ch 19 - respiratory assesment

Question 1

how should the thoracic cage be upon inspection?

Answer 1

symmetric, elliptical shape, downward sloping ribs,

Question 2

what disease would a barrel chest indicate?

Answer 2

COPD

Question 3

what disease does hypertrophied neck muscles indicate?

Answer 3

COPD

Question 4

what position would people with COPD likely sit in?

Answer 4

tripod position

Question 5

what does unequal chest expansion occur with?

Answer 5

atelectasis, lobar pneumonia, pleural effusion, thoracic trauma

Question 6

what is a fremitus?

Answer 6

a palpable vribration

Question 7

what does decreased fremitus occur with?

Answer 7

obstructed bronchus, pleural effusion, thickening pneumothorax or emphysema

Question 8

what does increased fremitus occur with?

Answer 8

compression or consolidation of lung tissue

Question 9

what is rhoncal fremitus palpable with?

Answer 9

thick bronchial secretions

Question 10

what is pleural friction premitus palpable with?

Answer 10

inflammation of the pleura

Question 11

what is creciptus?

Answer 11

coarse, crackling sensation palpable over skin surface

Question 12

what is resonance?

Answer 12

low pitched, clear, hollow sound that predominates in healthy lung tissue in the adult

Question 13

what is hyperresonance?

Answer 13

lower pitched, booming sound found when too much air is present such as in emphysema or pneumothorax

Question 14

what does a dull note indicate?

Answer 14

abnormal density in the lungs as with pneumonia, pleural effusion , atelectasis or tumor

Question 15

what are bronchial sounds like?

Answer 15

inspiration is shorter than expiration

Question 16

what are bronchovesicular sounds like?

Answer 16

inspiration is the same as expiration

Question 17

what are vesicular sounds like?

Answer 17

inspiration is greater than expiration

Question 18

a patient has obstruction in his bronchial tree. What do you expect to hear when auscultating his chest?

Answer 18

decreased or absent breath sounds

Question 19

a patient has hyperinflated lungs due to emphysema. what do you expect to hear when auscultating his chest?

Answer 19

decreased or absent breath sounds

Question 20

if fluid or pleural thickening are present in a patient’s lungs, what do you expect to hear upon auscultation?

Answer 20

decreased or absent breath sounds

Question 21

what are the characteristics of increased breath sounds?

Answer 21

• high pitched tubular quality
• prolonged expiratory phase
• distinct pause between expiration and inspiration

Question 22

you are auscultating a patient with pneumonia. what kind of sounds do you expect to hear?

Answer 22

increased breath sounds

Question 23

you are auscultating a patient with fluid in the interpleural space. what do you expect to hear?

Answer 23

increased breath sounds

Question 24

what caused adventitious breath sounds?

Answer 24

• moving air colliding with secretions in the airways
• popping open of previously deflated airways

Question 25

what are atelectatic crackles? where are they usually heard?

Answer 25

- non pathologic sounds caused by aerating the alveoli that usually get deflated during sleep - they last only a few breaths - usually heard in the periphery

Question 26

You are inspecting the anterior chest of a patient with emphysema. What do you expect to see?

Answer 26

hypertrophied abdominal muscles from increased effort to breathe

Question 27

A patient comes in and you notice tense, strained, facies with pursed lipped breathing. What disease do you suspect this patient has?

Answer 27

COPD

Question 28

A patient comes in with excessive drowsiness or anxiety and is restless. What do you suspect?

Answer 28

cerebral hypoxia

Question 29

A patient comes in after a diagnosis of COPD. When inspecting his distal phalanx, what do you see?

Answer 29

clubbing because of growth of vascular connective tissue

Question 30

what does noisy breathing occur with?

Answer 30

asthma or chronic bronchitis

Question 31

what does retraction suggest?

Answer 31

obstruction of respiratory tract or that increased effort is needed for breathing

Question 32

what does bulging indicate? what is it associated with?

Answer 32

- trapped air - emphysema or asthma

Question 33

when are accessory muscles used?

Answer 33

airway obstruction and massive atelectasis

Question 34

in what condition are rectus abdominis and intercostal muscles used from breathing?

Answer 34

COPD

Question 35

You are palpating the anterior chest of a patient with emphysema. What do you find?

Answer 35

abnormally wide costal angle with little inspiratory variation

Question 36

You find a palpable grating sensation in your patient. What do you suspect he has?

Answer 36

pleural friction fremitus

Question 37

When percussing a patient's chest you find cardiac dullness. What disorder do you suspect the patient has and why?

Answer 37

- emphysema - the lungs are hyper inflated which results in hyperresonance

Question 38

what does dullness behind the right breast occur with?

Answer 38

right middle lobe pneumonia

Question 39

a patient has an obstructive lung disease. What do you expect his forced expiration to be?

Answer 39

6 seconds or more