Term
| What are the anterior thoracic landmarks? |
|
Definition
Suprasternal notch
Sternum
Manibriosternal angle
Costal angle |
|
|
Term
| What are the posterior thoracic landmarks? |
|
Definition
Vertebra prominens
Spinous processess
Inferior border of the scapula
Twelth rib |
|
|
Term
| What are the reference lines? |
|
Definition
Midsternal
Midclavicular
Scapular
Vertebral
Anterior Axillary
Posterior Axillary
Midaxillary |
|
|
Term
| What are the lobes of the lungs? |
|
Definition
Anterior
Posterior
Lateral |
|
|
Term
| What is a the pleura of the lungs? |
|
Definition
What covers it.
Parietal - outside attaches to chest wall
Visceral - interior actually touches the lungs |
|
|
Term
| Where is the trachea NORMALLY located? |
|
Definition
| In the middle of the neck. |
|
|
Term
| What does the trachea brach to form? |
|
Definition
| Two smaller R + L brachial trees which then branch to form even smaller bronchioles. |
|
|
Term
| What are the 4 functions of the respiratory system? |
|
Definition
1.) Changing chest size during respiration
2.) Inspiration
3.) Expiration
4.) Control of respiration |
|
|
Term
| What are important subjective health history questions to ask your patient when performing a respiratory assessment? |
|
Definition
1.) Any cough? When did it start? Gradual or sudden?
2.) SOB? What causes it? How severe? How long?
3.) History of respiratory infections?
4.) Chest pain with breathing? Please point to the exact location
5.) History of smoking? At what age did you start? How many packs per day? For how long?
6.) Environmental exposures? Where do you work?
7.) Self-care behaviors? TB Skin test? Chest x-ray? Immuninizations? |
|
|
Term
| What equipment is needed for a respiratory physical exam? |
|
Definition
-Stethoscope
-Small ruler
-Marking pen
-Alcohol swab |
|
|
Term
| What are you looking for when INSPECTING the thoracic cavity? |
|
Definition
1.) Shape and configuration of chest wall
2.) Anteroposterior/transverse diameter
3.) Position of person
4.) Skin color and condition |
|
|
Term
| What are you looking for when PALPATING the thoracic cavity? |
|
Definition
1.) Symmetric expansion
2.) Tactile fremitus
3.) Crepitus |
|
|
Term
| What is tactile fremitus? |
|
Definition
| The patient repeats a word and you feel for vibrations and listen for diminished or increased sounds with your stethoscope. |
|
|
Term
| What are the abnormal findings with tactile fremmitus? |
|
Definition
| Tactile fremitus is pathologically increased over areas of consolidation and decreased or absent over areas of pleural effusion or pneumothorax (when there is air outside the lung in the chest cavity, preventing lung expansion). |
|
|
Term
|
Definition
| characterized by a peculiar crackling, crinkly, or grating feeling or sound under the skin, around the lungs, |
|
|
Term
| When percussing the chest, what is resonance? |
|
Definition
|
|
Term
| What is hyper resonance? What causes it? |
|
Definition
| Resonance increased above the normal, and often of lower pitch. Occurs in response to the chest over inflating with conditions such as emphysema or pneumothorax. |
|
|
Term
| What is dullness? What causes it? |
|
Definition
| The character of the sound obtained by percussing over a SOLID part incapable of resonating. LESS AIR. FULL OF LIQUID. PNEUMONIA. |
|
|
Term
| What is diaphragmatic excursion? |
|
Definition
| Where the diaphragm is on inspiration and where it moves to on expiration. Should be 3-5 cm between the two spots. |
|
|
Term
| When auscultating, what are you listening for? |
|
Definition
| Breath sounds, voice sounds, adventitious sounds. |
|
|
Term
| What are the 3 types of breath sounds? |
|
Definition
1.) Bronchial
2.) Bronchiovesicular
3.) Vesicular |
|
|
Term
|
Definition
| Muffled 99 heard. When there is fluid present, it is more audible. |
|
|
Term
|
Definition
