterior- between scapulae especially on right
anterior- around upper sternum in first and second intercostal spaces |
|
|
Term
Normal Breath Sounds
Vesicular |
|
Definition
Normal Vesicular Sounds:
Pitch: Low
Amplitude: soft
Duration: INSPIRATION>expiration
Quality: rustling
Normal location: over peripheral lung fields where air flows through smaller bronchioles and alveoli |
|
|
Term
Abnormal breathing sounds:
Decreased or Absent breath sounds |
|
Definition
Decreased or absent breath sounds occur:
1. when the bronchial tree is obstructed by secretions, mucus plug or a foreign body
2. in emphysema as a result of loss of elasticity in teh lung fibers and decreased force of inspired air; also, the lungs are already hyper inflated so the inhaled air does not make as much noise
3. when anything obstructs transmission of sound between the lung and your stethoscope, such as pleurisy or pleural thickening, or air (pneumothorax) or fluid (pleural effusion) in the pleural space
A silent chest means no air is moving in or out, which is an ominous sign |
|
|
Term
Abnormal Breathing sounds
Increased breath sounds |
|
Definition
Increased Breathing sounds: mean that sounds are louder than they should be.
eg. bronchial sounds are abnormal when heard over abnormal location, like the peripheral lung fields.
-they have a high pitched, tubular quality with a prolonged expiratory phase and a distinct pause between inspiration and expiration.
-they sound very close to the stethoscope, as if they were IN the tubing close to your ear.
-they occurs when consolidation (e.g.. pneumonia) or compression yields a dense lung area that enhances the transmission of sounds from the bronchi. (when inspired air reaches the alveoli, it hits solid lung tissue that conducts sound more efficiently to the surface) |
|
|
Term
|
Definition
Adventitious sounds: passes sounds that are not normally heard in the lungs they are heard as being superimposed on the breath sounds. caused by moving air colliding with secretions in the tracheobronchial passageways or by the popping open of previously deflated airways.
-crackles (rales) and wheeze (rhonchi) |
|
|
Term
Adventitious sounds
Atelectatic crackles |
|
Definition
Atelectatic crackles: are not pathological. they are short, popping, crackling sounds that sound like fine crackles but do not last beyond a few breaths
when sections of the alveoli are not fully aerated, they deflate slightly and accumulate secretions. crackles are heard when these sections are expanded by a few deep breaths. they are heard only in the periphery, usually in dependent portions of the lungs, disappear after the first few breaths or after a cough. |
|
|
Term
| Voice sounds / vocal resonance |
|
Definition
Voice sounds: determine the quality. auscultate over the chest wall. ask the persont o repeat a phrase such as "99" while you lisen over the chest wall. normal voice transmission is soft muffled and indistinct; you can hear sound through the stethoscope but cannot distinguish exactly what is being said. pathology that increases lung density enhances transmission of voice sounds.
-not done routinely its a supplemental maneuver performed if you suspect lung pathology. when performed you are testing for bronchophony, egophony, and whispered pectoriloquey.
Abnormal findings: consolidation or compression of lung tissue will enhance the voice sounds, making the words more distinct. |
|
|
Term
|
Definition
Bronchophony: ask the persont o repeat 99 while you listen with the stethoscpoe voer the chest wall; listn especially if you suspect pathology
normal: normal voice transmission is soft, muffled and indistinct, you can hear sounds through the stethoscope but cannot distinguish exactly what is being said
Abnormal: pathology that increases lung density will enhance transmission of voice sounds; you auscultate a clear 99. the words are more distinct than normal and sound close to your ear |
|
|
Term
Inspect Anterior Chest:
shape and configuration
facial expression
level of consciousness
color and condition
quality of respirations
retraction or bulging
accessory muscles
respiratory rate |
|
Definition
Inspect the anterior chest
Shape and configuration: of chest wall.
Normal: the ribs are sloping downward with symmetric interspaces. the costal angle is with 90 degrees. development of abdominal muscles
Abnormal:barrel chest has horizontal ribs and costal angle >90 degrees. hypertrophy of abdominal muscles occurs in chronic emphysema
Facial Expression: should be relaxed and benign
Abnormal: tense, strained, tired facies accompany COPD, pursing lips
Levels of consciousness: should be alert and cooperative
Abnormal: cerebral hypoxia causes excessive drowsiness or by by anxiety, restlessness and irritability.
Color and condition: free of cyanosis or unusual pallor. nails are of normal configuration. explore any skin lesions.
Abnormal: clubbing from chronic respiratory disease. Cutaneous angiomas (spider nevi) associated with lier disease or portal hypertension may be evident on the chest
Respiration quality: normal relaxed breathing is automatic and effortless regular and even, produces no noise, chest expands symmetrically. note any localized lag on inspiration.
