Ch18 Thorax And Lungs Health Assessment

Front 1

What are some general inspections you can make for thorax and lungs?

Back 1

nasal flaring
pursed lip breathing
purple complexion

Front 2

Child flares nostrils while breathing. What might this indicate?

Back 2

nasal flaring is indicative of hypoxia

(usually accompanied by labored respriations)

Front 3

Explain physiology of pursed lip breathing, and what the patient may have if he/she exhibits it.

Back 3

pursed lip breathing helps slow down expiration to keep alveoli open longer. (breathe in through nose, pursed lip expiration)

Front 4

A purplish complexion may indicate?

Back 4

COPD or CHF as a result of polycthemia. (compensatory mechanism for hypoxia)

Front 5

When inspecting the posterior thorax, what do you look for?

Back 5

- configuration - scoliosis
- use of accessory muscles - trapeziums
- client positioning - tripod position

Front 6

What is the tripod position? Where is itusually seen?

Back 6

patients with COPD often lean forward using arms to support weight to breathe

Front 7

When palpating the posterior thorax, what do you do?

Back 7

- tenderness, sensation - pain/warmth
- crepitus
- surface lesions/masses
- fremitus
- chest expansion

Front 8

What is crepitus? how does it occur?

Back 8

Crepitus is a crackling sensation that occurs when air escapes from lung to subcutaneous tissue.

- thoracic injury
- chest tube
- tracheostomy

Front 9

How do you assess for fremitus?

What is it?

Back 9

Palpate with ball of hand. Patient says "ninety-nine" as you move hand to each area.

Fremitus is the normal vibrations felt during vocalization. it should be symmetrical bilaterally.

Front 10

What increases fremitus?

What decreases fremitus?

Back 10

incr - consolidation

decr - bronch obstruction, air trapping, pleural effusion, pneumothorax

Front 11

What causes unequal chest expansion?

Decreased chest expansion?

Back 11

unequal - part of lung is obstructed or collapsed as with pneumonia --> severe atelectasis, pneumonia,
trauma, pneumothorax

decreased - COPD because of decreased diaphragm function

Front 12

Percuss for what when examining posterior thorax?

Back 12

tone and diaphragmatic expansion

Front 13

What is hyperresonance? When is it found?

Back 13

lower-pitched, booming sound found when too much air is present; found in emphysema or pheumo-thorax

Front 14

How to percuss for diaphragmatic excursion?

Back 14

1. exhale forcefully, hold breath
2. percuss along scapular line from T7
3. note sound change from resonant to dull
4. inhale deeply, hold it
5. percuss from last point, downward
6. mark change to dullness

Front 15

What is normal diaph excursion?

Back 15

3-5 cm in adults, bilaterally
up to 8cm in athletes

Front 16

How to auscultate for breath sounds?

Back 16

1. place diaphragm on post chest wall
2. client breathe deep thru mouth
3. listen for bronchial, bronchovesi, and vesicular sounds
4. auscultate from apices to bases

Front 17

How to auscultate for adventitious sounds?

Back 17

Breathe normally. Note locations of adventitous sounds, and where in breath cycle.

Front 18

Fine crackles found in

Back 18

late inspiration - pneumonia, congestive heart failure

early inspiration - (obstructive) - bronchitis, asthma, emphysema

Front 19

Coarse crackles found in

Back 19

pneumonia, pulmonary edema, pulmonary fibrosis

Front 20

pleural friction rub found in

Back 20

pleuritis

Front 21

sibilant wheeze found in

Back 21

= high pitched wheeze

in acute asthma, chronic emphysema

Front 22

sonorous wheeze found in

Back 22

bronchitis, sleep apnea

Front 23

What is stridor? Accompanied by?

Back 23

= honking wheeze

occurs with croup (barking cough)

Front 24

How to auscultate voice sounds?

Back 24

bronchophony - say ninety-nine
- distinct voice over consolidations

egophony - say ee
- sounds like A over consolidations

whispered pectoriloquy - whisper 1-2-3
- - distinct voice over consolidations

Front 25

What is the normal shape of a thorax?

Back 25

anteropost diam : transverse diam = 1:2

Front 26

What are some abnormal findings in the sternum?

Back 26

pectus excavatum - sunken sternum and adjacent cartilages

pectus carinatum - protruding sterum and adjacent ribs

Front 27

labored noisy breathing found in

Back 27

asthma. bronchitis

Front 28

tachypnea

describe, and clinical indication

Back 28

rapid shallow breathing

- fever, anxiety, exercise
- alkalosis, pneumonia, pleurisy

Front 29

bradypnea

describe, and clinical indication

Back 29

slow and regular depth

Front 30

hyperventilation

describe, and clinical indication

Back 30

increase rate and depth

- fear, exercise, anxiety
(ie Kussmal respiration - diabetic ketoacidosis)

Front 31

hypoventilation

describe, and clinical indication

Back 31

decrase rate, dec depth, irregular pattern

narcostics and anesthetics

Front 32

hypoventilation vs bradypnea

hyperventilation vs tachypnea

Back 32

bradypnea - slow, but normal pattern
hypoventilation - slow, dec depth, irregular

tachypnea - fast and shallow
hyperventilation - fast and deep

Front 33

Regular pattern of breathing interrupted by periods of apnea (no breathing)

Back 33

cheyne-stokes respiration

Front 34

irregular pattern and varying depth breathing, interrupted by periods of apnea

Back 34

Biot's respiration

Front 35

orthopnea found in

Back 35

heart failure

Front 36

PND found in

Back 36

heart failure

Front 37

Differenitate cough frequencies and their associated diseases.

Back 37

continuous - acute infection

early morning - bronchial inflammation/smoking

evening - sinusitis (postnasal drip)

Front 38

nonproductive cough found in

Back 38

upper respiratory infection

Front 39

white sputum

Back 39

viral infections, common cold

Front 40

yellow or green sputum

Back 40

bacterial infections

Front 41

blood in sputum

Back 41

hemoptysis

Front 42

rust colored sputum

Back 42

tuberculosis, pneumococcal pneumonia

Front 43

pink frothy sputum

Back 43

pulmonary edema

Front 44

GERD found in

Back 44

gastroesophageal reflux disease - often seen in asthma patients