ClassNotes

Question 1

Scapul location

Answer 1

lower tip of 7th or 8th intercostal

Question 2

c7

Answer 2

bony protruding at the base of the neck

Question 3

Mediastinum: contains

Answer 3

esophagus, trachea, heart, great vessels.

Question 4

Base rests on diaphragm location

Answer 4

6 rib, clavicular line

Question 5

Trachea and bronchi—dead space—What does this mean?

Answer 5

air that does not reach the alveloi

Question 6

respiratory system function

Answer 6

a) Supplies oxygen to the body for energy production.
b) Removes carbon dioxide as waste product of energy reactions.
c) Maintains homeostasis (acid-base balance).
d) Maintains heat exchange.

Question 7

right main bronchus compared to left

Answer 7

right main bronchus is shorter, wider and more vertical than the left main bronchus.

Question 8

DC: pregnancy

Answer 8

enlarging uterus elevates diaphragm. Has a decreased vertical
chest diameter, and compensatory increase in the horizontal diameter.

Increased estrogen—relaxes the chest cage ligaments.

Increased total chest circumference

Increased tidal volume to meet oxygen demands of fetus (deeper breathing); little change in RR)
Physiologic dyspnea—from increased awareness of need to breathe.

Question 9

DC: Aging adult

Answer 9

more rigid structure that is harder to inflate.

Costal cartilages become calcified—thorax less mobile.

Respiratory muscle strength decreases.

Decreased elastic properties within lungs; lungs have less tendency to collapse and recoil.

Decreased vital capacity (max amount air that client can expel after first filling lungs to the max).

Increased residual volume (amount of air remaining in the lungs after forceful expiration).

With aging: decreased number of aveoli; lung bases less ventilated; increased risk for DOE.

Question 10

Elderly have increased risk for postoperative pulmonary complications because:

Answer 10

Decreased ability to cough
Loss of protective airway reflexes
Increased secretions

Question 11

What are the two major pulmonary diseases in which there are greater risks for races other than Whites?

Answer 11

TB, Asthma

Question 12

SD: cough

Answer 12

ask about onset, frequency, duration, productivity, self-care
Timing will indicate what you should be thinking about in terms of causes

Question 13

SD: SOB

Answer 13

ask about onset, precipitating factors; ask about exposure to pets, pollen, food , exercise

affected by activity or position

Ask about associated factors—sweats, wheezing

Are there any alleviating factors?

Question 14

SD: Chest pain with breathing

Answer 14

ask about onset, duration, character (use PQRSTU)

Ask about coughing, recent respiratory infection, fever, chills

Question 15

SD: history of respiratory infection

Answer 15

asthma, pneumonia, bronchitis, TB

Question 16

SD: Environmental exposure

Answer 16

What are environmental conditions in Maine that might affect breathing?

Question 17

SD: Infants and children

Answer 17

Ask about frequency of URIs, allergies, noisy breathing. Assess risk for foreign body aspiration, toxic ingestions. Ask about exposure to secondhand smoke.

Question 18

SD: Aging Adult

Answer 18

Ask about any new SOB or fatigue, reduced activity level, new immobility, weight change, falls, chest pain while breathing.

Question 19

Objective data sequence

Answer 19

Inspect, Palpate, Percussion, Auscultation

Question 20

OD: Inspect

Answer 20

Assess facial expression to determine comfort of breathing.

Assess LOC, color and skin condition, quality of respirations, respiratory rate.

What position has client taken to breathe.

Look for symmetrical chest expansion.

What should be the relationship between the AP diameter and the transverse diameter?

Question 21

OD: Palpate

Answer 21

for symmetric expansion, tactile fremitus.

Symmetric expansion—unequal with atelectasis, pneumonia, pleural effusion, fractured ribs, pneumothorax

Tactile fremitus—palpable vibration; “ninety-nine” side to side should be symmetrical (if not, investigate further).

Crepitus—palpate to determine if present.

Question 22

OD: Preccusion

Answer 22

resonance—low-pitched, clear hollow sound over healthy lung tissue

Check for symmetry

Lower-pitched indicates more air (emphysema, pneumothorax)

Higher-pitched indicates increase in density (pneumonia)

Question 23

OD: Ausculatation

Answer 23

Breath sounds—bronchial (tracheal or tubular); bronchovesicular; vesicular

Question 24

Decreased or absent breath sounds could be due to

Answer 24

Bronchial tree obstruction—by what?
Decreased force of inspired air
Hyperinflation
Obstruction between lung and stethoscope

Question 25

Adventitious sounds

any forge

Answer 25

Crackles—inspiration

Wheezes—mainly expiration

Question 26

Describe breath sounds by these characteristics:

Answer 26

a) On inspiration or on expiration
b) Loudness
c) Pitch
d) Location on chest wall

Question 27

Common measurements

Answer 27

Spirometer—measures FEV (forced expiratory volume)

Pulse oximetry

6-minute walk test (6 MWT)—A person who walks >300 meters in 6 minutes is more likely to engage in activities of daily living.
(for Aging Adults)

Question 28

OB: Infants/Children

Answer 28

: has an equal AP to transverse chest diameter; by age 6, reaches adult ration of 1:2 (AP-to-transverse diameter).

Slight flaring of lower costal margins may occur with respirations.

Should see NO nasal flaring, sternal retraction, intercostal retraction.

Question 29

Newborns major respiratory muscle is

Answer 29

the diaphragm; intercostal muscles are not well developed. Abdomen will bulge with each inspiration; there will be little thoracic expansion.

Question 30

infants breath at what respiration/minutes

Answer 30

30-40

Question 31

infants breath at what respiration/minutes

Answer 31

30-40

Question 32

will hear bronchovesicular breath sounds in peripheral lung fields; breath sounds are louder and harsher up to what age

Answer 32

5-6

Question 33

Stridor

Answer 33

high-pitched inspiratory crowing sound; indicates upper airway obstruction (croup, foreign body aspiration, epiglottitis).

Question 34

OD: Aging Adult

Answer 34

has increased AP diameter—barrel chest.

If kyphosis present, will compensate by extending and tilting back head.

May tire easily. May become dizzy during lung exam.