Pulmonary Assessment

Front 1

location of suprasternal notch

Back 1

clavicle, 1st rib

Front 2

location of sternal angle; another name for this structure

Back 2

2nd rib, angle of Louis

Front 3

location of Xiphoid process

Back 3

7th rib

Front 4

what is located posteriorly at the first rib

Back 4

spinous process of T1

Front 5

What is located posteriorly at the 7th rib

Back 5

inferior angle of the scapula

Front 6

what lung is divided in half by oblique fissures at what location?

Back 6

T3

Front 7

which your inspection what are the three things you look at during respiratory effort?

Back 7

1. accessory muscle usage
2. retractions
3. depth

Front 8

what muscles are used to lift the chest during inspiration?

Back 8

sternomastoid and scalenes

Front 9

What muscle is used during expiration/

Back 9

abdominal to push the diaphragm up

Front 10

what is the ICD-9 code for actue respiratory distress?

Back 10

518.82

Front 11

What is the ICD-9 code for NOS respiratory distress?

Back 11

786.09

Front 12

what is the expected rate of respiration for an adult? per? newborn?

Back 12

adult: 12-20, per 20-30, newborn80

Front 13

what is orthopnea?

Back 13

SOB that begins when the patient lies down

Front 14

What is sudden onset of SOB after a period of sleep/

Back 14

Paroxysmal nocturnal dyspnea

Front 15

term for an increase in SOB in upright posture

Back 15

Playnpnea

Front 16

What is tachypnea?

Back 16

reate >25/min

Front 17

What is bradypnea?

Back 17

rate <12 min

Front 18

What is hyperpnea

Back 18

deeply >20min

Front 19

what is hypopnea?

Back 19

abnormally shallow breathing

Front 20

what is stridor vs. wheezes/

Back 20

stridor is inspiratory upper airway obstruction. wheezes are small airway obstruction. there are heard without a stethoscope

Front 21

term for vibration transmitted through the air in the bronchopulmonary tree to the chest wall when the patient speaks

Back 21

tactile fremitus

Front 22

during percussion you not a lower pitch and a hyper resonant tone. what is this indicative of?

Back 22

emphysema, asthma

Front 23

during percussion you note a musical pitch, and tympanic tone. dx?

Back 23

large pneumothroax

Front 24

What does a normal lung sounds like?

Back 24

resonant

Front 25

What has a flat tone, high pitch?

Back 25

large pleural effusion

Front 26

What has a dull tone with a medium pitch?

Back 26

lobar pneumonia

Front 27

give three reasons for asymmetric diaphragmatic height

Back 27

1. paralyzed diaphragm
2. effusion
3. large tumore

Front 28

What is the term for dullness where it doesn't belong?

Back 28

consolidation

Front 29

during auscultation what terms are used to describe what you hear? (6)

Back 29

1. location
2. type
3. duration
4. intensity
5. pitch
6. timing in respiratory cycle

Front 30

what are the three normal breath sounds are where are they heard?

Back 30

1. Bronchovesicular-over the main bronchi 2. vesicular-over less bronchi, bronchioles, and lobes. 3. bronchial-over trachea

Front 31

describe the duration, pitch and intensity expected with a vesicular breath sound

Back 31

inspiratory >expirationry, low pitch, and soft intensity. should hear over most of lung

Front 32

describe duration, pitch, intensity expected for bronchovesicular breath sounds

Back 32

inspiratory=expiratory, medium pitch, intermediate intensity. heard interscapular, high in bront. over the brain bronchi

Front 33

describe the bronchial breath sounds; duration, pitch intesnity

Back 33

e>i, high pitch, loud intesnity. heard over manubrium

Front 34

bronchial sounds heard over lung tissue and altered voice sounds are examples of what?

Back 34

altered and adventitious sounds

Front 35

low pitched wheezes, gurgling, rumbling or rattling sounds

Back 35

ronchi

Front 36

high pitched inspiratory honk

Back 36

stridor

Front 37

high pitched whistling or squeaking sound

Back 37

wheezes

Front 38

noisy, popping, high-pitched sounds

Back 38

crackles

Front 39

this adventitious sound may clear with a cough

Back 39

rhonchi

Front 40

A coarase loud sound heard over the lobe of the lung may indicate?

Back 40

consolidation, example of a bronchial sounds over lobe of lung

Front 41

this is an area of collapsed lung or alveoli and implies bronchiolar obstruction or poor ventilatory effort

Back 41

atelectasis

Front 42

what are your expected finding with atelectasis?

