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Flashcards

Thorax & Lungs

Adriana Morales PD Module 1 English 54 cards

Thorax & Lungs

Cards in this deck (54)

  1. 1What are the bony landmarks of the anterior thorax?- rib cage, sternum, suprasternal notch, clavicle, nipples
    - sternal angle (at 2nd intercostal)
    - imaginary reference lines
  2. 2What are the bony landmarks of the posterior thorax?- C7
    - tip of scapula @ 7th intercostal space
    - imaginary reference lines
  3. 3—1) anterior axillary line
    2) midaxillary line
    3) posterior axillary line    1) anterior axillary line 2) midaxillary line 3) posterior axillary line
  4. 4—midscapular line
    vertebral line    midscapular line vertebral line
  5. 5What are the pleurae in the lungs? (serous membranes)Visceral pleura covers the outer surface of each lung
    Parietal pleura lines the inner rib cage and thoracic cavity
    Pleural space is potential space between visceral and parietal pleurae    What are the pleurae in the lungs? (serous membranes)
  6. 6Aspects of the Thorax & Lungs Physical Exam- Assess respiratory rate, rhythm, effort and depth of breathing
    - Patient position
    - Sitting
    - Leaning forward
    - Supine
  7. 7Physical Exam: Inspection- Check for Respiratory Difficulty
    - Assessment of color
    - Observe patient’s posture
    - Inspect the nose for nasal flaring
    - Inspect the neck for accessory muscle use
    - Inspect the ribcage for retractions
    - Observe the shape of the chest, A:P diameter
    -Symmetry of respiratory movements
    Posterior : Deformity or spinal curvature
    and Symmetry of respiratory movements
  8. 8Physical Exam: PalpationAssess for:
    - Masses
    - Tenderness
    - Respiratory Expansion
    - Tactile Fremitus
  9. 9Physical Exam: Respiratory Expansion- Indicates equal expansion of lungs during a normal respiratory cycle
    - Assesses muscle tone in respiratory muscles
    - Assesses compliance of lungs, pleura and chest musculature
  10. 10Tactile Fremitus: What will more solid areas of lung sound like?- More solid areas of lung will transmit more vibrations
  11. 11What is tactile fremitus? What differences are you looking for?- Palpable vibrations transmitted from the bronchopulmonary tree to the chest wall
    - Look for asymmetrical difference in the intensity of the vibratory sensation
  12. 12What does increased fremitus suggest?- Increased fremitus suggests fluid, mass, or pneumonia
  13. 13What should you ask pt to say during tactile remits?Ask the patient to say “99” or “1-1-1”
  14. 14What is percussion?Screening the ant/lat/post thorax noting any change in the normal resonant sound
  15. 15What does percussion help us determine?Helps to determine if structures are air filled, fluid filled, or solid
    Compare bilaterally moving side to side
  16. 16What would resonant sounds indicate?Resonant – healthy lung tissue
  17. 17What would flat/dull sounds indicate?Flat/Dull – effusion or consolidation (fluid or solid has replaced air containing lung or occupies pleural space)
  18. 18What would hyper resonant lung sounds indicate?Hyperresonant – Emphysema, pneumothorax, asthma
  19. 19What would tympanic lung indicate?Tympanic – large pneumothorax
  20. 20Percussion (Special Test): What does diaphragmatic excursion check for?Diaphragmatic excursion (estimation): noting the distance between the levels of dullness on full expiration and inspiration (normally 5 to 6 cm)
  21. 21PERCUSSION anterior: (ladder technique)PERCUSSION
    posterior:
    (ladder technique)    PERCUSSION anterior: (ladder technique)PERCUSSION anterior: (ladder technique)
  22. 22What is the purpose of the ascultation?- Assess air flow thru tracheobronchial tree
    - Listening to breathing sounds
    - Listening to adventitious (added) sounds
  23. 23What should you then listen to if you hear abnormal breathing sounds?- If you hear abnormal breath sounds, you should then listen to spoken/whispered voice sounds as they are transmitted through the chest wall
  24. 24What are tracheal breath sounds?Sounds heard directly over trachea & neck
    Very loud/high pitched
    Expiratory/inspiratory component equal
  25. 25What are bronchial breath sounds?Heard directly over a major bronchus
    Loud/high pitched
    Short silence between insp & exp with exp lasting longer
  26. 26Where are Bronchovesicular breath sounds best heard?Best heard in 1st and 2nd ICS anteriorly and between scapula posteriorly
    Medium pitch
    Equal insp/exp
  27. 27Where are vesicular breath sounds best heard?Best heard over lung fields
    Soft low pitch
    Inspiration last longer than expiration
  28. 28What are types of adventitious sounds?- Rales
    - wheezes/rhonchi
    - stridor
    - pleural friction rub
    - mediastinal crunch
  29. 29What are rales?Intermittent, nonmusical dots in time
    Can be fine or coarse, dry or wet
    Crackling noises caused by deflated, fluid filled small airways popping open with air
    Can be heard with pneumonia, fibrosis, bronchitis
