Thorax And Lung

Front 1

subjective data collected during thorax and lung assessment

Back 1

cough, SOB, chest pain with breathing, history of respiratory infections, smoking history, environmental exposure, self-care behaviors

Front 2

hemoptysis

Back 2

coughing up blood

Front 3

orthopnea

Back 3

difficulty breathing when supine

Front 4

paroxysmal nocturnal dyspnea

Back 4

awakening from sleep with SOB and needing to be upright

Front 5

normal results of inspection of thoracic cage

Back 5

-note shape and configuration
-spinous processes should be straight
-thorax is symmetric, elliptical in shape
-ratio of anteroposterior to transverse diameter is 1:2 to 5:7

Front 6

barrel chested

Back 6

anteroposterior = transverse diameter
-associated with normal aging and chronic emphysema and asthma

Front 7

funnel breasted

Back 7

-aka pectus excavatum
-sunken strenum, most depressed at xiphoid process
-more noticeable on inspiration
-congenital, not symptomatic

Front 8

pigeon breast

Back 8

-aka pectus carinatum
-forward protrusion of strenum
-requires no treatment
-may be caused by rickets

Front 9

what do you palpate during a thorax/lung assessment?

Back 9

-confirm symmetric expansion
-tactile fremitus
-detect any lumps, masses, tenderness

Front 10

what do you percuss during thorax and lung exam?

Back 10

-percuss over lung fields
-estimate diaphragmatic excursion, which should be equal bilaterally and measure 3-5cm in adults

Front 11

increased tactile fremitus

Back 11

-density of lung tissue increases
-e.g. pneumonia

Front 12

decreased tactile fremitus

Back 12

-occurs with anything that obstructs transmission of vibrations
-e.g. obstructed bronchus, pleural effusion or thickening, pneumothorax, emphysema

Front 13

rhonchal fremitus

Back 13

vibration felt when inhaled air passes through thick secretions

Front 14

pleural friction fremitus

Back 14

-produced when inflammation of parietal or visceral pleura causes decrease in normal lubricating fluid
-synchronous with respiratory excursion

Front 15

fine crackles
aka rales

Back 15

-heard during inspiration
-crackling, popping sounds not cleared by coughing
-late inspiratory = pneumonia, heart faliure, interstitial fibrosis
-early inspiratory = chronic bronchitis, asthma, emphysema

Front 16

coarse rales

Back 16

-bubbling, sounds like velcro
-starts in early inspiration, may be present in expiration
-pulmonary edema, pneumonia, pulmonary fibrosis, terminally ill who have depressed cough reflex

Front 17

atelectatic crackles

Back 17

-disappear after first few breaths, not pathologic

Front 18

pleural friction rub

Back 18

-superficial sound that is coarse and low-pitched
-pleuritis, accompanied by pain with breathing

Front 19

sibilant wheeze

Back 19

-high-pitched musical squeaking sounds, mostly in expiration
-diffuse airway obstruction from acute asthma or chronic emphysema

Front 20

sonorous rhonchi

Back 20

-low-pitched wheeze
-snoring, moaning sounds, more prominent on expiration
-may clear somewhat by coughing
-bronchitis, single bronchus obstruction from airway tumor

Front 21

stridor

Back 21

-high-pitched crowing sounds, louder in neck
-croup and acute epiglottitis in children, foreign inhalation
-may be life-threatening

Front 22

signs and symptoms of lobar pneumonia

Back 22

-increased RR
-guarding and lag on expansion on affected side
-chest expansion decreased on affected side
-tactile fremitus increased if bronchus patent, decreased if bronchus obstructed
-dull when percussed
-voice have increased clarity
-crackles, fine to medium

Front 23

signs and symptoms of bronchitis

Back 23

-proliferation of mucous glands, inflammation of bronchi
-hacking, rasping productive cough, mucoid sputum
-tactile fremitus is normal
-resonant when percussed
-crackles over deflated area, may have wheeze

Front 24

emphysema

Back 24

-destruction of pulmonary connective tissue
-barrel chested, tripod position, SOB, tachypnea
-decreased tactile fremitus and chest expansion
-hyperresonant when percussed
-decreased diaphragmatic excursion
-decreased breath sounds
-usually no adventitious sounds, occasionally wheeze

Front 25

asthma

Back 25

-during severe attack = increased RR, SOB with wheeze, expiration labored
-fremitus decreased, tachycardia
-resonant when percussed
-prolonged expiration, voice sounds decreased
-bilateral wheezing on expiration

Front 26

coarse rales

Back 26

-bubbling, sounds like velcro
-starts in early inspiration, may be present in expiration
-pulmonary edema, pneumonia, pulmonary fibrosis, terminally ill who have depressed cough reflex

Front 27

atelectatic crackles

Back 27

-disappear after first few breaths, not pathologic

Front 28

pleural friction rub

Back 28

-superficial sound that is coarse and low-pitched
-pleuritis, accompanied by pain with breathing

Front 29

sibilant wheeze

Back 29

-high-pitched musical squeaking sounds, mostly in expiration
-diffuse airway obstruction from acute asthma or chronic emphysema

Front 30

sonorous rhonchi

Back 30

-low-pitched wheeze
-snoring, moaning sounds, more prominent on expiration
-may clear somewhat by coughing
-bronchitis, single bronchus obstruction from airway tumor

Front 31

stridor

Back 31

-high-pitched crowing sounds, louder in neck
-croup and acute epiglottitis in children, foreign inhalation
-may be life-threatening

Front 32

pleural effusion or thickening

Back 32

-increased respiration, dyspnea
-dry cough, tachycardia, cyanosis, abdominal distention
-fremitus decreased or absent
-chest expansion decreased on affected side
-dull to flat when percussed.
-NO diaphragmatic excursion on affected side
-breath and voice sounds decreased or absent
-no adventitious sounds

Front 33

heart failure

Back 33

-RR increased, SOB, orthopnea, nocturia, ankle edema, pallor
-skin moist
-tactile fremitus normal
-resonant percussion
-crackles at lung base

Front 34

pneumothorax

Back 34

-due to rupture or leak in chest wall, lung collapse
-unequal chest expansion
-fremitus decreased or absent
-tachycardia, decreased BP
-hyperresonant, decreasd diaphragmatic excursion
-breath and voice sounds decreased or absent
-no adventitious sounds

Front 35

Would you expect adventitious sounds with pleural effusion?

Back 35

No.

Front 36

What could a patient have with:
decreased fremitus
bilateral wheezing on expiration
hyperresonant or resonant when percussed

Back 36

asthma

Front 37

A patient presenting with:
decreased fremitus and chest expansion
hypperresonant
no adventitious sounds
increased anteroposterior diameter

Back 37

emphysema

Front 38

Patient presents with:
unequal chest expansion
absent/decreased fremitus
hypperresonant
decreased diaphragmatic excursion
no adventitious sounds

Back 38

pneumothorax
(air in pleural space)