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Respiratory & Thorax Flashcards

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1
Q

Normally we think of the ABCs in an emergency. What order should we consider during cardiac arrest?

A

CAD – we want to move that blood!

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2
Q

Name three anterior thoracic landmarks:

A
  • SUPRASTERNAL NOTCH
  • STERNUM
  • COSTAL ANGLE
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3
Q

Name three posterior thoracic landmarks:

A
  • SPINOUS PROCESSES
  • INFERIOR BORDER OF SCAPULA
  • TWELFTH RIB
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4
Q

The upper lobes of the lungs take up a very ________ amount of space.

A

Small

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5
Q

The right lung is shorter/longer because of the _______.

A

Shorter, liver

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6
Q

How many lobes does the right lung have?

A

3

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7
Q

Name the lobes of the right lung:

A
  • RUL
  • RML
  • RLL
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8
Q

The left lung is ___________ because of the _________.

A

Narrower, heart

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9
Q

Name the lobes of the left lung:

A
  • LUL

* LLL

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10
Q

The left lung has no ___________ lobe.

A

Middle

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11
Q

Anterior lung fields are best heard where?

A

Upper lobes

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12
Q

When auscultating the RML, how should the patient be positioned if they are laying down?

A

On their side

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13
Q

Posterior lung fields begin at ____ spinous process.

A

C7

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14
Q

Posterior lung fields extend to ______ on expiration.

A

T10

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15
Q

Posterior lung fields extend to ______ on inspiration.

A

T12 (with full lung capacity)

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16
Q

Posterior lung fields are best heard where?

A

Lower lobes

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17
Q

Which lobe is not accessible posteriorly?

A

RML

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18
Q

Pneumonia is more likely to be heard in the _____________ lungs.

A

Lower posterior

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19
Q

What are some things to ask when doing a health history re: respiratory?

A

• CHRONIC RESPIRATORY PROBLEMS (COPD, ASTHMA, CHRONIC BRONCHITIS)
• COUGH
- PRODUCTIVE – COLOR, NONPRODUCTIVE, HEMOPTYSIS
• SHORTNESS OF BREATH
• CHEST PAIN WITH BREATHING (plural friction)
• SMOKING/VAPING HISTORY
- PACK (PPD), & # OF YEARS
• ENVIRONMENTAL EXPOSURE
• OCCUPATIONAL EXPOSURE
• MEDICATIONS
• SELF-CARE BEHAVIORS

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20
Q

What is hemoptysis?

A

The spitting of blood that originated in the lungs or bronchial tubes

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21
Q

This to observe during inspection re: respiratory:

A 
ANY VISIBLE DISTRESS?
• EASE AND EFFORT OF BREATHING
• (DYSPNEA, ORTHOPNEA)
• CHEST MOVEMENT (USE OF ACCESSORY MUSCLES) 
• SPUTUM – COLOR, CONSISTENCY, AMOUNT
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22
Q

What is orthopnea?

A

The sensation of breathlessness in the recumbent position, relieved by sitting or standing.

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23
Q

When auscultating the chest, what are you listening for?

A

Can you hear any audible breath sounds?

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24
Q

Name some problematic breath sounds:

A

Stridor, wheeze, bubbling/gurgling, snoring, gasping.

