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43 Cards in this Set
- Front
- Back
How many pairs of ribs are there |
12 |
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What anatomic landmark is the lower boundary of the thorax |
diaphragm |
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lung lobes on L side vs R side |
2 on left; 3 on R "Fluid in the fissure --> seen between 1st and 2nd lobe of R lung" |
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CXR findings for TTN |
= streaky perihilar linear densities (perihilar --> anchors to heart with vessels) Perihilar streaking correlates with the engorgement of the lymphatic system with retained lung fluid, and fluid in the fissures |
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Spinal vertebrae (areas and how many vertebrae are in each area) |
7 Cervical 12 Thoracic 5 Lumbar 5 Sacral 4 Coccygeal --> Tip to remember: Eating times. 7 am breakfast, 12 pm lunch, 5 pm dinner. "Cool Things Like Spinal Column" |
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Chest references lines (6) |
Midsternal line Nipple line (across, not vertical) Midclavicular line Anterior axillary line Midaxillary line Posterior axillary line |
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What "sign" do you see with pneumomediastinum? |
Sail sign - lifts flap of thymus up Cross lateral xray will show air under sternum --> can go to neck (subq emphysema), esophagus (pneumoperitoneum), pneumopericardium (EMERGENCY!) & other places |
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Where do you needle decompress for a pneumothorax |
2nd ICS (unless placing a chest tube, then 4th ICS) |
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PDA "diastolic steal" occurs how? and what does it affect? |
Blood (typically) flows back to lungs with increasing blood in L atrium (up to 80% can go back to lungs). L-->R shunt once PVR decreases Diastolic steal decreases blood flow to organs (kidneys - low UOP, etc) |
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Pectus carinatum vs pectus excavatum |
carinatum - "pigeon chest" (outward) excavatum - "tunnel chest," (inward) may make baby look like they are having increased retractions Or may have prominent xyphoid process |
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What does barrel chest mean? When do you see it? |
Increased AP diameter, hyperinflation (will hear decreased lung sounds) TTN, MAS (alveoli don't close bc sticky --> increased diameter) Increased CO2, Turn down pressure bc baby cant exhale = overexpanded |
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Primary respiratory muscle |
diaphragm |
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periodic breathing |
irregular cycle, but normal cessation of breathing up to 5-20 seconds followed by rate of 50-60 bpm termed "Cheyne Stokes in kids and adults" |
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apnea |
cessation of breathing > 20 seconds or cessation of breathing < 20 seconds with bradycardia and cyanosis At least 25% of preemies Inverse relationship with GA |
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Why does nasal flaring help a baby in respiratory distress? |
Decreases airway resistance, increases minute ventilation |
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Why does grunting help a baby in respiratory distress? |
Partially closed glottic increases intrathoracic pressure preventing alveolar collapse (increased FRC) |
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Types of retractions (and why we see them) |
Suprasternal Intercostal Subcostal Substernal Thin chest wall and decreased lung compliance |
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Suprasternal retractions with gasping or stridor may indicate _________ |
upper airway obsruction |
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paradoxical breathing - what is it and why do we see it |
"see saw" breathing decreased lung compliance & indication of respiratory distress |
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head bobbing is a sign of ______ |
mild - severe labored breathing |
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Snoring/snorting is a sign of _______ |
nasal congestion |
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How do babies lung sounds differ from adults |
Louder and coarser than adults due to less subcutaneous fat Sounds are easily referred |
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Reasons lung sounds may be diminished |
Pleural space contains fluid Bronchus contains secretions Lungs hyperinflated |
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Lower lobes can only be assessed from where |
the back |
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Best lung auscultation technique |
diaphragm, start at top and move systematically from side to side |
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Neonates usually have ______ pitched sounds; intensity between inspiration and expiration is ______ |
higher pitched sounds Intensity is similar between inspiration and expiration |
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Bronchial breath sounds |
LOUDEST, heard at trachea short inspiration, longer expiration |
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Bronchovesicular |
inspiration = expiration in terms of pitch, intensity, quality Heard best @ 1st and 2nd ICS heard over manubrium and intrascapular areas |
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Vesicular |
soft, short, low pitched during expiration, louder, longer, higher pitched during inspiration heard all over chest except trachea and manubrium |
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Crackles (3 types) |
crackling or bubbling sound Fine - rubbing lock of hair (dependent lobes of lung, in alveoli, @ end of inspiration. A/C RDS & BPD) Medium - fizz or carbonated drink (bronchioles, A/C air through sticky surfaces, ie pneumonia, pulm congestion, TTN) Coarse - loud and bubbly, lower pitch, higher amplitude, long duration (significant accumulation of mucus or fluid in large airways) |
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Rhonci |
lower pitched from wheezes, more musical than crackles *rare in neonates |
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Wheezes |
"high pitched rhonci," heard on both inspiration and expiration (louder on expiration) seldom heard in infants other than with BPD homophonus - uniform heterophonus - not uniform |
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Rubs |
hold cupped hand to ear and rub finger over it -inflammation of pleura -on mechanical ventilators |
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Stridor |
high-pitched, hoarse sounds heard on inspiration and expiration but usually louder on inspiration at larynx or upper airway partial obstruction or post extubation *may have tracheomalacia, reposition baby |
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bowel sounds heard in lung fields? |
May be referred BUT also think about CDH - usually presents on L side with CDH with scaphoid abdomen |
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Where do you listen for air leaks in intubated babies? |
Over mouth or trachea |
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Palpate clavicles& sternum / ribs for ____ |
Clavicles for fracture Sternum & ribs for crepitus or masses |
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Costal cartilage - check for ______ |
hypertrophy or "rachitic roasary" (rickets) |
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Fremitus |
palpable vibration on chest wall air passing through fluid-filled tubes water hammer effect (intubated) |
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Normal size breast bud |
Full term - 0.5 - 1 cm, areola raised and stippled Hypertrophied? d/t maternal estrogen |
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What do you look for out of the ordinary regarding nipples? |
Fissures, hypertrophy, witch's milk (pseudo lactation), supernumerary/accessory nipples, mastitis |
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Internipple distance should be ______ |
< 1/4 chest circumference |
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S/S of Turner's syndrome |
(missing a sex chromosome) Short Failure to begin puberty Infertility Heart defects Wide spaced nipples |