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163 Cards in this Set

  • Front
  • Back
What are signs of normal breathing?
*No use of shoulder muscles
*Use of diaphragm as the major muscle at work; lower chest expansion during inspiration.
When are trapezius or shoulder muscles used during inspiration? Is it normal?
*Acute and chronic airway obstruction or atelectasis.
Which ethnicity generally has a larger thorax and greater lung capacity?
Adult Caucasians
Is kyphosis a normal finding? Why or why not?
Normal; it resultsl from a loss of lung resiliency and a loss of skeletal muscle.
What causes barrel chest?
Emphysema due to hyperinflation of the lungs.
A diameter of the anterior posterior thorax that equals the diameter of the transverse thorax is called what?
Barrel chest
What is kyphosis?
An increased curve of the thoracic spine
What condition is commonly the result of emphysema?
Barrel chest
At what angle should the ribs slope downward from the spine?
45 degrees
What is the ratio for the dimensions of a normal thorax?
What ethnicity and gender have a greater risk for lung cancer?
African American males
What is indicative of a non-productive cough?
*Upper respiratory irritation
*Early congestive heart failure
What is indicative of late-evening coughing?
Exposure to irritants during the day.
What is indicative of coughs during the night?
Post-nasal drip; sinusitis
What is indicative of pink, frothy sputum?
Pulmonary edema
What is indicative of a continuous cough?
Acute infections
What is indicative of early morning coughing?
*Chronic bronchial inflammation
What is indicative of rust-colored sputum?
*Pneumococcal pneumonia
What is hemoptysis?
Blood in the sputum.
What is indicative of hemoptysis?
Serious respiratory conditions.
What is indicative of yellow or green sputum?
Bacterial infections
What is indicative of white or mucoid sputum?
*Common colds
*Viral infections
What iconditions are associated with wheezing?
*Excessive secretions
What are some s/s of CHF?
*paroxysmal nocturnal dyspnea
*Non-productive coughs (early sign)
What is paroxysmal nocturnal dyspnea?
Severe dyspnea that awakens the person from sleep.
What is orthopnea?
Difficulty breathing while lying supine.
What is the strongest stimulus to breathe?
Carbon dioxide
Why might a normal aging adult experience dyspnea?
*Loss of elasticity in lungs.
*Fewer functional capillaries.
*Loss of lung resiliency.
Gradual onset of dyspnea is indicative of what?
Acute onset of dyspnea is indicative of what?
Viral or bacterial infection.
What position does an individual assume when COPD is present?
Client leans forward and uses arms to support weight and lift chest to increase breathing capacity; AKA tripod position.
What are you palpating for when assessing the thorax?
*tenderness, pain or other sensation
*chest expansion
*surface characteristics
What is crepitus?
A crackling sensation that occurs when air posses through fluid or exudate.
What is another name for crepitus?
Subcutaneous emphysema
When can crepitus be palpated?
When air escapes the lung or other airways into the subcutaneous tissue. Eg. thoracic injury, around a chest tube or tracheostomy.
What is fremitus?
Vibrations of air in the bronchial tubes transmitted to the chest wall and felt by the examiner when client says "99".
How do you palpate for fremitus?
Use the ball or ulnar edge of one hand.
What is a normal finding for fremitus?
Sounds are the same bilaterally. A decrease in intesity is heard as the examiner moves from the apex to the base.
What causes unequal fremitus?
Consolidation due to obstruction, air trapping in ephysema, pleural effusion.
What causes diminished fremitus?
Pneumothorax or obstruction of the tracheobronchial tree.
Why is the ball of the hand best for assessing tactile fremitus?
It is sensitive to vibratory sensation.
How do you palpate for chest expansion?
Place hands on the posterior chest wall with thumbs at the level of T( or T10. As the client takes a deep breath, observe the movement of your thumbs.
What is a normal observation when palpating chest expansion?
When client takes a breath, examiner's thumbs should move apart by 5-10 cm symmetrically.
What is atelectasis?
Collapse or incomplete expansion of the lungs.
