Lungs/Thorax Flashcards
(141 cards)
1
Q
Hemopytysis
A
Coughing up blood
2
Q
Orthopnea
A
Difficulty breathing when supine. State number of pillows needed to achieve comfort.
3
Q
Paroxysmal nocturnal dyspnea
A
Awakening from sleep with SOB and needing to be upright to achieve comfort
4
Q
Coughing continuously throughout day
A
Acute illness
5
Q
Cough in the afternoon/evening
A
Exposure to irritants at work
6
Q
Coughing at night
A
Post nasal drip; sinusitis
7
Q
Early morning cough
A
Chronic bronchial inflammation of smokers
8
Q
White or clear mucoid
A
Colds, bronchitis, viral infections
9
Q
Yellow or green mucous
A
Bacterial infection
10
Q
Rust colored mucous
A
TB, pneumococcal pneumonia
11
Q
Pink, frothy mucous
A
Pulmonary edema, some sympathomimetric medications have a side effect of pink-tinged mucous
12
Q
Decreased fremitus
A
Occurs when obstructed bronchitis, pleural effusion or thickening, pneumothorax, or emphysema. Any barrier that comes between the sound and your hand decreases fremitus.
13
Q
Increased fremitis
A
Occurs with compression or consolidation of lung tissue. This is present only when the bronchus is patent and the consolidation extends to the lung surface.
14
Q
Rhoncal fremitis
A
Palpable with thick bronchial secretions
15
Q
Pleural friction fremitis
A
Palpable with inflammation of the pleura
16
Q
Crepitis
A
A coarse, cracking sensation palpable over the skin surface. It occurs in subcutaneous emphysema when air escapes from the lung and enters the subcutaneous tissue, as after open thoracic injury or surgery.
17
Q
Hyperossance
A
Lower-pitched, booming sound found when too much air is present such as in emphysema or pneumothorax.
18
Q
Dull note
A
Soft, muffled thud) signals abnormal density in the lungs, as with pneumonia, pleural effusion, atelectasis, or tumor
19
Q
Barrel chest
A
Horizontal ribs and costal angle > 90 degrees
20
Q
When does hypertrophy of abdominal muscles occur?
A
Chronic emphysema
21
Q
Tense, strained, tired facies and purses lips while breathing
A
COPD
22
Q
Excessive drowsiness or anxiety, restlessness, irritability
A
Cerebral hypoxia
23
Q
Clubbing of distal phalanx occurs with __________ because of growth of vascular connective tissue.
A
COPD
24
Q
Noisy breathing
A
Severe asthma or chronic bronchitis
25
Unequal chest expansion
Pneumonia or pleurisy pain
26
Retraction of interspaces
Suggests obstruction of respiratory tract or atelectasis
27
Bulging of interspaces
Indicates trapped air as in the forced expiration associated with emphysema or asthma
28
Accessory muscles used to breath
Acute airway obstruction and massive atelectasis
29
Recite abdominis and internal intercostal muscles used for expiration
COPD
30
Abnormally wide costal angle with little inspiration variation
Emphysema
31
Lag in expansion
Atelectasis, pneumonia, and postoperative guarding
32
Palpable grating sensation with breathing
Pleural friction fremitus
33
inability to breathe, sharp pain on left side of chest. Cyanosis, tachypnea, tracheal deviation, to the right, decreased tactile fremitus on the left, hyperressonance on the left.
pneumothorax
34
70 y/o patient is being seen in the clinic for severe exacerbation of his heart failure. Which of these findings is the nurse most likely to observe?
A. shortness of breath, orthopnea, paroxysmal nocturnal dyspna, and ankle edema
35
The nurse is percussing over the lungs of a patient with pneumonia. The nurse knows percussion over an area with atelectasis the lungs will reveal;
dullness
36
____________ is a bony structure with a conical shape, which is narrower at the top
thoracic cage
37
___ pairs of ribs, and __ thoracic vertebrae
12, 12,
38
How many cervical, thoracic, and lumbar?
7, 12, 5, then sacrum, then coccyx
39
What is the breastbone?
Sternum
40
Angle of Louis
Manubriosternal angle, is at articulation of manubrium and sternum, and continuous with second rib
41
You can easily palpate down to the _______ rib
10th
42
Each intercostal space is numbered by ____________________.
The rib above it
43
Angle of Louis also marks site of tracheal ________ into right and left main bronchi;
bifurcation
44
Costal angle: the right and left costal margins form an angle where they meet at _________ process.
xiphoid process
45
Usually _____ degrees or less, this angle increases when rib cage is chronically overinflated, as in emphysema.
90
46
This is spinous process of C__; if two bumps seem equally prominent, upper one is C7 and lower one is T___.
C7, T1
47
What causes emphysema?
Lost elasticity in the alveoli. Impaired gas exchange.