Back 42

1. absent or decreased fremitus with plus 2. may be asymmetric expansion, tracheal shift toward affected side 3. dull percussion over collapsed area 4. absent or decreased breath sounds

Front 43

How is atelectasis treated?

Back 43

with incentive spirometry

Front 44

what is pleural effusion? where is it normally localized?

Back 44

fluid in space btwn. the visceral and parietal pleura. settles to lowest area unless localized-lng bases

Front 45

describe the pain felt with pleural effusion

Back 45

pain is sharp and exacerbated by coughing or deep breathing

Front 46

describe the findings of pleural effusion including; trachea position, fremitus, percussion, breath sounds, added sounds

Back 46

1. treachea shifts away from affected side (if one is larger) 2. decreased/absent fremitus, bronchophony 3. dull to flat percussion over fluid 4. decreased/absent breath sounds 5. possible pleural rub

Front 47

you have a pleural effusion with a pH finding of <7 what does this suggest?

Back 47

rheumatoid effusion

Front 48

a pleural effusion with glucose<20mg/dL is seen in what conditions?

Back 48

1. RA 2. occasionally infections 3. malignances

Front 49

What will you find with pleural space infection?

Back 49

frank pus and positive gram stain

Front 50

what cell type will you find in the blood or air in the pleural space?

Back 50

eosinphils

Front 51

what is the treatment for pleural effusion/

Back 51

observation if small and not empyema. drainage if large or infected rx. antibiotics. if 2nd to malignancies life expectancy si 12 wks.

Front 52

what is pneumothroax?

Back 52

air between visceral and parietal pleura is usually due to leakage from a penetrationg would to chest wall or rupture of lung structure. bleb, chest trauma, spontaneous

Front 53

what are your expected findings for pneumothroax include, trachea, fremitus, tone, breath sounds, added sounds

Back 53

1. trachea shifts toward opposite side in tension pneumothroax, decreased fremitus, hyper resonant, absent/decreased breath sounds over pleural air, possible pleural rub

Front 54

who is pneumothroax treated?

Back 54

observation if small and stable with no respiratory compromise. chest rube and/or surgical repair if large, tension or persistent leak

Front 55

what is infection of lung parenchyma causing fluid (secretion and pus) to accumulate in airways and alveoli?

Back 55

pneumonia/consolidation

Front 56

what are your expected findings is pneumonia/consolidation?

Back 56

1. visually dyspneic and tachypneic. 2 increased fremitus over consolidated area with bronchophony, ego phony and whispered pectroliquy. 3. dull to percussion over affected area 4. may find bronchial breath sounds. 5. late inspiratory coarse crackles

Front 57

crackles are heard into late inspiration. they are profuse and persistn from breath to breath. What conditio cause this?

Back 57

late inspiratory crackles-causes include interstitial lung disease (fibrosis) and early CHF

Front 58

crackles appearing early and end soon after the start of inspiration. they are coarse and few in number. sometimes expiratory crackles are associated. what are some causes?

Back 58

chronic bronchitis and asthma-early inspiratory crackles

Front 59

crackles heard midinspiratory and expiratory. what other sounds may be associated?

Back 59

bronchiectasis (not specific for this diagnosis) wheezes and rhonchi may be associated

Front 60

what are causes of wheezes in the chest?

Back 60

asthma, chronic bronchitis, COPD, CHF.

Front 61

in asthma when are wheezes heard? what can distinguish wheezes of asthma from chronic bronchitis?

Back 61

in asthma wheezes may be heard only in expiration or in both phases of respiratory cycle. Rhonchi suggest secretion enlarger airway. IN chronic bronchitis, wheezes and rhonchi often clear with coughing.

Front 62

what is a silent chest and how is it treated?

Back 62

patient is unable to force enough air through narrowed bronchi toprodcue wheezing. this is occasional in severe obstructive pulmonary dz. the resulting silent chest warrants immediate attention.

Front 63

what are causes of persistent localized wheezing?

Back 63

partial obstruction of bronchus as by a tumor or foreign body

Front 64

what is a wheeze that predominantly inspiratory. where is ti loudest and what may it indicate?

Back 64

stridor. often louder i the neck and over the chest wall. it indicates partial obstruction of the larynx or trachea and demands immediate attention

Front 65

inflamed and roughened pleural surfaces great against each other as they are repeatedly delayed by increased friction-->produces cracking sounds. know as.

Back 65

pleural rub

Front 66

a series of precordial crackles synchronous with the heart beat, not with respiration.

Back 66

mediastinal crunch also known as Hamman's sign

Front 67

what is the cause of a mediastinal crunch

Back 67

mediastinal emphysema (pneumomediastinum)