Respiratory System

Front 1

Name the 14 lung structures on class diagram.

Back 1

rib, collarbone, right lung: upper lobe, middle lobe, lower lobe) pericardium, diaphragm, trachea, bronci, left lung (2 lobes), ribs, pleura, pleural space, chest

Front 2

Inspection: AP diameter

Back 2

2:1

Front 3

A/P with COPD or lung disease due to air trapping

Back 3

1:1

Front 4

normal A/P

Back 4

twice as wide as lateral view of chest

Front 5

Inspection: Ease of Breathing

Back 5

1) Use of accessory muscles
2) intercoastal retractions (labored breathing)
3) Nasal flaring

Front 6

Eupnea

Back 6

Noral breathing at 12-18 breaths/minute

Front 7

Bradypnea

Back 7

Slower than normal rate (<10 breaths/minute) with normal depth and regular rhythm

Front 8

Tachypnea

Back 8

Rapid, shallow breathing > 24 b/m

Front 9

Hypoventilation

Back 9

Shallow irregular breathing

Front 10

Hyperventilation

Back 10

Increased rate and depth of breathing (called Kussmaul's respiration if caused by diabetic ketoacidosis)

Front 11

Apnea

Back 11

Period of cessation of breathing. Time duration varies; apnea may occur briefly during other breathing disorders, such as with sleep apnea. Life threatening if sustained.

Front 12

Cheyne-Stokes

Back 12

Regular cycle where the rate and depth of breathing increases, then decreases until apnea (usually about 20 seconds) occurs

Front 13

Biot's respiration

Back 13

Periods of normal breathing (3-4 breaths) followed by a varying period of apnea (usually 10 seconds to 1 minute)

Front 14

Palpation
Chest excursion

Back 14

place hands at T9 or T10

Should be symmetrical

Asymmetrical may indicate collapsed lung

Front 15

Palpation
Tactile Fremitus

Back 15

Vibrations

Can feel with palm/ball of hand over intercoastal spaces
"blue moon", "1-2-3", "99"

Use only 1 hand applied lightly

Normally vibrations decrease over periphery of lungs and increase over major airways

ABNORMAL: Opposite
Increase over periphery of lungs w/ consolidation

Decrease over airways w/ obstruction. Pleural effusion or collapsed lung (neurothorax)

Front 16

Percussion

Back 16

Detection of air, fluid, or sold

Will not detect deep lesions only 1-2 inches into chest

Front 17

Percussion Normal Findings

Back 17

Rosonance over air

Dullness over bone

Front 18

Percussion Abnormal Findings

Back 18

Flatness over solid tissue like tumor

Hyperresonance: over hyperinflated lung tissue

Front 19

Auscultation

Back 19

A anterior position
B posterior
C lateral

generally A&B used

from apex to base & from side to side

Front 20

Normal Breath Sounds
Bronchial:

Back 20

(tracheal) loud over trachea and larynx

Front 21

Normal Breath Sounds:
Bronchovesicular

Back 21

moderate over major bronchi @ 1st and 2nd ICS (intercostal space) posterior scapular

Front 22

Normal Breath Sounds
Vesicular

Back 22

soft oiver pheripheral fields

Front 23

Abnormal Breath Sounds
Decreased Sounds:

Back 23

Obstruction by secretions/mucous/foreign body

Loss of Elasticity and decreased force of inspired air

Front 24

Abnormal Breath Sounds
Absent breath sounds

Back 24

no air moving

Front 25

Abnormal Breath Sounds
Increased breath sounds

Back 25

abnormal when heard over an abnormal location

Front 26

Adventitious Sounds-not normally heard in lungs
Crackles (rales)

Back 26

high pitched
heard at end of inspiration. normally at base of lungs;
represents fluid; COPD
Does not clear when patient coughs

Front 27

Adventitious Sounds-not normally heard in lungs
Crackles (rales)

If courser than rubbing hair together next to ear, called this:

Back 27

Limecap

Front 28

Adventitious Sounds-not normally heard in lungs
Rhonchi

Back 28

Trachea and Bronchi
Loud low pitched over trachea.
On inspiration or expiration.
May clear on cough.
Fluid in airways.

Front 29

Adventitious Sounds-not normally heard in lungs
Wheezes

Back 29

Thoughout lung fields

Continuous high pitch musical sounds like sqeak on inspiration or expiration.

Asthma.

Severely narrowed bronchus.

Front 30

Adventitious Sounds-not normally heard in lungs
Pleural friction rub

Back 30

Anterior lateral fields.

Harsh, grating sound during inspiration.

Caused by inflammation of plecital flura against visercal flura.

Very painful.

Pleursy

Front 31

Voice Sounds
Bronchophony 99

Back 31

amplified sound
When austutating lung sounds, spoken word normally transmitted muffled. If fluid is compressing lungs, VIBRATIONS from patient's voice are transmitted clearly.

Front 32

Voice Sounds
Whispered pectoriloquy 1-2-3

Back 32

amplified sound
If positive heard over areas of consolidation

Sound normally almost inaudible and muffled

Front 33

Voice Sounds

Egophony

Back 33

"ee" sounds like "ay"

if area of consolidation or compression is present, "ee" will be heard as "ay";

Consolidation occurs with pneumonia, tumors, adolectisus

Front 34

Voice Sounds

Abnormal pectile premasis

Back 34

Increased density of lung tissue so better as conducting medium for vibration

Decreased: obstructs transmission or vibration

Front 35

Voice Sounds

Bronchial premasis

Back 35

Vibrations felt when inhaled air passes thru thick secretions in large bronchi

Front 36

Voice Sounds

Plural Friction premasis

Back 36

Inflammation of the peritial or visceral plural causes a decrease in normal lubricating fluid