48
Middle of the chest
-midclavicular line (is it on the left or right)
49
Manubriosternal angle (angle of Louis)
2nd intercostal space
| -site of bifurcation of the trachea
50
What classification of tissue is the diaphragm? Voluntary or involuntary?
- muscle
| - both voluntary and involuntary
51
How many intercostal spaces do we have?
11
52
Where is the PMI (point of maximal impulse)?
Lt
5th ICS
MCL
53
The higher the injury to the spinal cord the ___________
greater the risk for paralysis
54
What is the medical term for the shoulder blade?
scapula
55
Are processes depressions or projections?
projections
56
On anterior chest, note _______________ line and midclavicular line.
midsternal
57
Posterior chest wall has _______ (or midspinal) line and scapular line, which extends through inferior angle of scapula when arms are at sides of body.
vertebral
58
What is the anatomical landmark for the anterior axillary line
the axilla
59
Mediastinum: _______section of thoracic cavity containing esophagus, trachea, heart, and great vessels
middle
60
Base rests on ________ at about sixth rib in midclavicular line.
the diaphragm
61
Posteriorly, the location of ___ marks apex of lung tissue, and ___ usually corresponds to base.
C7, T10
62
Lobes of the lung
- Lungs are paired but not precisely symmetric structures.
- Right lung shorter than left because of underlying liver
- Left lung narrower than right because heart bulges to left.
- Right lung has three lobes, and left lung has two lobes.
63
Expiratory wheezes are found mostly where?
RUL and LUL
64
posterior chest is almost all _________ lobe.
lower
65
_________ lobe does not project onto posterior chest at all.
right middle lobe
66
Left lung only ____ lobes, upper and lower.
2
67
Visceral pleura lines ________ of lungs.
outside
68
It is continuous with _________ pleura lining inside of chest wall and diaphragm.
parietal
69
Pleural cavity normally has a vacuum, or ________ pressure,
negative
70
This is a potential space; when it abnormally fills with air or ____, it compromises lung expansion.
fluid
71
__________bronchus is shorter, wider, and more vertical than the left main bronchus.
right main
72
Bronchi are lined with ______ cells, which secrete mucus that entraps particles; bronchi are lined with cilia, which sweep particles upward where they can be swallowed or expelled.
goblet
73
_______ is a functional respiratory unit that consists of bronchioles, alveolar ducts, alveolar sacs, and the alveoli.
Acinus (parallel to kidney's nephron)
74
_______ are clustered like grapes around each alveolar duct.
Alveioli
75
______________ (slow, shallow breathing) causes carbon dioxide to build up in blood, and _____________ (rapid, deep breathing) causes carbon dioxide to be blown off.
hypoventilation, hyperventilation
76
Four major functions of the respiratory system
1. supply oxygen to the body
2. removing carbon dioxide as a waste product
3. maintaining homeostasis (acid-base balance) of arterial blood
4. Maintaining heat exchange
77
Normal stimulus to breathe for most of us is an increase of carbon dioxide in blood, or _____________.
hypercapnia
78
Normal value for pH
7.35-7.45
79
Normal value for HCO3
2.2-2.6
80
Normal value for PCO2
35-45
81
Normal percent Oxygen
98-100%
82
Normal stimulus to breathe for most of us is an increase of carbon dioxide in blood, or _____________.
hypercapnia
83
Decrease of oxygen in blood (____________) also increases respirations but is less effective .
hypoxemia
84
During the first ______ week s of fetal life, primative lung bud emerges
5
85
When does an infant's respiratory system function?
all body systems develop in utero, but the respiratory system alone does not function until birth
86
What conditions are associated with environmental tobacco smoke
- sudden infant death syndrome
| - negative behavioral and cognitive functioning, and increased rates of adolescent smoking
87
How much does the uterus elevate the diaphragm during pregnancy
4cm
88
Although the diahrpagm is elevated, it is not _________
fixed
- It moves with breathing even more during pregnancy, which results in an increase in tidal volume
- growing fetus increases oxygen demand on mother's body
89
Aging lung is more ______ structure that is, harder to inflate.
rigid
90
With aging, less surface area is available for ___ exchange.
gas
91
signs and symptoms of active TB incldue
coughing that lasts three or more weeks
coughing up blood
chest pain, pain with breathing or coughing
92
signs and symptoms of active TB incldue
coughing that lasts three or more weeks
coughing up blood
chest pain, pain with breathing or coughing
93
Prevalence of asthma in the US in 2011 was ___
8.4%
94
What is the most common chronic disease in childhood?
asthma
95
Who experiences the most asthma-related problems?
-blacks, hispanics, and american indians more so than Whites or Asians
96
Questions to ask when patient has shortness of breath
What brings it on? How severe is it? How long does it last?
Is it affected by position, such as lying down?
Occur at any specific time of day or night?
Shortness of breath episodes associated with night sweats?
Or cough, chest pain, or bluish color around lips or nails? Wheezing sound?Do episodes seem to be related to food, pollen, dust, animals, season, or emotion?
