Ch. 12 Lungs And Respiratory System

Front 1

fine crackles

Back 1

fine, high-pitched crackling & popping noises (discontinuous sounds) heard during end of inspiration. not cleaned by cough
clinical examples: may be heard in pneumonia, heart failure, asthma, & restrictive pulmonary diseases

Front 2

medium crackles

Back 2

medium-pitched, moist sound heard about halfway through inspiration. not cleaned by cough
clinical examples: same as fine crackles but condition is worse

Front 3

coarse crackles

Back 3

low-pitched, bubbling or gurgling sounds that start early in inspiration & extend into the first part of expiration
clinical examples: same as fine & medium crackles but condition is worse or in terminally ill clients w/ diminished gag reflex. also heard in pulmonary edema & pulmonary fibrosis

Front 4

wheeze

Back 4

high-pitched musical sound similar to a squeak. heard more commonly during expiration but may also be heard during inspiration. occurs in small airways
clinical examples: heard in narrowed airway diseases such as asthma

Front 5

rhonchi

Back 5

low-pitched, coarse, loud, low snoring or moaning tone. actually sounds like snoring. heard primarily during expiration but may also be heard during inspiration. coughing may clear
clinical examples: heard in disorders causing obstruction of trachea or bronchus such as chronic bronchitis

Front 6

pleural friction rub

Back 6

a superficial low-pitched coarse rubbing or grating sound, sounds like 2 surfaces rubbing together. heard throughout inspiration & expiration. loudest over the lower anterolateral surface. not cleared by cough
clinical examples: heard in individuals w/ pleurisy (inflammation of the pleaural surfaces)

Front 7

anterior thorax
INSPECT

Back 7

inspect the anterior thorax for shape & symmetry, muscle development, anteroposterior diameter to lateral diameter, and costal angle. ribs hsould slope down at about 45 degrees relative to spine. muscle development should be equal. anteroposterior (AP) diameter of chest should be approx. half the lateral diameter. anteriorly the costal angle should be <90 degrees

Front 8

abnormal findings for anterior thorax inspection

Back 8

asymmetry or unequal muscle development. in disorders that cause lung hyperinflation such as emphysema, the chest wall may have a barrel-shaped appearance b/c of an increased AP diameter. in this situation the ribs are more horizontal & the chest looks as if it is held in constant inspiration. the costal angle is >90 degrees. other chest wall skeletal deformities include scoliosis, pectus carinatum & pectus excavatum

Front 9

AUSCULTATE anterior thorax for breath sounds

Back 9

1. vesicular breath sounds should be heard throughout the periphery of the anterior lung fields including apex of lungs about the clavicles
2. bronchovesicular breath sounds are normally heard over the central area of the anterior thorax around the sternal border, these sounds are heard in an area that approximates where the bronchi split off from the trachea.
3. bronchial breath sounds are normally heard over the trachea and immediately above the manubrium

Front 10

abnormal findings for ascultation of anterior thorax

Back 10

adventitious breath sounds are extraneous sounds that are superimposed on the breath sounds. if you hear any, identify type of sound, location of sound, and phase of breathing in which it is heard.
diminished breath sounds may be heard in clients whose alveoli have been destroyed which may occur in clients w/ emphysema. diminished or absent breath sounds may be heard in clients w/ collapsed alveoli, which may occur in clients who have atelectasis or are having a severe asthma attack

Front 11

posterior thorax
PALPATE

Back 11

palpate posterior thoracic muscles for tenderness, bulges, & symmetry.
the spine should be straight & nontender from C7 through T12. the scapulae should be symmetric and the surrounding musculature well developed. posterior ribs hsould be stable and nontender. posterior rib cage should be symmetric & firm

Front 12

abnormal findings for palpation of posterior thoracic muscles

Back 12

note any crepitus which feels like a crinkly or crackly sensation under your fingers. this abnormal finding indicates air in the subcutaneous tissue caused by an air leak from somewhere in the respiratory tree.
pleural friction rub may be felt as a coarse, grating sensation during inspiration. it occurs secondary to inflammation of the pleural surface.
muscular development that is asymmetric or an unstable chest wall may indicate a thoracic disorder, such as fractured ribs

Front 13

PALPATE posterior chest wall

Back 13

palpate for thoracic expansion.
both thumbs should move apart symmetrically on the posterior chest wall with each breath

Front 14

abnormal findings for palpation of posterior chest wall

Back 14

a unilateral or unequal movement of your thumbs suggests asymmetry of expansion, which may be caused by pain, fractured ribs or chest wall injury, pneumonia and atelectasis or collapsed lung.
if unequal chest wall movement is noted further evaluation is warranted

Front 15

PALPATE posterior thoracic wall

Back 15

palpate posterior thoracic wall for vocal (tactile) fremitus.
fremitus should feel bilaterally equal, although the quality of the vibrations may vary from person to person b/c of chest wall density & relative location of the bronchi to the chest wall

Front 16

abnormal findings for palpation of posterior thoracic wall

Back 16

vibrations feel unequal when comparing sides. decreased or absent fremitus occurs when the vibrations are blocked which may occur in clients who have emphysema pleural effusion pulmonary edema or bronchial obstruction.
increased fremitus occurs when the vibrations feel enhanced -- sometimes described as a rougher or coarser vibrations. this occurs when lung tissues are congested or consolidated, which may occur in clients who have pneumonia or a tumor

