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36 Cards in this Set
- Front
- Back
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Tracheal (Bronchial)
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Heard at the intrethoracic trachea and major bronchi
loud, hard and tubular High pitch Exp. may be longer than insp. with a slight pause between |
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Bronchovesicular Sounds
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Upper half of sternum anteriorly
-between scapula posteriorly More muffled then tracheal sounds Insp. and Exp are equal in length with no pause Moderate pitch |
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Vesicular Sounds
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Over lung parenchyma
soft muffled sounds Low pitch Insp. louder than exp Insp lasts 3x longer than exp Exp begins immediately after insp and rapidly fades out |
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Types of abnormal breath sounds
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Absence of a normal breath sound
Normal BS heard in an area of the chest where it isnt normal Adventitious BS |
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Causes of absence of normal breath sounds
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Patient not breathing
Improper use/function of stethoscope Lung Pathophysiology -Atelectasis -Pneumothorax -Pleural effusion |
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Clinical Implications of hearing bronchial bs where you should hear vesicular bs
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Bronchovesicular - Partial Consolidation
Bronchial/Tracheal - Complete Consolidation |
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Continuous Adventitious BS
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(lasts longer than 25 msecs)
Rhonchi Wheezes Stridor |
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Discontinuous Adventitious BS
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(Short duration)
Crackles (Rales) Pleural Friction Rub |
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Rhonchi
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Snoring sound
Associated with sputum producing diseases -Resolving pneumonia -Bronchitis Can effect insp and exp phase Cleared or lessened with -coughing -suctioning |
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Wheezes
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Sounds generated by the vibration of the wall of a narrowed or compressed airway as air passes thru a high velocity
Airway can be narrowed by -B. spasms -secretions -Foreign bodies -Airway wall edema |
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Relationship between pitch and airway diameter
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Inverse Relationship
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Polyphonic Wheezes
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Multi Airways
Begin and end simultaneously |
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Monophonic Wheezes
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Indicates a partial obstruction of a single bronchus
ex. Endobronchial tumor |
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Common Diseases that produce wheezes
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Asthma
Emphysema CHF Pneumonia Partial airway obstruction with a foreign body |
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Stridor
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high pitched cont. sound similar to a wheeze
produced by partial obstruction of the extrathoracic airway Primarily an Insp. sound Can often be heard without a stethescope indicates vent. might soon be compromised Emergency intubation equipment should be kept close |
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Common diseases producing stridor
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Post ext. airway edema
Partial airway obstruction with a foreign body Pediactric diseases -croup (in kids) -epiglottitis (infection of the glottis) (lethal) |
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Crackles (Rales)
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Discont. sound produced in intrathoracic airways
produced by sudden explosive opening of airways that contain fluid or are collapsed |
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Early Insp. Crackles
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Sudden opening of larger airways as seen in bronchitis
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Late Insp. Crackles
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Sudden opening of peripheral airways
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Diseases that cause crackles
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Atelectasis
Pulm. edema CHF Pulm. Fibrosis Pneumonia |
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Pleural Friction Rub
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Creaky Sound
Produced by visceral and parietal becoming inflamed and rub together during breathing Mostly during insp. Usually associated with sites of pt pleuritic pain Can help confirm diagnosis of pleurisy |
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E to A Egophony
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Abnormal sound transmissions in the presence of pleural effusion over an area of consolidation
pt is instructed to repeat the letter E Affected areas will make it sound like the pt is saying A |
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Whispering Pectoriloquy
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Abnormal BS in the presence of an area of patchy consolidation
pt is instructed to whisper 1,2,3 Over normal lung areas, no words will be heard Over affected areas listener will here 1,2,3 |
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Procedure for Chest Auscultation
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1. Position pt in upright sitting position
2. Inspect areas areas of the chest 3. Position diaphragm of stethescope directly onto skin of the pt 4. Instruct pt to breath -open mouth -Insp. deeply -Exhale passively 5. Listen for full resp. cycle per position 6. Move stethoscope to opposite symmetrical side of chest 7. Localize any adventitious breath sounds -Type -Area of chest -Occurance during resp cycle |
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Inspection of the Abdomen
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Check for scars:
How old and where is the scar and abdominal distension: May impair diaphragmatic function May impair ability to breath deeply and cough Causes: Hepatomegaly and Ascites |
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How to check for ab use during exhalation
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Place hand on abdomen, and watch during exp phase
*a sign of increase WOB and forced exhalation |
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Signs of Resp disease that can be identified in the extremities
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Clubbing
Cyanosis Pedal Edema Capillary Refill Peripheral Skin Temp |
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Clubbing
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Painless enlargement of the termianl phalanges of the fingers and toes
angle advances past 180 degrees Mechanism is unknown requires years to develop best visualized by profile |
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Chronic Cardiopulmonary Diseases associated with clubbing
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Cyctic Fibrosis
Bronchiectasis Bronchogenic CA Cyanotic Congenital Heart Disease |
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Acrocyanosis
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cyanosis of the hands, feets, fingers, toes, and nail beds
Associated with: -hypoxia -poor peripheral perfusion |
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Things that cause poor peripheral perfusion
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Low CO
Peripheral Vasoconstriction |
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Pedal edema
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Accumulation of fluid in the subcutaneous tissues around the ankles
ankles and feet because they are gravity dependent Edematous area will swell and leave a pit when a finger indentation is made Pitting edema helps to decide how much swelling there is (1-4) |
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Pedal Edema indacates...
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RSHF
Corpulmonale |
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Cor Pulmonale
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RSHF caused by increased BP in pulm arteries
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Capillary Refill
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Assess CO thru perfusion to the digits
Less then 3 sec refill is normal More than 3 sec refill is abnormal |
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Cool peripheral skin to touch means
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Decreased peripheral blood perfusion
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