Quiz 3 Chapter 18 no pic lungs and thorax

Question 1

Suprasternal notch; Sternum; Manubriosternal angle (“sternal angle” or “angle of Louis”); Costal angle (should be 90 degrees or less; ribs join at angle at xiphoid process.)

Answer 1

Anterior thoracic landmarks

Question 2

Angle of Louis -

Answer 2

important for listening for heart and lung sounds, also for 2nd rib, ICS’s. Point where trachea bifurcates (at T4 posteriorly)

Question 3

Vertebra prominens C7 (Feel the bony spur on neck -most prominent one is C7, next one down is T1); Spinous processes (T1-T3); Inferior border of scapula; Twelfth rib

Answer 3

Posterior Thoracic Landmarks

Question 4

Useful when documenting findings: Midsternal line, Midclavicular line, Scapular line (back), Vertebral line (spine), *Anterior-, posterior-, and midaxillary lines

Answer 4

Location of reference lines

Question 5

Mediastinum (behind sternum and b/w lungs), Lobes of lungs (3 on right, 2 on left), pleurae (protective layer), tracheal and bronchial tree (check location)

Answer 5

Thoracic cavity

Question 6

Down to T10 on exhalation; T12 during inhalation

Answer 6

How far down lungs extend

Question 7

Irregular respiratory pattern; obligatory nose breathers to 3 months; asthma, bronchitis, pneumonia frequent; Cheyne-Stokes respiration in sleep. Don’t base everything on APGAR

Answer 7

Infants resp

Question 8

Thin chest wall - hyperresonance is normal

Answer 8

Children resp

Question 9

Increased transverse diam. of chest; diaphragm elevated b/o growing fetus. Deeper breathing, same RR, may feel like they have “dyspnea”

Answer 9

Pregnant resp

Question 10

Barrel-shaped in COPD. Dec vital capacity, muscle strength & elastic properties. Dyspnea w/ exertion due to less ventilation in lung bases. Cheyne-Stokes pattern in sleep may be normal

Answer 10

Older adult resp

Question 11

Coughing (dry, productive, sputum, quantity, color), SOB, fever, chest pain with breathing, hx of resp infection, smoking, hoarseness, environmental, self-care

Answer 11

Health History Questionnaire

Question 12

Sputum and condition

Colds, virus, bronchitis =

Answer 12

clear/white

Question 13

Sputum and condition

Bacterial infection =

Answer 13

yellow / green

Question 14

Sputum and condition

TB / pneumococcal pneumonia =

Answer 14

rust-colored/bloody

Question 15

Sputum and condition

Pulmonary edema =

Answer 15

frothy

Question 16

Cough*, Hemoptysis, Dyspnea, Wheezing, Cyanosis, Chest pain, Sleep apnea, Sputum production, Clubbing
Chronic bronchitis = x3 months of yr for 3 yrs in a row

Answer 16

Pulmonary disease symtoms

Question 17

Observe shape of chest wall. Transverse > anteroposterior (not barrel). Symetrical, ribs slope down about 45 degrees from spine

Answer 17

Posterior thoracic cage inspection

Question 18

__ __: Assess for symmetric expansion of the chest with inspiration. Normal = 4-5 cm. change

Answer 18

Chest expansion:

Question 19

Place ulnar side of hands on chest wall while pt. says “99” or “blue moon”; Should feel (equal) vibration not incor diminish; air trapping and consolidation affect normal intensity

Answer 19

Tactile (or vocal) fremitus

Question 20

Abnormal tactile fremitus

increased=

Answer 20

consolidation

Question 21

Abnormal tactile fremitus

decreased=

Answer 21

emphysema, pneumothorax, pleural effusion

Question 22

Abnormal tactile fremitus

rhonchial fremitus

Answer 22

thick secretions in bronchi

Question 23

pleural friction fremitus

Answer 23

creaky; pleuritis

Question 24

Palpate the entire chest wall for

Answer 24

crepitus, tenderness

Question 25

Side to side and compare. Avoid bones. Go down to about T10

Answer 25

Pattern for percussion

Question 26

Best if they sit up, Slightly forward, crossing arms; Lie to side if lying down; Have them breathe and little deeper and through the mouth. Left to right, drop down, back to left, etc. Avoid bone

Answer 26

Auscultation