What may be normal findings of palpating chest expansion in an older adult?
Decreased expansion due to calcification of the costal cartilages and loss of the accessory musculature. However, it should be symmetric.
What are some conditions that cause unequal chest expansion?
Chest trauma
What is pneumothorax?
Air in the pleural space.
What can cause a decreased lung excursion?
COPD due to decreased diaphragmatic function.
How do you percuss for tone on the thorax?
Right to left and top to bottom starting at the apices above the scapulae, comparing sides.
What is the normal percussion tone elicited over normal lung tissue?
Why might the examiner hear hyperresonance upon percussion?
Trapped air as in emphysema or pneumothorax
Why might the examiner hear dullness upon percussion?
Fluid or solid tissue replaces air in the lungs or occupies the pleural space.
What are some examples of dullness heard upon percussion?
Lobar pneumonia, pleural effusion or tumor.
What are normal measurements for diaphragmatic excursion?
3-5 cm bilaterally in adults.
7-8 cm bilaterally in well-conditioned clients.
What is a normal position for the diaphragm?
the level of the diaphragm may be higher onthe right because of the postition of the liver.
What is the procedure for percussing diaphragmatic excursion?
Client exhales forcefully and holds breath. At T7, percuss intercostal spaces of the right posterior chest wall. Percuss downward unti the tone changes from resonance to dullness.-Mark.
Client inhales deeply and holds. Percuss intercostal spaces from mark downward until resonance changes to dullness.-Mark. Measure and repeat on left posterior thorax.
What are some causes of uneven excursion?
Unilateral pneumonia, damage to the phrenic nerve or splenomegaly.
An abnormal finding of diaphragmatic descent may be due to what?
Atelectasis of the lower lobes or by emphysema, in which diaphragmatic movement and air trapping are minimal. The diaphragm remains in a low position upon expiration and inspiration.
Other possible causes are pain or abdominal changes such as extreme ascites, tumors or pregnancy.
What are the three normal breath sounds that can be auscultated?
Bronchial, bronchovesicular and vesicular.
What could diminished or absent breath sounds indicate?
Obstruction as a result of secretions, mucus plug or a foreign object.
Abnormalities of the pleural space.
What are some examples of abnormalities of the pleural space?
Pleural thickening, pleural effusion or pheumothorax.
When might you hear louder than normal breath sounds?
Consolidation or compression that results from a denser lung.
What can cause diminished inspiratory breath sounds?
Emphysema with a loss of elasticity of lung tissue.
What are normal respiratory patterns?
12-20/min and regular
What is tachypnea?
Respiration greater than 24/min and shallow.
Tachypnea is a normal response to what?
Fever, anxiety, exercise
What is bradypnea?
Respirations of less than 10/min and regular.
With what conditions can tachypnea occur?
Alkalosis, pneumonia or pleurisy
When does normal bradypnea occur?
Well-conditioned athletes
When does abnormal bradypnea occur?
Medication-induced depression of the respiratory center, diabetic coma, neurologic damage.
What is hyperventilation?
Increased rate and increased depth.
What are Kussmal's repirations?
A type of hyperventilation associated with diabetic ketoacidosis.
What are some causes of hyperventilation?
Extreme exercie, fear or anxiety. Other causes include disorders of the CNS, an overdose ofthe drug salicylate or severe anxiety.
What is hypoventilation?
Decreased rate, descreased depth, irregular pattern.
What is associated with hypoventilation?
Overdose of narcotics or anesthetics.
What is Cheyne-Stokes respiration?
Regular pattern characterize by alternating periods of deep, rapid breathing followed by periods of apnea.
Cheyne-Stokes respiration may be a result of what?
Severe CHF, drug overdose, increased intracranial pressure or renal failure.
When might Cheyne-Stokes respiration be a normal value?
Elderly during sleep
What is Biot's respiration?
Irregular pattern characterized by varying depth and rate of respiration followed by periods of apnea.
When might Biot's respiration be seen?
Meningitis or severe brain damage.
