Lecture 6: Pulmonary Assessment: Thorax & Lungs Flashcards

Question

Adventitious (Unexpected) Breath Sounds

Answer 1

ask pt to cough and if clears it normal (?) 1. disscontinuous Discrete/Intermittent Crackles Pleural friction rub 2. continuous connected: Wheeze Rhonchi Stridor

Answer 2

Crackles: High-pitched, discontinuous sounds heard during inspiration Crackling or popping sound Bases in lungs Causes: fluid, i.e. pulmonary edema (CHF)

Answer 3

Pleural Friction Rub Mechanism: inflamed pleura cause friction during respiration Usually, unilateral Coarse, low, grating Like pieces of leather rubbing, walking on fresh snow, “creaky” Causes: inflammation of the pleura, tissues that line the lungs Painful -- Break the words down: Visceral = internal organs in the main cavities of the body Parietal = relating to the wall of the body or of a body cavity

Answer 4

Wheeze high pitched/musical Mechanism: air flow through compressed or swollen airways Predominate in expiration Examples: COPD, asthma, tumors, bronchitis

Answer 5

Rhonchi low pitched, musical snoring, heard throughout cycle Mechanism: airflow obstruction by secretions Clears somewhat with cough or suctioning Bronchitis major cause in outpatients

Answer 6

*medical emergency* Obstruction or constriction of larynx Increased pitch, inspiratory, crowing sound Louder in neck Originates larynx or trachea Examples: anaphylaxis, croup in children, epiglottis Medical emergency- ABCs- airway, breathing, circulation- may skip the history during emergency- what is the priority?

Answer 7

Egophony- (EE to AY changes) Bronchophony Whispered pectoriloquy Pathology that increases lung density enhances transmission of voice sounds.

Answer 8

Auscultate chest while person phonates a long E sound Normal: hear E sound through stethoscope Abnormal: sound changes to bleating long A sound Indicates consolidation or compression

Answer 9

Ask patient to say “ninety-nine” several times in a normal voice Auscultate several symmetrical areas over each lung Normal: Sounds should be muffled and indistinct Abnormal: if sounds are louder and clearer- consolidation

Answer 10

Ask patient to whisper “ninety-nine” several times Auscultate several symmetrical areas over each lung Normal: faint sounds or nothing Abnormal: Positive whispered pectoriloquy = you hear sounds clearly

Answer 11

Percussion- dull (abnormal density) Tactile Fremitus- increased Bronchophony, egophony and whispered pectoriloquy present Abnormal bronchial sounds in areas where they don’t belong

Answer 12

Pneumothorax: Percussion- hyperresonant (abnormal density) Tactile Fremitus- decreased or absent Breath sounds ↓or absent Usually, unilateral Unequal chest expansion No adventitious sounds Tracheal shift away from affected side

Answer 13

Pleural Effusion (excess fluid between layers of pleura outside lungs) -Percussion - dull to flat -Tactile fremitus - decreased or absent -Breath sounds decreased or absent -Tracheal shift away from affected side -CHF, Cancer, Pneumonia

Answer 14

Chronic Obstructive Pulmonary Disease (COPD) Sequela-bronchitis & emphysema) - ↑ AP diameter, ↓chest expansion - Percussion- hyperresonant (due to air trapping, too much air) - Tactile fremitus- decreased - Breath sounds- decreased with prolonged expiration, occasional wheeze

Answer 15

↓expansion on affected side Percussion: Dull (abnormal density) Tactile fremitus- decreased or absent Breath sounds decreased or absent over affected area Occasional fine crackles if bronchus patent Tracheal shift toward affected side Blunt injury, medical procedures

Answer 16

Inspection Thoracic cage, respirations, skin color, condition, nail beds, clubbing, cap refill, persons’ facial expression& LOC Palpation Confirm symmetric expansion, tactile fremitus, crepitus, detection of any lumps, masses, or tenderness Percussion Lung fields Auscultation Assess breath sounds, not abnormal/ adventitious breath sounds Perform bronchophony, egophony, or whispered pectoriloquy, if needed.

Answer 17

1. Introduce self to client. Two identifiers for patient verification. (1) (patient safety) 2. Explain procedure and rationale for assessment. (1) (patient-centered care) 3. Provide for privacy. (1) (patient-centered care) 4. Wash hands. (1) (patient safety) 5. Position- patient in relaxed seated position 6. Inspect- Facial expression (2) Skin color (2) Resp rhythm (2) Use of accessory muscles (2) Assess AP/T diameter (2) Capillary Refill (2) Nail clubbing (2) 7. Palpate Anterior (front) chest for crepitus (2) Posterior (back) chest for tactile fremitus (2) Posterior (back) chest respiratory expansion (2) 8. Percuss Posterior (back) chest for resonance (2) 9.Auscultate Anterior, lateral and posterior (normal, adventitious, compare bilaterally) Instruct client to take deep breaths, with attention to avoid hyperventilation (2) 10. **Place stethoscope on bare skin (4) 11. Auscultate anterior or posterior and left or right lateral (2) 12. Use contralateral placement of stethoscope, which is no greater than 2 inches apart (2) 13. Chart (10) Date, time, signature, credentials, only chart what you assess, do not chart what you omit, correct use of abbreviations, landmarks, bilaterally, do not use “normal or good” to describe findings, do not use complete sentences

Lecture 6: Pulmonary Assessment: Thorax & Lungs Flashcards

(41 cards)