Exam 2 Content Material Flashcards
In what order would you conduct a lung assessment?
- Inspection
- Palpation
- Percussion
- Auscultation
How would you ascultate lung sounds anteriorly?
Auscultate from the apices in the supraclavicular areas down to 6th rib.
How would you ascultate lung sounds posteriorly?
Auscultate from the apices at C7 to bases , around T10, and laterally from axilla to 7th or 8th rib.
When auscultating the lungs, a lung sound abnormal when what occurs?
The sound is abnormal if it is in the area where you are not supposed to hear it.
Ex: Hearing Vesicular sounds in an area when you are supposed to hear Bronchovesicular sounds.
What are some characteristics of Bronchial breath sounds?
- Pitch = High
- Amplitude = Loud
- Duration = Longer on expiration than inspiration
- Quality = Harsh, Hallow, tubular
- Normal location = Trachea and larynx
What are some characteristics of Bronchovesicular breath sounds?
- Pitch = Moderate
- Amplitude = Moderate
- Duration = Inspiration is equal to expiration
- Quality = Mixed
- Normal location = Over major bronchi where fewer alveoli are located
What are some characteristics of Vesicular breath sounds?
- Pitch = Low
- Amplitude = Soft
- Duration = Inspiration is greater than expiration
- Quality = Rustling (like the sound of wind in the trees)
- Normal location = Over peripheral lung feilds where air flows through the smaller bronchioles and alveoli
What is consolidation?
Compression of the lung tissue by an object (a mass, extra fluid, etc)
What 3 tests should you conduct if you hear abnormal breath sounds (Increased, Diminished, Silent or Absent breath sounds)?
- Bronchophony
- Whispered Pectoriloquy
How would you perform a Baronchophony?
- Ask Pt. to Say “99” ask you listen to chest wall with stethoscope
- Normally you should hear soft muffled sounds
- If you hear a clear “99” while auscultating a mass or some other pathology is present = bad.
How would you perform a Whispered Pectoriloquy?
- Ask Pt. to Whisper “1-2-3” as you auscultate
- You should hear muffled faint almost inaudible sounds
- If consolidation is present you will hear a very clear “1-2-3” when listening.
How would you perform an Egophony?
- Ask Pt. to say “Ee-ee-ee” when auscultating
- You should hear the sound “Ee-ee-ee” when listening
- If there is consolidation in the area of auscultation you will instead hear an “Aa-aa-aa” sound instead of an “Ee-ee-ee”.
What causes strider and what are some characteristics of this adventitious breath sound?
- Cause = Upper airway obstruction, Inflammed tissues or lodged foreign body
- Characteristics = Continuous High Pitch, Crowing sound, Monophasic, Louder in neck than over chest wall, Inspiratory
What causes Fine Crackles and what are some characteristics of this adventitious breath sound?
- CAUSE =
Early: Chronic Bronchitis, Asthma, Emphysema
Late: Atelectasis, Restrictive lung disease, Pneumonia, Heart Failure, Interstitial Fibrosis
- Characteristics =
Discontinuous, high pitch, short crackling during inspiration, Not cleared by cough.
On Insp: Inhaled air collides w/ previously deflated airways
On Exp: Sudden airway closing
What causes Coarse Crackles and what are some characteristics of this adventitious breath sound?
- Cause = Pulmonary edema, Pneumonia, Pulmonary fibrosis, Term. ill w/poor cough reflex
- Characteristics =
Discontinuous, loud, low pitch, bubbling and gurgling sounds, start in early inspiration & moving into early expiration. May decrease with cough or suctioning
Inhaled air collides with secretions in trachea and large bronchi
What causes Pleural Friction Rub and what are some characteristics of this adventitious breath sound?
- Cause = Pleuritis – occurs w/ pain on breathing
- Characteristics = Coarse, Low pitch, Discontinuous occurring with inspiration & expiration Leathery sound, Pleura rub together
What causes Wheeze-high pitch or sibilant and what are some characteristics of this adventitious breath sound?
- Cause = Diffuse airway obstruction, Asthma, Chronic Emphysema
- Characteristics = Continuous high pitch sound, musical squeaking sound, polyphonic, Mostly Expiratory, but in both insp/exp
What causes Wheeze- low pitch or sonorous rhonchiand what are some characteristics of this adventitious breath sound?
- Cause = Bronchitis, single bronchus obstruction from airway tumor
- Characteristics = Continuous low pitch sound, Monophasic, Musical snoring, Throughout entire cycle
What manifestations would you see in a patient with COPD?
- Pursed lips when breathing
- Tense, strained, tired faces
- Hypertrophied neck muscles
- Use of rectus abdominis, intercostal, and accessory neck muscles in expiration –> Tripod position
What causes Emphysema?
Caused by destruction of pulmonary connective tissure and is characterized by permanent enlargement of airsacs distal to terminal bronchioles and rupture of interalveolar walls.
This increases airway resistance, especially on expiration producing a hyperinflated lung
What causes Atelectasis?
Collapsed shrunken section of alveoli or an entire lung as a result of an:
- Airway obstruction (the bronchus is completely blocked by thick exudate, aspirated foreign body, or tumor)
- compression of the lung
- Lack of surfactant (hyaline membrane disease)
What causes Bronchitis?
- Proliferation of mucus glands in the passageways, resulting in excessive mucus secretion.
- Inflammation of bronchi with partial obstruction of bronchi by secretions or constrictions
- It is usually caused by cigarette smoking
What manifestations would you see in a patient with Asthma?
- Increased RR, SOB w/ audiable wheeze
- Use of accessory muscles
- Labored and prolonged Expiration
- Wheezing on expiration and sometimes on inspiratory
What manifestations would you see in a patient with a Pneumothorax?
- Unequal chest expansion
- Tachypena, bulging in interspaces
- Tactile fremitus absent
- Tracheal shift to opposite side
- Chest expansion decreased on affected side
- Decreased BP
This is an example of what? Describe some characteristics of this.
Barrel Chest
- Equal anteroposterior-to-transverse diameter and ribs are horizontal
- Associated with normal aging and also with chronic emphysema and asthma as a result of hyper inflation of the lungs
This is an example of what? Describe some characteristics of this
Pectus Excavatum
- Markedly sunken sternm and adjacent cartliages (funnel breast)
- Depression begins at 2nd intercostal space
- More noticable on inspiration
This is an example of what? Describe some characteritics of this
Pectus Carinatum
- Forward protrusion of the sternum
- Ribs slope back at either side and vertical depressions along costochondral junctions.
How does blood flow through the heart?
- Blood flows feom the inferior & superiormvena cava into the right atrium
- The blood then flows through the tricuspid valve into the right ventricle
- It the flows through the pulmonary valve into the pulmonary arteries to get oxygenated in the lungs
- The newly oxygenated blood returns to the heart through the pulmlnary veins into the left atrium
- The blood then passes through the mitral valve into the left ventricle
- Once the left ventricle fills the blood it will then pass through the mitral valve, into the aorta and to the rest of the body
Wharm are the sites where you should check a patient’s pulse?
- Temporal
- Carotids
- Brachial
- Radial (ulnar)
- Popliteal
- Femoral
- Dorsalis pedis
- Posterior tibial
