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67 Cards in this Set

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When auscultating, describe 5 techniques you should use.
1. Stethoscope against bare skin
2. Breathe through mouth
3. Begin at posterior apex and move inferior, anterior then lateral.
4. Listen for 1 full breath cycle
5. Compare symmetrical areas
What are 5 things you should document when performing auscultations?
1. Intensity - correlates with rate of air flow, loud, moderate, soft
2. Pitch - frequency when it reaches your ear
3. Duration - i.e. long, short, continous, interrupted
4. Location - chest wall surface, side of body, relative to anatomical land marks
5. Breath phase during the sound was heard
What do bronchial/tracheal sounds sound like?
Where are they heard?
Ratio I:E?
Loud, high pitched
Normal if heard over the manubrium
2:3
What do bronchovesicular sounds sound like?
Where are they heard?
Ratio I:E?
Medium in intensity and pitch
1st and 2nd intercostal spaces and between scapula
1:1
What do Vesicular sounds sound like?
Where are they heard?
Ratio I:E?
Soft, lower pitched, ALWAYS NORMAL SOUND
Peripheral lung fields
3:2
What are two abnormal breath sounds?
1. Absent or diminished sounds
2. Bronchial breathing
What are some reasons why breath sounds would be absent or diminished?
Due to sound transmission being blocked. i.e. obesity, pleural effusion, pneumothorax, severe airway obstruction, COPD.
What does it mean if you hear bronchial breathing sounds?
Suggest consolidation
What are adventitious sounds?
Sounds that are superimposed over the top of normal breath sounds.
What do crackles or rales sound like?
Brief, DISCONTINUOUS, non-musical, crackling sounds. "Popping" sound. Can also be described as fine or course crackles.
When do you hear crackles/rales?
During INSPIRATION
What is the physiological cause of crackles/rales?
Air that passes through moisture in alveolar system or from an abrupt opening of closed alveoli.
What does it mean if you hear late inspiratory crackles?
Usually associated with CHF, pneumonia and interstitial lung disease.
Where (location) do late inspiratory crackles begin?
Usually begin in the base of the lung and move superiorly as the condition worsens.
What does it mean if you hear early inspiratory crackles?
Usually associated with chronic bronchitis and asthma.
What do early inspiratory crackles sound like?
Loud low pitched and course. Audible at the mouth.
What do wheezes and rhonci sound like?
Musical CONTINUOUS sounds.
Why does wheezing or rhonci occur? What is going on physiologically? What are two conditions they are associated with?
Occur as air travels through narrowed tracheal bronchial airways. Caused by vibration of bronchial walls that are narrowed or constricted.
Caused by bronchospasm and foreign bodies.
During which part of breathing does wheezing and rhonchi occur?
Occurs during inspiration AND expiration.
What does rhonchi sound like?
Low-pitched wheezes or "sonorous rhonchi". Snoring quality.
What causes rhonchi?
Secretions in the airways that may clear w/ coughing.
What part of breathing does rhonchi occur?
Usually during expiration, sometimes during inspiration.
What does a wheeze sound like?
High-pitched and continuous. Hissing or shrill in nature.
What would be a physiological problem that would produce wheezing?
Results from airway swelling, tumors, asthma and COPD.
What does stridor sound like?
Continuous, loud sound, musical. Very loud, can hear it across the room, don't need stethoscope, something stuck in airway.
What is the cause of stridor?
Obstruction of the trachea or larynx, aspirated foreign body, tumor, croup, epiglottis. Pt will be in acute respiratory distress.
What does a pleural friction rub sound like?
Loud creaking or grating sound. Sound will disappear when pt holds their breath. Will hear it over area of most intense chest wall pain.
What is the physiological cause of pleural friction?
Pleural inflammation or irritation that is caused by two inflammed pleural surfaces rubbing together.
Why might you miss hearing pleural friction?
Sound disappears when pt holds their breath. Can be difficult to hear as pts don't take deep inspiratory breaths due to pain upon inhalation.
How do you test for normal transmitted voice sounds?
What is heard normally?
Have pt repeat "99" or "1,2,3".

Should hear muffled, non-distinct sounds.
How do you test for bronchophony?
What is normal?
What is abnormal?
Auscultate and ask pt. to talk.
Normal - unintelligible words.
Abnormal - clear words
What is happening physiologically if bronchophony is abnormal?
Air filled lung has been replaced with fluid - pulmonary consolidation.
How do you test for whispered pectoriloquy?
What is normal?
What is abnormal?
Have pt whisper series of words as you auscultate.
Normal - should be non-distinct/unintelligible.
Abnormal - Sound is heard clearly.
What does it mean if you hear an abnormal whispered pectoriloquy? Physiologically?
Consolidated lung tissue transmits higher frequency sounds more clearly.
How do you test for egophony?
What is normal?
Abnormal?
Have pt repeat "E" and ascultate.
Normal - Should hear a muffled "E" or non-distinct sound
Abnormal - "E" sounds like "A". Document "E to A changes"
Where is the aortic area located?
2nd intercostal space and right sternal border.
Where is the pulmonic area located?
in/near 2nd intercostal space and left sternal border.
Where is the tricuspid area located?
5th intercostal space at left sternal border.
Where is the mitral area located?
5th intercostal space at left mid-clavicular line.
What will you hear if you use the diaphragm of the stethoscope? The bell?
Diaphragm to hear high pitched sounds.