Abnormal: noisy breathing as in asthma or chronic bronchitis
unequal chest expansion- when part of the lung is obstructed or collapsed as with pneumonia,or when guarding to avoid postoperative incisional pain or pleurisy pain.
Retraction: no retraction or bulging of the interspaces should occur on inspiration.
Abnormal: retraction suggests obstruction of respiratory tract or increased inspiratory effort is needed, as with atelectasis. bulging indicates trapped air as in the forced expiration associated with emphysema or asthma.
Accessory muscles: should not be used to augment respiratory effort accept with heavy exercise
Abnormal: accessory muscles asre used in acute airways obstruction and massive atelectasis. rectus abdominis and internal intercostal muscles are sued to force expiration in COPD
Respiratory rate: is within normal limits for the person's age, pattern fo rbaething si regular.
Abnormal: tachypnea and hyperventilation, bradypnea, and hypoventilation, periodic breathing. |
|
|
Term
|
Definition
Palpate anterior chest: note any tenderness, detect any superfiscial lumps. note skin mobility and turgor, and note skin temp and moisture.
symmetry and chest expansion-place hands on anterolateral wall with thumbs along the costal margins and pointing toward xiphoid process.
Abnormal: abnormally wide costal angle with little inspiratory variation occurs with emphysema
as person takes a deep breath. watch thumbs move apart symmetrically, and note smooth chest expansion with your fingers.
Abnormal: a lag in expansion occurs with atelectasis, pneumonia and postop guarding. a palpable grating sensation with breathing indicated pleural friction fremitus
assess for tactile fremitous, palpating over lung apices int he supraclavicular areas, compare vibrations from one side to the other as person repeats 99 |
|
|
Term
|
Definition
Percuss anterior chest: begin percussing the apices in the supraclavicular areas, then percussing interspaces and comparing one side with the other, move down the anterior chest.
note borders of cardiac dullness normally found on teh anterior chest and don't confuse with lung pathology. in the right hemithorax, the upper border of liver dullness is located in the fifth intercostal space in the right midclavicular line. on the left symphony is evident over the gastric space.
Abnormal: lungs are hyperinflated with chronic emphysema, which results in hyper resonance where you would expect cardiac dullness. dulness beyond the right breast occurs with right middle lobe pneumonia |
|
|
Term
Auscultate the anterior chest
Breath sounds
measure pulmonary function status (3) |
|
Definition
Auscultate the anterior chest:
Breath sounds- auscultate the lung fields over the anterior chest from the apices in the supraclavicular areas down tot he 6th rib. progress side to side as you move downward and listen to one full respiration in each location use sequence indicated for percussion. evaluate normal breath sounds, noting any abnormal breath sounds and any adventitious sounds. if the situation warrants assess voice sounds.
Measuring Pulmonary function status:
Forced expiratory time
spirometer
pulse oximeter |
|
|
Term
|
Definition
forced expiratory time is the number of seconds it takes for the person to exhale from total lung capacity to residual volume. it is a screening test to measure airflow obstruction.
-ask perosn to inhale the deepest breath possible and then to blow it all out hard, as quickly as possible with mouth open. listen with stethoscope over the sternum. normal time for full expiration is 4 seconds or less.
Abnormal: a forced expiration of 6 seconds or more occurs with obstructive lung disease.
Abnormal: mild obstruction of airflow is a FEV1/FCV ratio of 60%-70%; moderate obstruction is a measure of 50%-60% severe obstruction is a ratio of less than 50% |
|
|
Term
|
Definition
Spirometer: measures lung health in chronic conditions such as asthma. tell pt to inhale deeply then to exhale into the spirometer as fast as possible until the most air possible is exhaled.
Forced vital capacity- FVC is the total volume of air exhaled.
Forced expiratory volume in 1 second- FEV1 is the volume exhaled in the first measured second. a normal outcome is FEV1/FVC ratio of 75% o greater, meaning no significant obstruction of airflow is present, |
|
|
Term
|
Definition
| Pulse Oximeter: is a noninvasice methof to assess arterial oxygen saturation (SpO2). a healthy person normally has an SpO2 of 97%-98%. but every SpO2 result must be evalauted in the context of a pt HGB level, acid-base balance and ventilatory status |
|
|
Term
|
Definition
Kyphosis: increased anteroposterior diameter giving a barrel shape or an outward curvature of the thoracic spine. the person compensates by holding the head extended and tilted back. chest expansion amy be somewhat decreased although it should still be symmetrical.
causes significant pain and limited mobility. severe deformities impair cardiopulmonary function. |
|
|
Term
Normal adult respiratory pattern
rate
depth
pattern
depth
pulse/respirations |
|
Definition
Normal Adult:
rate- 10-20 breaths/ min
depth-500-800 ml
pattern-even
ratio of pulse to respirations is fairly constant about 4:1 both values increase as normal response toe exercise, fear, or fever
depth- air moving in and out withe each respiration. |
|
|
Term
|
Definition
Tachypnea- rapid, shallow breathing. increased rate, >24/min
normal response to fear, fever and exercise.