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25
When assessing HOW the patient is breathing, what are you checking?
* RATE (TACHYPNEA, BRADYPNEA, APNEA) * VOLUME (HYPERVENTILATION, HYPOVENTILATION) * DEPTH (DEEP, NORMAL, SHALLOW) * RHYTHM (REGULAR, PAUSES)
26
What is a normal respiratory rate?
12-20 breaths per minute
27
What is a normal breathing rate called (fancy medical term)?
Eupnea
28
What is the normal breathing rate for a newborn?
30-60 breaths per minute
29
What is the name for an increased respiration rate?
Tachypnea
30
What are some causes of tachypnea?
PNEUMONIA, PULMONARY EDEMA, ACIDOSIS, SEPTICEMIA, PAIN
31
What is the name for a decreased respiration rate?
Bradypnea
32
What is a potential cause of bradypnea?
ICP INCREASE DUE TO DRUG OD
33
What happens during hyperventilation?
* DEPTH & RATE INCREASES * DEEP AND REGULAR * > 24 BREATH/MIN
34
What happens during hypoventilation?
* DEPTH & RATE DECREASE, SHALLOW & IRREGULAR * < 10 BREATHS/MIN * CAN SEE WITH PROLONGED BED REST, NARCOTICS
35
What is apnea?
Not breathing (transient cessation of breathing, 10-20 seconds)
36
``` Name this breathing pattern: • RATE AND DEPTH ARE VARIABLE, REGULAR- IRREGULAR RHYTHM CYCLES SLOW AND SHALLOW TO DEEP AND FAST, WITH PERIODS OF APNEA • DEATH RATTLES • DEATH RALES ```
Cheyne-stokes
37
Name this breathing pattern: • RATE & DEPTH CAN BE VARIABLE, IT IS IRREGULAR, IMAGE SHOWS INCREASED DEPTH AND RATE W/ ABRUPT PAUSES • ASSOC W/ H ICP (INCREASED INTRACRANIAL PRESSURE) • Also called "ataxic breathing"
Biots
38
``` Name this breathing pattern: • REGULAR BUT ABNORMALLY DEEP AND INCREASED IN RATE • AIR HUNGER • ACIDOTIC BREATHING • RAPID AND DEEP ```
Kussmaul respirations | This is a type of hyperventilation
39
What breathing pattern is seen with things like TBI, post-stroke, carbon monoxide poisoning?
Cheyne-stokes
40
What breathing pattern is seen with things like diabetic ketoacidosis, exercise, metabolic acidosis, renal failure.
Kussmaul
41
What is pectus carinatu?
An uncommon birth defect in which a child's breastbone protrudes outward abnormally.
42
What is pectus excatavum?
A condition in which a person's breastbone is sunken into his or her chest.
43
What posture is a curvature of the spine measuring 50 degrees or greater on an X-ray, presents hunchback, stooped; from damaged or compressed vertebrae?
Kyphosis
44
What posture is a sideways curvature of the spine assessed often in middle-school, can be idiopathic.
Scoliosis
45
For what are you assessing in the spine?
* TENDERNESS * TEMPERATURE * SKIN INTEGRITY * POSITION OF TRACHEA * THORACIC EXPANSION
46
What is tactile fremitus?
Also known as tactile vocal fremitus, refers to the vibration of the chest wall that results from sound vibrations created by speech or other vocal sounds
47
How do you test for tactile fremitus?
* USE PALMAR OR ULNAR SURFACE * PALPATE VOCAL SOUNDS, I.E. PATIENT REPEATS “99” * SYSTEMATICALLY PALPATE SIDE TO SIDE IN SAME ARE
48
What are "normal" tactile fremitus results?
PALPABLE (FAINT) VIBRATIONS OF CHEST WALL OVER LUNG FIELDS FROM SPEECH OR SOUNDS
49
What is crepitus?
* SUBCUTANEOUS EMPHYSEMA | * AIR LEAKS INTO THE SUB-Q TISSUE
50
Re: Palpation over lungs. What do healthy lungs feel like?
* RESONANCE OVER LUNG FIELDS: LOW PITCHED, CLEAR, HOLLOW
51
What are some unhealthy lung palpation feels?