| You will have the patient say E. If you hear E, it's normal. If it sounds like A - it is abnormal. |
|
|
Term
| What is whispered pectoriloquy? |
|
Definition
| Muffled 1,2,3. IF there is fluid in the lungs, it is more audible. |
|
|
Term
| When inspecting the anterior chest, what are you looking for? |
|
Definition
Shape and configuration of chest wall
Facial expression
Level of consciousness
Skin color and condition
Quality of respirations
Rib interspaces
Accessory muscles |
|
|
Term
| When percussing, where is the sound heard most resonantly? |
|
Definition
|
|
Term
| How do you measure pulmonary function status? |
|
Definition
Forced expiratory time
Pulse oximeter
6 - minute distance walk |
|
|
Term
| What are the abnormalities of the configuration of the thorax? |
|
Definition
1.) Barrel chest
2.) Pectus excavatum
3.) Pectus carinatum
4.) Scoliosis
5.) Kyphosis |
|
|
Term
| What is pectus excavatum? |
|
Definition
| When the sternum is sunken in. It is genetic |
|
|
Term
| What is pectus carinatum? |
|
Definition
| Forward protrusion of the sternum. |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| What are abnormal breathing patterns? |
|
Definition
Sigh
Tachypnea
Bradypnea
Hyperventilation
Hypoventilation
Cheyne-Stokes respiration
Biot’s respiration
Chronic obstructive breathing |
|
|
Term
| What causes an INCREASED tactile fremitus? |
|
Definition
Conditions that increase lung density. Consolidated or compressed tissue. ANY FLUID RETAINING LUNG DISORDER.
Lobar Pneumonia |
|
|
Term
| What causes a DECREASED tactile fremitus? |
|
Definition
Conditions with OBSTRUCTIONS
Emphysema
Chronic Asthma
Pleural Effusion – there is fluid but it is NOT consolidated inside of the lungs. It is in the INTRAPLEURAL SPACE.
Pneumothorax – feel below the scapula on the effected side |
|
|
Term
| What is rhoncial fremitus? |
|
Definition
| a palpable vibration produced during breathing caused by partial airway obstruction. The obstruction can be due to mucus or other secretions in the airway, bronchial hyperreactivity, or tumors. |
|
|
Term
| What is pleural friction fremitus? |
|
Definition
| a palpable vibration of the wall of the thorax caused by friction between the parietal and visceral pleura of the lungs |
|
|
Term
| What are discontinuous adventitious breath sounds? |
|
Definition
Fine Crackles
Coarse Crackles
Atelectactic crackles
Pleural friction rub |
|
|
Term
| What causes fine crackles? |
|
Definition
wet diseases mostly
sometimes in obstructive |
|
|
Term
| What are the continuous sounds? |
|
Definition
Sibilant Wheeze
Sonorous Rhonchi Wheeze
Stridor |
|
|
Term
| What is a sibilant wheeze? |
|
Definition
High pitch
Obstructed Airway |
|
|
Term
| What is a sonorous rhonchi wheeze? |
|
Definition
Low pitch
Obstructed Airway |
|
|
Term
|
Definition
High pitch sound on inspiration
Obstructed Airway |
|
|
Term
| Tactile Fremitus would be increased when? |
|
Definition
The patient has an advanced case of pneumonia
LUNG IS CONSOLIDATED WITH FLUID! |
|
|
Term
| What are the physiological changes with age and the lungs? |
|
Definition
Costal cartilage changes
Decrease in elastic properties
Decreased amount of air expelled
Increased amount of air remaining after expiration
Gradual loss of intra-alveolar septa and alveoli |
|
|
Term
|
Definition
| Collapsed shrunken section of alveoli or an entire lung as a result of 1.)airway obstruction, the alveolar air beyond it is gradually absorbed by the pulmonary capillaries and the alveolar walls cave in. 2.) Compression on the lung and 3.)Lack of surfactant |
|
|
Term
| What are the abnormal findings of inspection of atelectasis? |
|
Definition
| Cough. Lag on expansion affected side. Increased respiratory rate and pulse. Possible cyanosis. |
|
|
Term
| What are the abnormal findings of palpation of atelectasis? |
|
Definition