Abnormal: increases with respiratory insufficiency, pneumonia, alkalosis, pleurisy, and lesion in the pons |
|
|
Term
|
Definition
| bradypnea- slow breathing. a decreased but regular rate (<10/min). drug induces, icreased intracranial pressure, and diabetic coma. |
|
|
Term
| Cheyne stokes respirations |
|
Definition
| Cheyne stokes respirations- increasing in rate and depth and the decreasing. the breathing periods last 30-25 seconds with periods of apnea (20seconds) alternating the cycle. the most common cause is severe heart failure. renal failure, meningitis, drug overdose, and increased intracranial pressure. occurs normally in infants and aging persons during sleep |
|
|
Term
|
Definition
| Hyperventilation: increase in both rate and depth. hyperventilation blows of CO2 causing a decreased level in the blood (alkalosis). normally occurs with extreme exertion, fear, anxiety. also occurs with diabetic ketoacidosis (kussmaul respirations) hepatic coma, salicylate overdose. lesions of the midbrain and alterations in blood gas concentration. |
|
|
Term
|
Definition
| Hypoventilation- irregular shallow pattern caused by an overdose of narcotics or anesthetics. may also occur after prolonged bed rest or conscious splinting of the chest to avoid respiratory pain. |
|
|
Term
|
Definition
| Biots: similar to Cheyne-stokes except that the pattern is irregular. a series of normal respirations followed by a period of apnea. the cycle length is variable lasting anywhere from 10 seconds to 1 minute. seen in head trauma, brain abscess, heat stroke, spinal meningitis, and encephalitis |
|
|
Term
| Chronic obstructive breathing |
|
Definition
| Chronic obstructive breathing: normal inspiration and prolonged expiration to overcome increased airway resistance. (ex:COPD) |
|
|
Term
| pleural friction fremitus |
|
Definition
| Pleural friction fremitus: produced when inflammation fo the parietal or visceral pleura causes a decrease in the normal lubrication found. opposing surfaces make a coarse grating sounds when rubbed together during breathing. and feels like two pieces of leather grating together. in synchronous with respiratory excursion. also called palpable friction rub |
|
|
Term
Discontinuous sounds
fine
coarse |
|
Definition
Discontinurous sounds are discrete crackling sounds. cradles and pleural friction rub
Fine Crackles (rales)- discontinuous high pitched, short crackling, popping sounds heard during respiration that are not cleared by coughing.
inspiratory crackles: inhaled air collides with previously deflated airways, airways suddenly pop open creating explosive crackling sounds ex. restrictive disease, obstructive disease, posturally induced crackles.
expiratory crackles: sudden airway closing
Coarse crackles: loud, low pitches, bubbling and gurging sounds that start in early inspiration and may be present in expiration; may decrease somewhat by suctioning or coughing but will reappear shortly- sounds like opening velcro . inhaled air collides with secretions in teh trachea and large bronchi. Ex: pulmonary edema,pneumonia, pulmonary fibrosis, and terminally ill |
|
|
Term
|
Definition
| pleural friction rub: very superficial sound, coarse and low pitched grating quality. sounds just like crackles but CLOSE tot he ear, sounds louder if you push the stethoscope harder onto the chest wall sound is inspiratory and expiratory. caused whenpleurae become inflamed and lose their normal lubricating fluid. pleural surface rub together, heard best in anterolateral wall where greatest lung mobility exists. ex: pleuritis |
|
|
Term
Continuous sounds (3)
high & low |
|
Definition
Continuous sounds: are connected musical sounds
Sibilant Wheeze: high pitched musical squeaking sounds that sound polyphonic, predominate in expiration but amy occur in both. air squeezed or compressed through passageways narrowed almost to closure by collapsing, swelling secretions or tumors. ex: asthma or emphysema
Sonorou Rhonchi Wheeze- Low pitched wheeze, monophonic, single note, musical snoring, moaning sounds heard throughout the cycle, although they are more prominent on expiration; may clear somewhat by coughing. caused by airflow obstruction ex: bronchitis
Stridor- high pitched, monophonic, inspiratory, crowing sounds louder in neck than over chest wall. originating in larynx or trachea, upper airway obstruction from swollen, inflamed tissues or lodged foreign body ex: croup, acute epiglotititis, and foreign inhalation |
|
|
