Flashcards in Phsyical assessment of Pulmonary system lecture Deck (37):
which of the 4 cornerstones are used in the pulmonary exam?
Where can we get the closest to the lung tissue?
the intercostal space
What is a good starting point for determining clinical anatomy?
What is located 5cm below the suprasternal notch?
the sternal angle (angle of Louis)
What intercostal space is located at the same level and the sternal angle?
What is marker for the beginning of the posterior chest wall?
the C-7 spinous process.
Which lobes can you auscultate anteriorly?
RUL, RML, LUL
Where can you auscultate the Lower Lobes anteriorly?
LLL and RLL are located at the costophrenic angle
What lobes can you osculate posteriorly?
LLL and RLL (uppers as well)
systemic signs of pulmonary dz.
signs of respiratory distress
Rate and effort
accessory muscle use
Unusual respiratory noises
What do you inspect anteriorly?
pigeon chest (convex)
funnel chest (concave)
funnel chest (concave)
inspection of posterior chest
Palpation of chest
Any abnormalities seen on inspection.
Symmetric chest expansion
causes of asymmetric chest expansion
Decreased tactile fremitus indicates
unusual thick chest wall
Increased tactile fremitus indicates:
percussion note for pleural effusion
dull/flat depending on size
Percussion note for consolidation (edema/pna)
dull over area of decreased aeration
percussion note for atelectasis
dull over atelectasis
percussion note for normal lung tissue
percussion note for ptx
hyperresonant or tympanic if large
percussion note for COPD
percussion note for Asthma
what 3 things are you listening for on ausculation?
Presence of adventitious sounds
when abnormal-sound of whispered word
What must you ALWAYS ask pt to do when auscultating?
breathe through mouth.
soft and low
throughout inspiration but fade after 1/3 expiration.
Louder than vesicular sounds
Heart equally insp. and exp. usually separated by interval
Heart best at 1 and 2 ICS anterior, and between scap posterior
very loud high pitched sounds
Exp sounds longer
heart best over manibrium
3 types of adventitious sounds
low pitched - snoring/geese honking-secretions in large airways
High pitched, shrill, inspiratory/expiratory, assoc. w/ asthma, COPD, bronchitis
Stridor-long inspiratory wheeze
fine-high pitched brief duration (suddenly pop open during late inspiration!!
Coarse-Low pitched louder longer duration-alveoli bubbles through secretions early inspiration!!
NOTE WHAT PHASE OF BREATHING YOU HEAR THE CRACKLES!