| Chest expansion decreased on affected side. Tactile fremitus decreased or absent over area. WITH A LARGE COLLAPSE, TRACHEAL SHIFT TO AFFECTED SIDE IN HOPES OF REFILLING THE DAMAGED SIDE BETTER. |
|
|
Term
| What are the abnormal findings of percussion of atelectasis? |
|
Definition
| Dull over affected area, NO AIR TO RESONATE SOUND. |
|
|
Term
| What are the abnormal findings of auscultation of atelectasis? |
|
Definition
| Breath sounds decreased vesicular or absent over area. Voice sounds variable. Usually decreased or absent over affected area. |
|
|
Term
|
Definition
| RBC and WBC pass from blood to alveoli which causes them to fill up with bacteria, solid cellular debris, fluid and blood cells. This decreases surface area and causes hypoxemia. |
|
|
Term
| What are the abnormal findings of inspection of lobar pneumonia? |
|
Definition
o Increased resp. rate
o Guarding/lag on affected side
o Children – sternal retraction + nasal flaring |
|
|
Term
| What are the abnormal findings of palpation of lobar pneumonia? |
|
Definition
o Chest expansion decreased on affected side
o Tactile fremitus increased if bronchus are patent, decreased if obstructed. |
|
|
Term
| What are the abnormal findings of percussion of lobar pneumonia? |
|
Definition
| o Dull over lobar pneumonia |
|
|
Term
| What are the abnormal findings of auscultation of lobar pneumonia? |
|
Definition
o Breath sounds = louder w/ patent bronchus as if coming directly from larynx
o Voice sounds have increased clarity
o Bronchophony, egophony, and whispered pectorliloquy present
o Children – diminished breath sounds |
|
|
Term
| What are the adventitious sounds of lobar pneumonia? |
|
Definition
| o Crackles – fine to medium |
|
|
Term
|
Definition
| Proliferation of mucus glands in the passageways, resulting in excessive mucus secretions. Inflammation of bronchi with partial obstruction of bronchi by secretions/constriction. Sections of lung distal to obstruction may be deflated. May be acute or chronic. Chronic = cigarette smoking. |
|
|
Term
| What are the abnormal findings of inspection of bronchitis? |
|
Definition
| Hacking, rasping cough productive of thick mucoid sputum. Chronic - dyspnea, fatigue, cyanosis, possible clubbing of fingers. |
|
|
Term
| What are the abnormal findings for palpation of bronchitis? |
|
Definition
| None. Tactile fremitus is normal. |
|
|
Term
| What are the abnormal findings for percussion of bronchitis? |
|
Definition
|
|
Term
| What are the abnormal findings for auscultation of bronchitis? |
|
Definition
Normal vesicular. Voice sounds normal.
Chronic = prolonged expiration. |
|
|
Term
| What are the adventitious sounds associated with bronchitis? |
|
Definition
| Crackles over deflated areas. May have wheeze |
|
|
Term
|
Definition
| Caused by the destruction of pulmonary connective tissue that is characterized by permanent enlargement of air sacs distal to terminal bronchioles and rupture of intraalveolar walls. Increases resistance, producing a hyper inflated lung and an increase in lung volume. |
|
|
Term
| What are the abnormal findings of inspection of emphysema? |
|
Definition
o Increased anteroposterior diameter.
o Barrel chest.
o Use of accessory muscles
o Tripod positions
o Shortness of breath
o Respiratory distress
o Tachypnea |
|
|
Term
| What are the abnormal findings of palpating of emphysema? |
|
Definition
| o Decreased tactile fremitus and chest expansion. |
|
|
Term
| What are the abnormal findings of percussion of emphysema? |
|
Definition
o Hyperresonant. Decreased diaphragmatic excursion.
• Enlargement of the air sacs – sound resonantes against air. |
|
|
Term
| What are the abnormal findings of auscultation of emphysema? |
|
Definition
o Decreased breath sounds.
o May have prolonged expiration.
o Muffled heart sounds.
• Deeper within the chest |
|
|
Term
| What are the adventitious sounds associated w/ emphysema? |
|
Definition
o Usually none, wheeze occasionally.