Name some abnormal adventitious breath sounds.
fine crackles, coarse crackles, pleural friction rub, sibilant wheeze, sonorous wheeze.
What is a sonorous wheeze?
Low-pitched snoring or moaning sounds heard primarily during expiration but may be heard throught the respiratory cycle. Wheezes may clear with coughing.
What is a sibilant wheeze?
High-pitched musical sounds heard primarily during expiration but may also be head on inspiration.
What is the source of a sibilant or sonorous wheeze?
Air passing through constricted passages caused by swelling, secretions or tumor.
When are sibilant wheezes heard?
Acute asthma or chronic emphysema.
When are sonorous wheezes heard?
Bronchitis or single obstructions and snoring before an episode of sleep apnea.
What is stridor?
Harsh honking wheeze with severe broncholarynospasm, such as occurs with croup.
What is a sign of croup?
Name some discontinuous sounds.
Fine and coarse crackles.
Name some continuous sounds.
Pleural friction rub, sibilant and sonorous wheezes.
What is a pleural friction rub?
Low-pitched, dry, grating sound. Sound is like crackles, only more superficial and occurs during both inspiration and expiration.
What is the source of a pleural friction rub?
Sound is the result of rubbing of two inflamed pleural surfaces.
Name a condition of a pleural friction rub.
What are the chracteristics of coarse crackles?
Low-pitched, bubbling, moist sounds that may persist from early inspiration to early expiration. Like softly separating Velcro.
What are the characteristics of fine crackles?
High-pitched, short, popping sounds heard during inspiraton and not cleared with coughing. Sounds are discontinuous.
What is the source of coarse crackles?
Inhaled air comes into contact wth secretions in the large bronchi and trachea.
What is the source of fine crackles?
Inhaled air suddenly opens the small deflated air passages that are coated and sticky with exudate.
Fine crackles occuring late in inspiration are indicative of what?
Restrictive diseases such as pneumonia and CHF.
Fine crackles occuring early in inspiration are indicative of what?
Obstructive disorders such as bronchitis, asthma, or emphysema.
Coarse crackles may indicate what?
Pneumonia, pulmonary edema and pulmonary fibrosis. Velcro rales of pulmonary fibrosis are heard louder and closer to stethoscope, usually do not change location, and are more common in clients with long-term COPD.
What is the normal pitch of bronchial breath sounds?
What is the normal quality of bronchial breath sounds?
Harsh or hollow
what is the normal amplitude of bronchial breath sounds?
What is the duration of normal bronchial breath sounds?
Short during inspiratio, long in expiration.
What is the location of bronchial breath sounds?
Trachea and larynx
What is the normal pitch of bronchovesicular breath sounds?
what is the normal quality of bronchovesicular breath sounds?
What is the normal amplitude of bronchovesicular breath sounds?
What is the duration of normal bronchovesicular breath sounds?
Same in inspiraton and expiration.
What is the location of normal bronchovesicular breath sounds?
Over the major bronchi-posterior; between the scapulae; anterior:
around the upper sternum in the first and second intercostal spaces.
What is the pitch of normal vesicular breath sounds?
what is the quality of normal vesicular breath sounds?
What is the normal amplitude of vesicular breath sounds?
What is the normal duration of vesicular breath sounds?
Long in inspiration, short in expiration.
What is the normal location of vesicular breath sounds?
Peripheral lung fields
How should you perform auscultation the thorax?
Begin from the apices of the lungs at C7 and continue to the bases at T10 and laterally from the axilla down to the seventh or eight rib; making a backwards, continuous 's' from top left to bottom left.
How long should you listen at each posterior thorax?
One complete cycle
When would it be advantageous for the client to wear a thin t-shirt upon thoracic ausculatation?
When the chest is extremely hairy as to not hear friction.
How should you ausculatate the anterior thorax?
Ausculatate from the apices of the lungs slights above the calvicles to the bases of the lungs at the sixth rib.
How should the client breathe during ausculatation of the thorax?
Deeply through the mouth
How should you perform palpation of the posterior thorax?
