Exam 2: Auscultation, Breathing Pattern and Cough Assessment Flashcards
(33 cards)
What are the components of ventilation and gas exchange assessment?
- RR- ventilation
- SpO2- gas exchange
- breathing pattern
- breathing sounds
- cough
Should you observe or palpate the chest wall/breathing pattern first?
observe, view anterior, lateral, posteriorly
During your inspection what types of things should you see anatomically?
- lateral costal expansion- bucket handle
- diaphragmatic excursion- expansion with ab during inhalation
- anterior chest wall- pump handle
- are accessory muscle being used?
- Check posture!`
What other types of things are you looking for during expansion?
- Is the breathing symmetrical and coordinated?
- Any retractions?
- Normal I/E ratio is 1:2 seconds
- nasal flaring, cyanosis, mouth breathing?
What are retractions?
in pts with severe obstructive or moderate to severe restrictive dz they breath so hard you can see their bones
What can your palpation confirm about your observations?
- is diaphragm or upper chest wall moving more?
- lateral costal expansion
- accessory muscle usage
- fremmitus- vibratory tremors felt
What is the ratio between anterior chest wall and lateral chest wall?
anterior across should be double the lateral
What are the 3 different areas to measure the chest wall?
- angle of louis
- xiphoid process
- midpoint between umbilicus and xiphoid
What are the three types of breath sounds in normal?
- bronchial
- vesicular
- bronchovesicular
What are characteristics of bronchial sounds?
- over upper lobes to sternum (btwn shoulder blades posteriorly)
- high pitched hollow and loud
- expiration is longer and louder, with pause in between I and E
What are characteristics of vesicular sounds?
- entire chest wall distal to major airways
- muffed, low pitched
- inhalation is longer
What are the characteristics of bronchovesicular?
- over angle of louis and lower costosternal border
- vesicular on inhalation, bronchial on exhalation
- Equal I/E, no pause between them
What is a decreased sound?
abnormal, decreased turbulent airflow due to mucus, edema, atelectasis, something clogging airflow
What is a transposition air sound?
hearing a normal breath sound in an area it shouldn’t be in, meaning these is a consolidation of lung tissue
What is an example of transposition air?
in some dz the alveoli enlarge so more air is getting in them but there is less gas exchange
What is crackles or rales?
discontinuous lung sounds that sound like brief bursts of popping bubbles
more common in inspiration
What causes these crackles?
opening of closed airways like atelectasis
movement of air through secretions or fluid
How do you document crackles?
where it happened, when it happened, was it on inhalation or exhalation
What is a wheeze or rhonchi?
musical like wheezes, continuous sound with a constant pitch and variable duration
can occur in both inhalation and exhalation
What causes wheezing?
bronchoconstriction or decreased smooth muscle, movement of air through secretions that block airways
What is a plural rub?
sounds like two pieces of leather rubbing together, heard on I or E
causes: pleural inflammation
What are important things to remember when auscultating?
- pt must breath in and out through mouth
- listen to 2 breaths at each location
- alternate left to right
What are voice sounds used for?
used to confirm findings of abnormal auscultation
What should a spoken word normally sound like?
- sound diminishes as it descends chest wall
- in abnormal would indicate consolidation of lung tissue due to pneumonia, fluid filled alveoli or severe fibrosis