• Really obstructed |
|
|
Term
|
Definition
| An allergic hypersensitivity to certain inhaled allergens, irritants, microbes, stress, or exercise that produces a complex response characterized by bronchospasm, inflammation, edema in the walls of the bronchioles, and secretion o highly viscous mucus in the airways. |
|
|
Term
| What are the abnormal findings in inspection of asthma? |
|
Definition
o Severe attack
• Increased resp. rate
• SOB w/ audible wheeze
• Use of accessory neck muscles
• Cyanosis
• Apprehension
• Retraction of intercostal muscles
• Expiration is labored + prolonged
o Chronic
• Barrel chest |
|
|
Term
| What are the abnormal findings of palpation of asthma? |
|
Definition
| o Tactile fremitus decreased, tachycardia. |
|
|
Term
| What are the abnormal findings of percussion of asthma? |
|
Definition
| o Resonant. May be hyperresonant if chronic. |
|
|
Term
| What are the abnormal findings of auscultation of asthma? |
|
Definition
o Diminished air movement. Breath sounds decreased with prolonged expiration.
o Voice sounds decreased. |
|
|
Term
| What are the adventitious sounds associated with asthma? |
|
Definition
| o Bilateral wheezing on expiration, sometimes inspiratory/expiratory wheezing. |
|
|
Term
| What is congestive heart failure? |
|
Definition
| Pump failure with increasing pressure of cardiac overload causes pulmonary congestion or an increased amount of blood present in the pulmonary capillaries. Dependent air sacs are deflated, pulmonary capillaries engorged. Bronchial mucosa become swollen. |
|
|
Term
| What are the abnormal findings of inspection of CHF? |
|
Definition
o Increased respiratory rate
o SOB
o Orthopnea
o Paroxysmal nocturnal dyspnea
• Waking up @ night not being able to breathe
o Nocturia
o Ankle edema
o Pallor in light-skinned people |
|
|
Term
| What are the abnormal findings of palpation of CHF? |
|
Definition
o Skin moist
o Clammy
• Working harder to get breath in and out
o Tactile fremitus normal. |
|
|
Term
| What are the abnormal findings of percussion of CHF? |
|
Definition
|
|
Term
| What are the abnormal findings of auscultation of CHF? |
|
Definition
o Normal vesicular.
o Heart sounds include S3 GALLOP.
• Too much fluid in heart (TENNESSEE) |
|
|
Term
| What are the adventitious sounds associated with CHF? |
|
Definition
|
|
Term
| What is a pleural effusion/thickening? |
|
Definition
| Collection of excess fluid in the intrapleural space with compression of overlying lung tissue. Effusion may contain watery capillary fluid, protein, purulent matter, blood, or milky lymphatic tissue. Gravity settles fluid in the dependent areas of the thorax. Presence of fluid subdues ALL lung sounds. |
|
|
Term
| What are the abnormal findings of pleural effusion upon inspection? |
|
Definition
| Increased respiration, dyspnea, dry cough, tachycardia, cyanosis, abdominal distention. |
|
|
Term
| What are the abnormal findings of palpation of pleural effusion? |
|
Definition
| Tactile fremitus decreased or absent. TRACHEAL SHIFT AWAY FROM AFFECTED SIDE. Chest expansion decreased on affected side |
|
|
Term
| What are the abnormal findings of percussion of pleural effusion? |
|
Definition
| Dull to flat. No diaphragmatic excursion on affected side. |
|
|
Term
| What are the abnormal findings of auscultation of pleural effusion |
|
Definition
| Breath sounds decreased or absent, voice sounds decreased or absent. When remainder of lungs is compressed near the effusion, may have bronchial breath sounds over the compression along with bronchophony, ego phony, and whispered pectorliloquy. |
|
|
Term
|
Definition
| Free air in the pleural space causes partial or complete lung collapse. Air in pleural space neutralizes the usual negative pressure present thus the lung collapses. Usually unilateral. Can be SPONTANEOUS (air enters pleural space through rupture of lung wall), TRAUMATIC (air enters through opening or injury in chest wall), or TENSION (trapped air in pleural space increases, compressing lung and shifting mediastinum to the unaffected side) |
|
|
Term
| What are the abnormalities of inspection of pneumothorax? |
|
Definition
o Unequal chest expansion.
o Large – tachypnea, cyanosis, apprehension, bulging in interspaces |
|
|
Term
| What are the abnormalities of palpation of pneumothorax? |
|
Definition
o Tactile fremitus decreased or absent.
o Tracheal shift to opposite (unaffected) side.
o Chest expansion decreased on affected side.
o Tachycardia, decreased BP. |
|
|
Term
| What are the abnormalities of percussion of pneumothorax? |
|
Definition
o Hyperresonant.