From neck(left scapulae) to just above the waist(base of the lungs); top to bottom and left to right, comparing bilaterally.
Upon palpation of the posterior thorax, fingers are best for assessing what?
Sensation, lumps, lesions
Tactile fremitus is best felt with what?
Palm of hand
What can you assess best using anterior thoracic palpation?
Lung's right middle lobe.
What is scoliosis?
A deformity that imparts an 'S' to the spine.
Scoliosis is primarily found in what gender/age group?
Young females
What is kyphosis?
A deformity that is a pronounced forward curvature of the thoracic spine.
In what group is kyphosis common?
What is another name for pectus carinatum?
Pigeon chest
What is pectus carinatum?
A minor deformity in which the sternum protrudes but requires no treatment; depressed costal cartilages.
What is another name for pectus excavatum?
Funnel chest
What is pectus excavatum?
A congenital malformation characterized by a sunken sternum and seldom causing symptoms other than self-consciousness.
What sounds should you ausculatate for?
Breath, adventitious and voice sounds.
Where is flatness detected upon percussion?
Over the muscles and bones.
Where is dulness detected upon percussion?
Breast tissue, the heart and liver.
Where is tympany detected?
Over the stomach.
What is a normal costal angle?
No more than 90 degrees
Pain or tenderness at the costachondral junction of the ribs is indicative of what?
Fractures, especially in older clients with osteoporosis.
Labored and noisy breathing occurs during what conditions?
Severe asthma and chronic bronchitis.
What is indicative of bulging of the intercostal spaces?
Trapped air seen in emphysema or asthma.
What is indicative of retraction of intercostal spaces?
Increased inspiratory effort due to obstruction of the respiratory tract or atelectasis.
What group of people may use nasal flaring and why?
Small children in labored respiration.
Nasal flaring could indicate what?
When might you see pursed lip breathing?
Asthma, emphysema or CHF as a physiologic response to help slow down expiration and keep alveoli open longer.
When might neck muscles be abnormally used during breathing?
Facilitates inspiration in acute or chronic airway obstruction or atelectasis.
What muscles are typically used for breathing when experience COPD?
Abdominal and intercostal muscles.
Abdominal and intercostal muscles are used for breathing during what condition?
What is a normal color for the face, lips, chest during breathing?
Ambient skin color with pik undertones.
When might cyanosis be seen?
Client is cold, hypoxic.
What color is seen in clients with COPD or CHF as a result of polycythemia?
Ruddy to purple complexion.
How do you auscultate for bronchophony?
Ask the client to repeat the phrase "99" when you listen to the chest wall.
How do you auscultate for egophony?
Ask the client to repeat the letter "E" while you listen to the chest wall.
How do you aucultate for whispered pectoriloquy?
Ask the client to whisper the phrase "1-2-3" while you listen to the chest wall.
What are adventitious breath sounds?
Added or superimposed breath sounds over the normal breath sounds.
What are normal bronchophony findings?
voice transmission is soft, muffled, and indistinct. The sound of the voice may be heard, but the actual phrase cannot be distinguished.
What are normal egophony findings?
Voice transmission will be soft and muffled, but the letter "E" should be distinguishable.
What are normal whispered pectoriloquy findings?
Transmission of sound is very faint and muffled. It may be inaudible.
What are abnormal bronchophony findings?
The words will be easily understood and louder over areas of increased denisyt. This may indicate consolidation from pneumonia, atelectasis or tumor.
What are abnormal egophony findings?
Over area of consolidation or compession, the sound will be louder and change to "A".
What are abnormal whispered pectoriloquy findings?
Over areas of consolidation or compression, the sound will be transmitted clearly and distinctly. In such areas, it will sound as if the client is whispering directly into the stethoscope.
Why might the sternum and ribs be more prominent in the older client?
Loss of subcutaneous fat.
When are sternal retractions observed?
During labored breathing.
Pain in the chest is usually associated with what?
Pleura, thoracic muscles and tracheobronchial tree, but not in the lungs due to lack of nerve endings.