What do you do in a hard-breathing attack? Take a special position, or use pursed-lip breathing? Do you use any oxygen, inhalers, or medications?
How does the shortness of breath affect your work or home activities? Is it getting better or worse or staying about the same?
97
Additional History for Aging Adult
Tell me about your usual amount of physical activity.
(For those with a history of chronic obstructive pulmonary disease, lung cancer, or tuberculosis): How are you getting along each day? Any weight change in last 3 months? How much?
How is your energy level? Do you tire more easily? How does your illness affect you at home and at work?
Do you have any chest pain with breathing?
Do you have any chest pain after a bout of coughing or after a fall?
98
______________ diameter should be less than transverse diameter.
Anteroposterior
99
Instruct person to breathe through ______, a little bit deeper than usual.
mouth
100
Use flat ________ endpiece of stethoscope and hold it firmly on person’s chest wall; listen to at least one full respiration in each location.
diaphragm
101
Side-to-side ____________ is most important.
comparison
102
Normal ratio of AP (anterior posterior) to transverse for adult
transverse side is greater than twice of the AP (anterior posterior) 1:2
103
Normal ratio of AP (anterior posterior) to transverse for child
more round abdomen - about 1:1
104
If a patient is stabbed, should you remove the object?
No
105
When does blood pool in the posterior side?
-If dead because gravity
106
Fremitis is a ______ vibration
palable
107
Why do you ask the patient to say 99 or blue moon when assessing for tactile fremitis?
It will illicit vibrations; CHECK for symmetry
108
Which condition increases vibrations
the most solid consolidation/thickness, the more vibrations (ex pneumonia)
109
How to assess tactile fremitis
start over lung apices and palpate from one side to the other
110
Factors that affect the normal intensity of tactile fremitis
- relative location of the bronchi to the chest wall
- decreases as you progress down because more and more tissue impedes
- using fingers, gently palpate the entire chest wall
- enables noting any areas of tenderness, skin temperature and moisture, detecting any superficial lumps or masses, and exploring any skin lesions noted on inspection
111
a lot of sound upon percussion
hyperresonance
112
What sound should you hear in abdomen
tympany
113
What shound should you hear in the lungs
resonance
114
What sound should you hear in the liver
dullness
115
What sound should you hear in the bone
flat
116
What covers the lungs?
visceral pleura
117
What is the wall the cages the lungs
parietal pleura
118
Fluid around lungs
pleural fluid
119
Diaphragmatic Excursion
1. First, ask the person to “exhale and hold it” briefly while you percuss down scapular line until sound changes from resonant to dull on each side.
2. This estimates level of diaphragm separating lungs from abdominal viscera; it may be somewhat higher on right side because of presence of liver.
3. Mark the spot.
120
Where do you assess for symmetry on the back during breathing?
On the 9th or 10th spinal process
121
When assessing breath sounds, ask the patient to breath through the ______, a little bit deeper than usual
mouth
122
Going from superior to inferior, what breath sounds will you hear?
- bronchial sounds
- bronchovesicular sounds
- vesicular sounds
123
Is there bronchial sound in the posterior thorax?
No
124
Use flat ________ endpiece of stethoscope and hold it firmly on person’s chest wall; listen to at least one full respiration in each location
diaphragm
125
The nurse knows that the proper technique for assessing lungs in an adult patient is auscultation is performed __________________.
In a Z pattern
126
What are adventitious breath sounds?
Added sounds that are not normally heard in the lungs
127
What is the term for crackles?
rales
128
What is the term for wheezing?
rhonchi
129
What are voice sounds? How do you assess?
1. broncophany
2. Egonphany
3. Whispered pecteriliery
130
1. broncophany
Ask patient to say 99. Normally what you hear is muffled. If you can hear clearly, that is an area that is abnormal, suspicion of adventitious breath sound.
131
2. egonphany
If you hear "a" when patient says "e" then abnormal
132
3. Whispered pecteriloly
If you can hear the whisper clearly, then that is abnormal
133
TB is ___________ bacteria. Where does the TB bacteria want to be in the lungs?
aerobic; apex of lungs
134
Assess tactile (_____) fremitus
vocal
135
Normal respiration rate for infatns
25 to 40 breaths per minutes, count for 1 full minute
136
Why is sound more amplified in infants?
Their skin is very thin
137
Kyphosis
hunchback
138
The nurse is assessing a patient with tactile fremitis the nurse suspects the patient has
2. a mild case of pneumonia
139
Prenatal exposure to smoke causes __________
chronic hypoxia
140
Prenatal and postnasal exposure to secondhand tobacco smoke increases risk for ___________
sudden infant death syndrome, lower respiratory illnesses, acute and chronic otitis media, breathlessness, asthma, and adverse lung function throughout childhood
141
prenatal exposure to nicotine increases risk for ________________
ADHD and depression in children and adolescents
