what questions should you ask during the lung health history?
chest pain dyspnea (SOB) wheezing cough hemoptysis (spitting up blood)
what extrathoracic structures may also cause chest pain
neck
gallbladder
stomach
pancreas (pancreatitis)
what thoracic structure is not innervated with sensory nerves?
lung parenchyma
dyspnea
abnormal or uncomfortable breathing in the context of that person’s “normal”
unpleasant sensation or difficulty in breathing
wheezing
musical respiratory sounds that may be audible
- indicates airway obstruction (secretions, tissue inflammation)
- does not always mean asthma
cough
common symptom (trivial-ominous)
reflex response to stimulae that irritate receptors in the larynx, trachea, or large bronchi
typically respiratory but may be cardiac or GI
what is often the last symptom to go when a person has an URI
cough
why does the cough persist even after the disease is over with?
reactive inflammation of the airway
how can GERD cause a cough
acid in esophagus can cause bronchospasm in the airway
what should you differentiate in a cough?
dry or moist
productive or non productive
-may be moist but non productive if they can not expectorate any sputum
what should you consider with sputum?
volume
color
odor
consistency
orthopnea
difficulty breathing while lying down
-described by how many pillows it takes to breathe comfortably
mucoid sputum
translucent, white, grey
purulent sputum
yellowish, green
mycoplasma pneumonia typically has a
dry hacking cough
-atypical pneumonia
bronchitis (viral), viral/bacterial pneumonia typically has a
sputum producing cough
anaerobic lung abscess typically has
foul smelling sputum
cystic fibrosis typically has
tenacious, sticky sputum
bronchiectasis or lung abscess typically has
large volumes of sputum
where can blood come from that comes out of the mouth?
oral mucosa (lesions)
nose
lungs
GI
characteristics of hemoptysis
blood streaked frank blood (glob of blood)-what size? (quarter, half dollar, dime)
hemoptysis
blood that is expectorated from somewhere below the vocal cords (trachea, bronchi)
what are the 4 A’s for smoking cessation?
Ask
Advise
Assist
Arrange
Steps of the exam
initial survey (breathing, color, accessory muscle use, posture)
exam of posterior chest (sitting)
exam of anterior chest (supine)
special techniques
what to observe on palpation
tenderness? abnormalities?
test chest expansion
tactile fremitus (vibration on palpation)
tactile fremitus
transmitted through bronchopulomary tree to the chest wall
- use ball or ulnar surface of hand
- say “ninety nine” if faint, speak louder or deeper
- have to have a baseline
what does decreased fremitus mean?
obstructed bronchus COPD pleural effusion fibrosis pneumothorax some tumors thick chest wall (obese)
when is a good time to do tactile fremitus?
if someone has aspirated something or has some problem that would be only on one side, you would be able to note a decrease in vibration on one side only
what does increased fremitus mean?
increased density of tissue (consolidation)
-almost impossible to tell the difference
what does percussion do?
produces audible sound and palpable vibration
establishes content of underlying fluid
penetrates 5-7 cm
elevated hemidiaphragm
when one side of the diaphragm is higher than the other
what is the normal amount of diaphragmatic excursion
5-6 cm
bronchophony
say “ninety nine”
normal: sounds should be muffled or indistinct
abnormal: louder, clearer sounds (something is helping sound to transmit more readily through the chest wall)
- while auscultating
egophony
say “ee”
normal: hear a long e sound
abnormal: “ee” sounds like “ay”
- while auscultating
whispered pectoriloquy
whisper “ninety nine”
normal: sounds heard faintly, if at all
abnormal: loud, clear sounds
a percussed lung that gives a flat sound could indicated
large pleural effusion
a percussed lung that gives a dull sound could indicate
a lobar pneumonia
a percussed lung that gives a normal resonant sound could indicate
simple chronic bronchitis
a percussed lung that gives a hyperresonant sound could indicate
emphysema, pneumothorax
a percussed lung that gives a tympany sound could indicate
large pneumothorax