Bell to hear low pitched sounds.
Other than what you hear, what else should you document when performing ausculatations?

How does position impact ability to hear heart sounds?
Position: seated, standing, supine, left side lying.

Lean forward brings heart closer to chest wall.
1. When can S1 be heard?
2. Physiology?
3. Significance?
4. Frequency?
5. Stethoscope side?
6. Heard best where?
7. Sound you'll hear?
1. Beginning of systole
2. Closure of mitral and tricuspid valve.
3. Normal Significance
4. High Frequency
5. Diaphragm
6. Heard best at mitral area
7. LUB
1. When can S2 be heard?
2. Physiology?
3. Significance?
4. Frequency?
5. Stethoscope side?
6. Heard best where?
7. Sound you'll hear?
1. End of systole, beginning of diastole.
2. Closure of aortic and pulmonic valve.
3. Normal significance
4. High frequency
5. Diaphragm
6. Heard best at aortic area
7. DUB
1. When can S3 be heard?
2. Physiology?
3. Significance?
4. Frequency?
5. Stethoscope side?
6. Heard best where?
7. Sound you'll hear?
1. Early diastole, rapid filling, 0.12-0.16 sec after S2
2. "Ventricular Gallop", rapid ventricular filling, blood bouncing off dilated ventricle.
3. Normal for kids and adults up to 30. Adults >30 = ventricular failure.
4. Low frequency
5. Bell
6. Heard best at apex with pt on left lateral or supine position.
7. LUB-DUB-DUB
1. When can S4 be heard?
2. Physiology?
3. Significance?
4. Frequency?
5. Stethoscope side?
6. Heard best where?
7. Sound you'll hear?
1. End of diastole, just before S1
2. When atria contract. "Atrial Gallop". Decreased ventricular compliance or increased resistance to ventricular filling.
3. Heard in HTN, MI, pulm HTN, angina, pulm stenosis. Pressure in ventricles is too high. Need stronger atrial contraction to force blood into ventricle.
4. Low
5. Bell
6. Apex - best heard in supine or left lateral
7. THRUB-DUB
When palpating the mediastinum, what are you going to check?
Tracheal position and/or alignment
What can affect the position?

What would cause this? (5)
Shifts of hte intrathoracic structures.

Pleural effusion, tension pneumothorax, mediastinal mass, atelectasis, post-pneumonectomy
What are the three sites you would measure chest wall excursion?

At what point during breathing should these measurements be taken?
1. Level of 3rd rib/at the level of the axilla
2. Xiphoid process
3. Half the distance btwn the xiphoid process and umbilicus.

Take during quiet breating and maximal inspiration.
What three locations would you use to measure tidal volume?

How much excursion is expected at each site?
Same three as chest excursion.

2/8th inch, 3/8th inch and 4/8th inch respectively.
How much excursion is expected for vital capacity?

How do these measurements vary?
1 1/2 to 4 inches.

Vary according to size and tend to get larger as you move down the chest wall.
What will the measurement of vital capacity excursion tell us?
What the patient's recruiting pattern is for deep ventilation. i.e. recruitment of upper accessory muscles vs. intercostals vs. more diaphragm
Describe the fremitus technique.
Place palms of hands on different lung segments bilaterally as patient says "99". Compare vibration felt.
What is tactile or vocal fremitus?
Vibration caused by vocal chords on phonation. Vibration is transmitted by the bronchopulmonary system and felt on chest wall.
What is rhonchal fremitus?
Palpable vibration on chest wall produced by TURBULENT AIR FLOW over THICK SECRETIONS in the airways.
What does increased fremitus indicate?
What could it be due to?
Increased lung density due to pneumonia, edema, lung tumor or pulmonary fibrosis
What does decreased fremitis indicate?
What could this be a result of? (4)
Indicates decreased lung density.

Emphysema, pleural effusion, pneumothorax, thick chest wall
What does absent fremitis mean?
Collapsed lung
What is the purpose behind percussion? (2)
Determine whether the underlying tissues are air-filled, liquid filled, or solid.
Determine position and boundaries of diaphragm and underlying organs.
Describe how you perform percussion.
Press the DIP of middle finger firmly against chest; tap the tip of this joint with the middle finger of the opposite hand. Tap in a relaxed, quick manner using sharp wrist motion.
What does it mean if you percuss and hear resonance tones? What does this sound like?
Normal lung tissue.

Hollow ringing sound.
What does it mean if you percuss and hear dullness?
Means you are over an organ.
What does it mean if you percuss and hear hyperresonance?

What does this sound like?
Heard if lungs are overinflated.

"boom"
What does it mean if you percuss and hear flatness?

What does this sound like?
Over a muscle or atelectic lung.

Sounds dull, soft intensity, high pitch, short duration.
What does it mean if you percuss and hear tympany?

What does this sound like?
Over the stomach's gastric bubble.

Sounds like a drum
Describe how you perform diaphragmatic excursion measurement.
Percuss at level of 10th rib until you locate the diaphragm. Mark this location. Have patient take a deep breath and hold it. Percuss again to find newly located border of diaphragm.
As you are percussing, how can you tell if you are over the diaphragm?
Tone will change from resonance to dullness.
What is normal excursion for diaphragmatic excursion measurement?
3-5 cm