* ASYMMETRY IN PERCUSSION NOTES | * AREAS OF DULLNESS OR FLATNESS OVER LUNG TISSUE
52
Name 3 normal breath sounds:
BRONCHIAL, BRONCHO - VESICULAR, and VESICULAR
53
Talk about vesicular breath sounds (where are they heard? Where are they heard best? What is making these sounds?):
* AUDIBLE OVER MOST OF THE ANTERIOR, POSTERIOR AND LATERAL LUNG AREAS * HEARD BEST AT BASES * SOFT BREEZY QUALITY AND OCCUR MAINLY DURING INSPIRATIONS * CREATED BY AIR MOVING THROUGH THE BRONCHIOLES AND ALVEOLI
54
Talk about bronchial breath sounds (where are they heard? What do they sound like?):
* HEARD AROUND THE TRACHEA | * HIGH PITCHED AND “HARSH” WITH A LONG, LOUD EXPIRATION
55
Talk about broncho-vesicular breath sounds (where are they heard? What do they sound like? When are they heard?):
* NEAR THE STERNUM AND BETWEEN THE SCAPULAE * MODERATE PITCH AND INTENSITY—”BLOWING” * OCCUR EQUALLY OVER INSPIRATION AND EXPIRATION
56
Name this breath sound: • CRACKLING OR POPPING SOUNDS OF VARYING INTENSITY • MAY BE DESCRIBED AS FINE OR COARSE • CANNOT BE CLEARED BY COUGHING • CAUSED BY AIR PASSING THROUGH FLUID OR MUCUS • FINE VS COURSE
CRACKLES (FKA RALES)
57
Name this breath sound: • LOW-PITCHED, COARSE, GURGLING, LOUDER SOUNDS • MAY HAVE MOANING OR SNORING QUALITY • MAY BE ALTERED OR CLEARED BY COUGHING • CAUSED BY AIR PASSING THROUGH NARROWED AIR PASSAGES DUE TO SECRETIONS, SWELLING OR TUMORS
RHONCHI (FKA GURGLES)
58
Name this breath sound: • WHISTLING SOUND • MAY BE DESCRIBED AS SONOROUS, MUSICAL, MOANING • DESCRIBE RELATED TO INSPIRATION/EXPIRATION • CAUSED BY AIR PASSING THROUGH A CONSTRICTED BRONCHUS DUE TO SECRETIONS, SWELLING OR TUMOR • MORE PRONOUNCED ON EXPIRATION • CAN SOMETIMES HEAR WITH NO STETHOSCOPE
Wheezing
59
Name this breath sound: • SQUEAKING OR GRATING SOUND • HEARD IN LATERAL LUNG FIELDS DURING INSPIRATION AND EXPIRATION • HEARD OFTEN IN AREA OF AREAS OF GREATEST THORACIC EXPANSION • CAUSED BY THE RUBBING TOGETHER OF INFLAMED PLEURAL SURFACE
PLEURAL FRICTION RUB
60
``` Name this breath sound: • USUALLY CAN BE HEARD WITHOUT A STETHOSCOPE • CROWING NOISE • HEARD DURING INSPIRATION • THINK OBSTRUCTION OR SWELLING ```
STRIDOR
61
If you ask you patient to cough, which sound will NOT go away and which will?
Crackles will not go away, rhonchi will
62
What is egophony?
Increased resonance of voice sounds heard when auscultating the lungs.
63
What is pectoriloquy?
The sound of words heard through the chest wall and usually indicating a cavity or consolidation of lung tissue
64
What is bronchophony?
The abnormal transmission of sounds from the lungs or bronchi. Bronchophony is a type of pectoriloquy.
65
What are some tests related to pulmonary function?
* PEAK FLOW METER * PULMONARY FUNCTION TEST (tidal volume, etc) * ARTERIAL BLOOD GAS * INCENTIVE SPIROMETER (10/hr)
66
Talk about how the effects ageing has on pulmonary function?
• THORAX MAY BECOME MORE ROUNDED, DUE TO KYPHOSIS (OSTEOPOROSIS). • LOSS OF SKELETAL MUSCLE STRENGTH + CONSTANT LUNG INFLATION CAUSES THE ANTEROPOSTERIOR DIAMETER OF THE CHEST TO WIDEN—BARREL CHEST. • BREATHING RATE AND RHYTHM ARE UNCHANGED AT REST—INCREASED WITH EXERCISE—TAKES LONGER TO RETURN TO BASELINE. • DEFLATION OF LUNGS IS INCOMPLETE • ELASTIC TISSUE OF THE ALVEOLI LOSES IT STRECHABILITY AND CHANGES FIBROUS TISSUE, WHICH DECREASES EXERTIONAL CAPACITY.

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