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36 Cards in this Set

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Name the 14 lung structures on class diagram.
rib, collarbone, right lung: upper lobe, middle lobe, lower lobe) pericardium, diaphragm, trachea, bronci, left lung (2 lobes), ribs, pleura, pleural space, chest
Inspection: AP diameter
2:1
A/P with COPD or lung disease due to air trapping
1:1
normal A/P
twice as wide as lateral view of chest
Inspection: Ease of Breathing
1) Use of accessory muscles
2) intercoastal retractions (labored breathing)
3) Nasal flaring
Eupnea
Noral breathing at 12-18 breaths/minute
Bradypnea
Slower than normal rate (<10 breaths/minute) with normal depth and regular rhythm
Tachypnea
Rapid, shallow breathing > 24 b/m
Hypoventilation
Shallow irregular breathing
Hyperventilation
Increased rate and depth of breathing (called Kussmaul's respiration if caused by diabetic ketoacidosis)
Apnea
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.
Cheyne-Stokes
Regular cycle where the rate and depth of breathing increases, then decreases until apnea (usually about 20 seconds) occurs
Biot's respiration
Periods of normal breathing (3-4 breaths) followed by a varying period of apnea (usually 10 seconds to 1 minute)
Palpation
Chest excursion
place hands at T9 or T10

Should be symmetrical

Asymmetrical may indicate collapsed lung
Palpation
Tactile Fremitus
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)
Percussion
Detection of air, fluid, or sold

Will not detect deep lesions only 1-2 inches into chest
Percussion Normal Findings
Rosonance over air

Dullness over bone
Percussion Abnormal Findings
Flatness over solid tissue like tumor

Hyperresonance: over hyperinflated lung tissue
Auscultation
A anterior position
B posterior
C lateral

generally A&B used

from apex to base & from side to side
Normal Breath Sounds
Bronchial:
(tracheal) loud over trachea and larynx
Normal Breath Sounds:
Bronchovesicular
moderate over major bronchi @ 1st and 2nd ICS (intercostal space) posterior scapular
Normal Breath Sounds
Vesicular
soft oiver pheripheral fields
Abnormal Breath Sounds
Decreased Sounds:
Obstruction by secretions/mucous/foreign body

Loss of Elasticity and decreased force of inspired air
Abnormal Breath Sounds
Absent breath sounds
no air moving
Abnormal Breath Sounds
Increased breath sounds
abnormal when heard over an abnormal location
Adventitious Sounds-not normally heard in lungs
Crackles (rales)
high pitched
heard at end of inspiration. normally at base of lungs;
represents fluid; COPD
Does not clear when patient coughs
Adventitious Sounds-not normally heard in lungs
Crackles (rales)

If courser than rubbing hair together next to ear, called this:
Limecap
Adventitious Sounds-not normally heard in lungs
Rhonchi
Trachea and Bronchi
Loud low pitched over trachea.
On inspiration or expiration.
May clear on cough.
Fluid in airways.
Adventitious Sounds-not normally heard in lungs
Wheezes
Thoughout lung fields

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

Asthma.

Severely narrowed bronchus.
Adventitious Sounds-not normally heard in lungs
Pleural friction rub
Anterior lateral fields.

Harsh, grating sound during inspiration.

Caused by inflammation of plecital flura against visercal flura.

Very painful.

Pleursy
Voice Sounds
Bronchophony 99
amplified sound
When austutating lung sounds, spoken word normally transmitted muffled. If fluid is compressing lungs, VIBRATIONS from patient's voice are transmitted clearly.
Voice Sounds
Whispered pectoriloquy 1-2-3
amplified sound
If positive heard over areas of consolidation

Sound normally almost inaudible and muffled
Voice Sounds

Egophony
"ee" sounds like "ay"

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

Consolidation occurs with pneumonia, tumors, adolectisus
Voice Sounds

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

Decreased: obstructs transmission or vibration
Voice Sounds

Bronchial premasis
Vibrations felt when inhaled air passes thru thick secretions in large bronchi
Voice Sounds

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