Respiratory Powerpoint

Question 1

Examine the posterior thorax and lungs while the patient is

Answer 1

sitting

Question 2

Examine the anterior thorax and lungs with the patient

Answer 2

supine

Question 3

Anteriorly with percussion, the heart normally produces an area of

Answer 3

dullness to the left of the sternum from the 3rd to 5th rib interspaces. Supraclavicular retraction is often present

Question 4

Inspect the chest; front and back; noting thoracic landmarks for the following:

Answer 4

Size and shape, symmetry, color, superficial venous patterns, prominence of ribs

Question 5

Evaluate respirations for the following

Answer 5

rate and rhythm or pattern

Question 6

Inspect chest movements with breathing for the following

Answer 6

• Symmetry

- Use of accessory muscles

Question 7

Palpate the thoracic muscles/skeleton

Answer 7

• pulsations
• tenderness
• bulges/depressions
• unusual movement/position
• elasticity of rib cage
• immovability of sternum
• rigidity of thoracic spine

Question 8

Palpate the chest for the following

Answer 8

• symmetry
• thoracic expansion
• sensations such as crepitus, grating vibration
• tactile fremitus

Question 9

Percuss on the chest, comparing sides, for the following:

Answer 9

• diaphragmatic excursion

- percussion tone intensity, pitch, duration, and quality

Question 10

Auscultate the chest with the stethoscope diaphragm, from apex to base, comparing sides for the following:

Answer 10

• Intensity, pitch, duration, and quality of breath sounds
• Adventitious breath sounds (crackles, rhonchi, wheezes, friction rub)
• Vocal resonance

Question 11

Inspect the posterior chest from a midline position behind the patient, note

Answer 11

the shape of the chest and the way in which it moves

Question 12

Percuss chest anterior, lateral, posterior

Answer 12

-compare tones bilaterally

Question 13

Percussion

-Perform from side to side to assess for asymmetry

Answer 13

• strike using the tip of your tapping finger

- use the lightest percussion that produces a clear note

Question 14

Percussion helps establish whether the underlying tissues (5-7cm deep) are

Answer 14

air-filled, fluid-filled, or solid

Question 15

Percussion Tones

Resonance

Answer 15

is normal

Question 16

Percussion Tones

Hyperresonance indicates

Answer 16

hyperinflation

Question 17

Percussion Tones

Dullness indicates

Answer 17

diminished air exchange

Question 18

Tactile Fremitus - place thumbs at the level of the

Answer 18

10th rib with fingers loosely grasping and parallel to the lateral rib cage; watch the distance b/t the thumbs as they move apart during inspiration

Question 19

Tactile Fremitus

Estimate the extent of

Answer 19

diaphragmatic excursion. Descent may be limited by several types of pathologic processes such as pleural effusion, atelectaisis, or diaphragmatic paralysis

Question 20

Posterior Chest
Auscultation
Listen to the breath sounds with the

Answer 20

diaphragm of a stethoscope after instructing the patient to breathe deeply through an open mouth

Question 21

Posterior Chest
Auscultation
Move from one side to the other and compare

Answer 21

symmetric areas of the lungs

Question 22

Normal breath sounds

Vesicular:

Answer 22

Soft and low pitched, low intensity; usually heard over most of both lungs

Question 23

Normal breath sounds

Bronchial:

Answer 23

louder and higher in pitch and intensity; usually heard over the manubrium

Question 24

Normal breath sounds:

Bronchovesicular:

Answer 24

intermediate intensity and pitch; usually heard over the 1st and 2nd interspaces (major bronchi)

Question 25

Normal breath sounds | Tracheal:

Answer 25

very loud and high pitched, heard over trachea and neck

Question 26

Adventitious Sounds | Crackles (formerly called rales)

Answer 26

-Heard more often during inspiration and characterized by discrete discontinuous sounds

Question 27

Adventitious Sounds | Fine Crackles

Answer 27

High pitched and relatively short in duration

Question 28

Adventitious Sounds | Coarse Crackles

Answer 28

Low pitched and relatively longer in duration

Question 29

Adventitious Sounds | Rhonchi

Answer 29

Deeper, more rumbling, more pronounced during expiration, more likely to be prolonged and continuous, and less discrete than crackles

Question 30

Adventitious Sounds Rhonchi Caused by

Answer 30

the passage of air through an airway obstructed by thick secretions, muscular spasm, new growth, or external pressure

Question 31

Adventitious Sounds | Wheezes

Answer 31

Continuous, high-pitched, musical sound (almost a whistle) heard during inspiration or expiration

Question 32

Adventitious Sounds Wheezes Caused by

Answer 32

a relatively high-velocity air flow through a narrowed or obstructed airway

Question 33

Adventitious Sounds Wheezes May be caused by the

Answer 33

bronchospasm of asthma (reactive airway disease) or acute or chronic bronchitis

Question 34

Adventitious Sounds | Friction Rub

Answer 34

- Occurs outside the respiratory tree | - Dry, crackly, grating, low-pitched sound and is heard in both expiration and inspiration

Question 35

Adventitious Sounds Friction Rub Caused by

Answer 35

inflamed, roughened surfaces rubbing together

Question 36

``` Adventitious Sounds Mediastinal Crunch (Hammam Sign) ```

Answer 36

Dry, crackly, grating, low-pitched sound and is heard in both expiration and inspiration

Question 37

Adventitious Sounds Mediastinal Crunch (Hammam Sign) Caused by

Answer 37

inflamed, roughened surfaces rubbing together | -Occurs outside the respiratory tree

Question 38

Vocal Resonance | Spoken voice transmits sounds through

Answer 38

the lung fields that may be heard with the stethoscope

Question 39

The following auditory changes may be present in any condition that consolidates lung tissue

Answer 39

- Bronchophony - Pectoriloquy - Egophony

Question 40

Vocal resonance diminishes and loses intensity when there is

Answer 40

loss of tissue within the respiratory tree (ex. with the barrel chest of emphysema)

Question 41

Bronchophony

Answer 41

greater clarity and increased loudness of spoken sounds

Question 42

Pectoriloquy

Answer 42

extreme brinchophony where even a whisper can be heard clearly through the stethoscope

Question 43

Egophony

Answer 43

Intensity of the spoken voice is increased and there is a nasal quality (E's become stuffy broad A's)

Question 44

The sternal angle, also called the manubriosternal joint or Angle of Louis, is the angle formed by the

Answer 44

junction of the manubrium and the body of the sternum in the form of a secondary cartilaginous joint (symphysis)

Question 45

The sternal angle is a ____ clinical landmark

Answer 45

palpable. The angle is 140 degrees

Question 46

The Angle of Louis or sternal angle marks the approx. level of the

Answer 46

2nd pair of costal cartilages and the level of the intervertebral disc b/t T4 and T5