o Decreased diaphragmatic excursion. |
|
|
Term
| What are the abnormalities of auscultation of pneumothorax? |
|
Definition
o Breath sounds decreased or absent
o Voice sounds decreased or absent |
|
|
Term
| What is penumocystitis jiroveci pneumonia? |
|
Definition
| cysts containing the organism and macrophages form in the alveolar spaces. The walls thicken and the disease spreads bilaterally to interstitial fluids. |
|
|
Term
| What are the abnormalities of inspection of p. pneumonia? |
|
Definition
o Anxiety
o SOB
o Dyspnea on exertion
o Malaise
o Tachypnea
o Fever
o Dry non productive cough
o Intercostal retractions in children
o Cyanosis |
|
|
Term
| What are the abnormalities of palpation of p. pneumonia? |
|
Definition
| o Decreased chest expansion |
|
|
Term
| What are the abnormalities of percussion of p. pneumonia? |
|
Definition
| o Dull over areas of diffuse infiltrate |
|
|
Term
| What are the abnormalities of auscultation of p. pneumonia? |
|
Definition
| o Breath sounds may be diminished |
|
|
Term
| What are the adventitious sounds associated with p. pneumonia? |
|
Definition
| o Crackles may be present but are often absent |
|
|
Term
|
Definition
Inhalation of tubercle bacilli into the alveolar wall.
Intial - acute inflammatory response.
Second - Scar issue forms, lesions calcify and shows on x-ray
Thrid - Reactivation of previously healed lesion. Dormant bacilli now multiply, producing necrosis, cavitation, and caseous lung tissue.
Fourth - Extensive destruction as lesion erodes into bronchus, forming air-filled cavity. Apex usually has most damage, |
|
|
Term
| What are the abnormalities of inspection of tuberculosis? |
|
Definition
Cough initially nonproductive, later productive of purulent yellow-green sputum may be blood tinged.
Dyspnea, orthopnea, fatigue, weakness. |
|
|
Term
| What are the abnormalities of palpation of tuberculosis? |
|
Definition
| Skin moist at night from night sweat |
|
|
Term
| What are the abnormalities of percussion of tuberculosis? |
|
Definition
| Resonant inititally. Dull over any effusion. |
|
|
Term
| What are the abnormalities of auscultation of tuberculosis? |
|
Definition
| Normal or decreased vesicular breath sounds |
|
|
Term
| What are the adventitious sounds associated with tuberculosis? |
|
Definition
| Crackles over upper lobes and persist following full expiration and cough. |
|
|
Term
| What is a pulmonary embolism/ |
|
Definition
| Undissolved materials originating in legs or pelvis detach and travel through the venous system returning through the heart and occluding pulmonary vessels. |
|
|
Term
| What are the abnormalities of inspection of p.e? |
|
Definition
o Apprehensive
o Restless
o Anxiety
o Mental status changes
o Cyanosis
o Tachypnea
o Cough
o Hemoptysis
o PaO2<80% on pulse ox
o Respiratory alkalosis |
|
|
Term
| What are the abnormalities of palpation of p.e? |
|
Definition
| o Diaphoresis, hypotension. |
|
|
Term
| What are the abnormalities of percussion of p.e? |
|
Definition
|
|
Term
| What are the abnormalities of auscultation of p.e? |
|
Definition
o Tachycardia
o Accentuated pulmonic component of S2 heart sound. |
|
|
Term
| What are the adventitious sounds associated with p.e? |
|
Definition
|
|
Term
|
Definition
| An acute pulmonary insult that damages alveolar capillary membrane which leads to increased permeability of pulmonary capillaries and alveolar epithelium and to pulmonary edema. Show dark,red,firm, airless tissue with some alveoli collapsed and hyaline membranes lining the distended alveoli. |
|
|
Term
| What are the abnormalities of inspection of ARDS? |
|
Definition
| Restlessness, disorientation, rapid shallow breathing, cough, thin, frothy sputum, retractions of intercostal spaces and sternum. Decreased PaO2 blood gases show alkalosis. |
|
|
Term
| What are the abnormalities of palpation of ARDS? |
|
Definition
|
|
Term
| What are the abnormalities of auscultation of ARDS? |
|
Definition
|
|
Term
| What are the adventitious sounds associated with ARDS? |
|
Definition
|
|