Front 17

AUSCULTATE thorax

Back 17

auscultate thorax for vocal sounds (vocal resonances).
when there is an indication of consolidation of the lung or if there was an abnormal finding when tactile fremitus was performed, evaluate for vocal resonance.
includes 3 techniques: testing for bronchophony, whispered pectoriloquy, & egophony

Front 18

abnormal findings for auscultation of thorax

Back 18

abnormal is sound is louder & clearer. if there is consolidation or compression of the lung, the sound will actually sound like "ninety-nine" or "one-two-three"

Front 19

bronchophony

Back 19

expected response is a muffled tone such as "nin-nin" or muffled "one-two-three"

Front 20

whispered pectoriloquuy

Back 20

expected response is a muffled "one-two-three"

Front 21

abnormal findings of auscultation for whispered pectoriloquy

Back 21

increased clarity & loudness of sounds which may be found in consolidation or compression of lung

Front 22

egophony

Back 22

final test for vocal resonance. it evaluates intensity of the spoken voice.
expected response is the sound of a muffled "e-e-e"

Front 23

abnormal findings for testing for egophony

Back 23

if there is auscultation of the lung, you may hear changes in intensity & pitch so that the sound appears to be an "a-a-a"

Front 24

PALPATE trachea for position

Back 24

trachea should be palpable, midline, and slightly movable

Front 25

abnormal findings for palpation of trachea position

Back 25

if trachea is not at midline, it may be an indication of a thorax mass, mediastinal shift or some degree of lung collapse

Front 26

PALPATE anterior thoracic muscles for tenderness, bulges, and symmetry

Back 26

clavicles should be symmetric & surrounding musculature well developed. anterior ribs should be stable & nontender. rib cage should be symmetric & firm. sternum & xiphoid should be relatively inflexible

Front 27

abnormal findings: palpation of anterior thoracic muscles

Back 27

note any crepitus.
pleural friction rub may be felt as a coarse grating sensation during inspiration.
muscular development that is asymmetric or an unstable chest wall may indicate a thoracic disorder, such as fractured ribs

Front 28

PALPATE anterior chest wall for thoracic expansion

Back 28

both thumbs should move apart symmetrically on anterior chest walls with each breath

Front 29

abnormal findings: palpation of anterior chest wall

Back 29

a unilateral or unequal movement of your thumbs suggests asymmetry of expansion, which may be caused by pain, fractured ribs or chest wall injury, pneumonia, and atelectasis or collapsed lung

Front 30

PALPATE the anterior thoracic wall for vocal (tactile) fremitus

Back 30

fremitus should feel bilaterally equal, although quality of the vibrations may vary from person to person b/c of chest wall density & relative location of bronchi to chest wall

Front 31

abnormal findings: palpation of anterior thoracic wall

Back 31

vibrations feel unequal when comparing sides.
decreased or absent fremitus.
increased fremitus.

Front 32

acute bronchitis

Back 32

an inflammation of the mucous membranes of the bronchial tree caused by viruses or bacteria

Front 33

pneumonia

Back 33

an infection of terminal bronchioles and alveoli. may be caused by bacteria, fungi, viruses, mycoplasma, or aspiration of gastric secretions.

Front 34

tuberculosis

Back 34

contagious, bacterial infection caused by mycobacterium tuberculosis. infection primarily in the lungs, but kidney, bone, lymph node, and meninges can also be involved.

Front 35

pleural effusion

Back 35

an accumulation of serous fluid in the pleural space between the visceral and parietal pleurae

Front 36

asthma

Back 36

hyperreactive airway disease characterized by bronchoconstriction, airway obstruction, and inflammation in response to inhalation of allergens or pollutants, infection, cold air, vigorous exercise, or emotional stress

Front 37

emphysema

Back 37

destruction of alveolar walls causes permanent abnormal enlargement of the air spaces

Front 38

chronic bronchitis

Back 38

characterized by hypersecretion of mucus by the goblet cells of the trachea and bronchi resulting in a productive cough for 3 months in each of 2 successive years. it is caused by irritants such as cigarette smoke and air pollution or by infection.

Front 39

pneumothorax

Back 39

air in the pleural spaces results in this. there are three types: 1. closed, which may be spontaneous, traumatic, or iatrogenic 2. open, which occurs following penetration of the chest by either injury or surgical procedure and 3. tension, which develops when air leaks into the pleura and cannot escape

Front 40

hemothorax

Back 40

blood in the pleural space caused by injury to the chest results in this, but it also may be a complication of thoracic surgery

Front 41

atelectasis

Back 41

refers to collapsed alveoli caused by external pressure from a tumor, fluid, or air in the pleural space (compression _____) or by removal of air from hypoventilation or obstruction by secretions (absorption _____)

Front 42

lung cancer

Back 42

an uncontrolled growth of anaplastic cells in the lung. agents such as tobacco smoke, asbestos, ionizing radiation, and other noxious inhalants can be causative agents