Learning The Disease Process

Question 1

A COPD patient comes into the hospital what can you expect when doing inspection on them?

Answer 1

• barrel chest
• JVD ( JVP)
• tripod positioning
• pursed lip breathing
• clubbing
• pedal edema
• accessory muscle usage
• cyanosis

Question 2

A asthma patient comes in to the emergency room what can you expect on inspection?

Answer 2

• barrel chest
• tripod position
• pursed lip breathing
• accessory muscle usage

Question 3

A patient has pneumonia what can you expect on inspection?

Answer 3

• accessory muscle usage
• cyanosis
• tracheal deviation towards the affected side
• fever

Question 4

A patient has atelectasis what can you expect on inspection?

Answer 4

• accessory muscle usage
• cyanosis
• tracheal deviation toward affected side

Question 5

A patient has pneumothorax what can you expect on inspection?

Answer 5

• accessory muscle usage
• cyanosis
• tracheal deviation away from affected side

Question 6

A patient has pleural effusion what can expect on inspection?

Answer 6

• accessory muscle usage
• cyanosis
• tracheal deviation away from affected side

Question 7

A patient has pulmonary edema what can you expect on inspection?

Answer 7

• accessory muscle usage
• cyanosis
• pink frothy sputum

Question 8

A patient has pneumonia and has tracheal deviation. Will it be away or toward the affected site?

Answer 8

Toward

Question 9

A patient has atelectasis and has tracheal deviation. Will it be toward or away from affected site?

Answer 9

Toward

Question 10

A patient has pneumothorax and has tracheal deviation. Would it be toward or away from affected site?

Answer 10

Away

Question 11

A patient pleural effusion and has tracheal deviation. Will it be away or toward the affected site?

Answer 11

Away

Question 12

What does JVD stand for?

Answer 12

Jugular venous distention

Question 13

What does pursed lip breathing intel?

Answer 13

Inhales through the nose and blows air out through the lips
( creates the back pressure in lungs)
- associated with COPD ( smell the roses blow out the candles)

Question 14

What is cyanosis?

Answer 14

A blueish discoloration of patients skin due to hypoxemia

Question 15

What is nasal flaring?

Answer 15

More common in pediatrics but com on in adults too!

Question 16

What is central cyanosis?

Answer 16

Early stages of cyanosis blueish lips or cyanosis within the lips or gums (oral mucosa) results from hypoxemia ( one way hypoxemia presents itself)

Question 17

What is bronchopnony?

Answer 17

An increase in the intensity and clarity of vocal resonance produced by enhanced transmission of vocal vibrations
- “one”, “two”, “three”, “ninety-nine”

Question 18

What is egophony?

Answer 18

An increase in the intensity of the spoken word with the presence of a nasal quality
- “ e” will sound like “ a” with a nasal quality over an area of consolidation

Question 19

What is whisper pectoriloquey?

Answer 19

Same technique as bronchophony except the patient whispers “ one”, “ two”, “ three”
- whispered words will be clear over areas of consolidation

Question 20

What is diminished breath sounds?

Answer 20

Very low breath sounds clear but not really hearing anything

Question 21

What is absent breath sounds?

Answer 21

No breath sounds at all

Question 22

What are wheezes (rhonchi) ?

Answer 22

High pitch continuous sounds. Caused by vibrations created by high velocity air passing through smaller diameter airways.
Heard on expirations
Monophonic- single note, one obstructed airway.
Polyphonic- multi notes, multi obstructed airways.

Question 23

What are crackles?

Answer 23

Caused by airflow moving through secretions or fluid in the airways, but not always.

Question 24

What a coarse crackles?

Answer 24

Heard during inspiration/expiration

Often cleared with a cough

Question 25

What are fine crackles?

Answer 25

Heard when airways pop open during inspiration

Question 26

What is stridor?

Answer 26

High pitched wheeze, heard loudly on inspiration, due to upper airway obstruction

Question 27

What is bronchial?

Answer 27

Identical to tracheal sounds, heard over lung periphery, large areas of consolidation

Question 28

What is pleural friction rub?

Answer 28

Creaking or grating sound, heard when pleural surfaces become inflamed and rub together

Question 29

What is tracheal breath sounds?

Answer 29

- Heard over the trachea - loud intensity - slight pause between inspiration and expiration - length of inspiration= length of expiration

Question 30

What is bronchovesicular breath sounds?

Answer 30

``` - heard over upper half of the sternum And between inspiration and expiration - not as loud as tracheal - lower in pitch - length of inspiration= the length if expiration ```

Question 31

What is vesicular breath sounds?

Answer 31

- soft, muffled sounds heard over lung periphery - lower in pitch and intensity than bronchovesicular - all of inspiration heard, only first 1/3 of expiration

Question 32

What is digital clubbing and what does it mean when a patient had this?

Answer 32

Enlargement of terminal phalanges of the fingers and toes. It is the the manifestation of cardiopulmonary disease, caused by many disease states that have chronic hypoxemia. ( cystic fibrous patients nail beds angle down and enlargement of fingers and toes)

Question 33

What is capillary refill?

Answer 33

- assessed by pressing briefly but firmly on the fingernail bed and noting the speed at which the blood flow returns. - normal capillary refill is <3 seconds - an abnormality more than three seconds indicates decreased cardiac output, poor peripheral perfusion, and hypoxemia

Question 34

What is pedal edema?

Answer 34

Most often from right sided heart failure which causes an increased hydrostatic pressure of the venous system and leaking of fluid from the vessel into the surrounding tissues. - most often affected - the tissue pits or indents when pressing firmly with a finger

Question 35

What is peripheral skin temperature?

Answer 35

When perfusion is poor compensatory vasoconstriction in the extremities help shunt blood to the vital organs. The reduction in peripheral perfusion causes the extremities to become cool to the touch.