  30. 30What do wheezes/rhonchi sound like? What do wheezes indicate? What do rhonchi indicate?- Musical continuous sounds
    - Wheezes indicate narrowed bronchi (high-pitched)
    - Rhonchi indicate secretions (low pitched, snot-like)
  31. 31What does stridor sound like? What does it indicate?high pitched wheeze during inspiration that is louder at the neck; indicates upper airway obstruction
    Note: if you listen to someones trachea it will sound louder than other areas, DANGEROUS! Impending respiratory failure, might be foreign body in trachea
  32. 32What does Pleural Friction Rub sound like?“creaking noise” in one area;
    pleural surfaces rubbing against each other (rubbing hair by ear)
  33. 33What does Mediastinal Crunch (Hamman’s sign) sound like?- precordial crackles caused by air between pleurae
  34. 34What are the 3 special tests for auscultation?1- bronchophony
    2- egophony
    3- whispered pectoriloquy
  35. 35How do you test for Bronchophony? What does a normal lung sound like? What does a bronchophony sound like?Ask patient to say “99” and listen with stethoscope
    Normal: MUFFLED
    Bronchophony: LOUD & CLEAR (indicated air-filled lung has become AIRLESS
  36. 36How do you test for egophony? What is abnormal?Ask patient to say “EE” while listening with stethoscope
    If you hear EE instead of AY & quality is nasal, indicates pneumonia or other consolidation
  37. 37How do you test for whispered pectoriloquy? What does a normal whisper sound like and what does consolidation sound like?Ask patient to whisper “99” while listening with stethoscope
    Normal: Barely audible
    Consolidation: LOUD & CLEAR
  38. 38What is respiratory excursion?purcussing diaphragm and estimating distance that diaphragm expands (assymetry)
  39. 39What is peak flow?- used to access obstruction
    - pt. breathes as hard & fast as they can into meter, dial shows if pt has increased respiratory flow (i.e. seen in asthma) and then give them breathing treatment to see if peak flow number improves
  40. 40What tests are not normally done during a lung physical exam?Respiratory excursion
    Tactile fremitus
    Bronchophony
    Egophony
    Whishpered pectoriloquy
    Peak flow
  41. 41Chronic Obstructive Pulmonary Disease (COPD)chronic bronchitis & emphysema
  42. 42What is chronic bronchitis? What is emphysema?Chronic bronchitis – excessive mucus production in bronchi
    Emphysema – over distention of alveoli, with alveolar destruction
  43. 43What are the Common Pulmonary Diseases? (4)- COPD
    - asthma
    - pneumothorax
    - pneumonia
  44. 44What are the physical findings during general and thoracic inspection for COPD? Percussion? Auscultation? Adventitious sounds?General: clubbing, cyanosis, accessory muscle use
    Thoracic: barrel chested habitus, increased AP diameter
    Percussion: hyperresonant
    Auscultation: decreased breath sounds
    Adventitious sounds – none; or crackles, wheezes and rhonchi
  45. 45What is asthma?Hyper-reactivity of bronchial tree resulting in inflammation, hypersecretions and bronchoconstriction
    No structural or permanent damage
  46. 46Asthma can be asymptomatic with exacerbations or:Mild intermittent
    Mild persistent
    Moderate persistent
    Severe persistent
  47. 47What are some physical findings during an asthma attack? Are there any physical findings during a normal exam?Accessory muscles used to breathe
    Percussion: resonant
    Wheezes
    Decreased peak flow
    - not during attack: normal exam
  48. 48What is a pneumothorax?Air leakage into the pleural space cause pressure gradient between space and lungWhat is a pneumothorax?
  49. 49What is a spontaneous pneumothorax due to?spontaneous rupture of bleb (bulla)
  50. 50What is a traumatic pneumothorax due to?Due to penetrating injury to lung from knife, bullet, or rib fragments
  51. 51What are the physical findings during a pneumothorax?Chest rise is asymmetrical
    Hyperresonant percussion note over affected lung
    Breath sounds and tactile fremitus are decreased or absent
  52. 52What is Pneumonia?- Inflammation of lung tissue caused by bacterial, viral or mechanical causes
    - Alveoli fill with fluid or pus
    - pneumonia can be lobar or diffuse
  53. 53What are the physical findings during inspection for pneumonia? Percussion? Auscultation? Transmitted sounds?- Inspection: normal unless respiratory distress
    -Percussion: dull
    - Auscultation: bronchial breath sounds, inspiratory rales
    Increased Transmitted sounds (bronchony, egophony and whispered pectoriloquy)
    Increased tactile fremitus
  54. 54What are these muscles used during?neck accessory muscles used during respiratory difficultyWhat are these muscles used during?

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Description
PD Module 1 Flashcards on Thorax & Lungs, created by Adriana Morales on 22/10/2016.
Created by
Adriana Morales · Oct 2016
Updated
Feb 6, 2018
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  • Created by Christina Phan · Oct 15, 2016
  • Copied by Adriana Morales · Oct 22, 2016
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