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Patient Assessment > Thorax and Lung review > Flashcards

Thorax and Lung review Flashcards

(90 cards)

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1
Q

2nd intercostal space is used for

A

needle insertion for tension penumothorax

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2
Q

angle of louis

A

sternal angle
-5 cm lower than suprasternal notch

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3
Q

4th intercostal space is used for

A

chest tube insertion

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4
Q

level of the 4th rib

A

endotracheal tube on chest xray

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5
Q

7th intercostal space is for

A

thoracentesis needle

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6
Q

What vertebra is the most protruding process when neck is flexed?

A

c7 vertebra

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7
Q

What spinous process does the lower border of the lung lie around?

A

T10

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8
Q

Where should the RML be assessed along?

A

right anterior axillary line

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9
Q

Traits of the right main bronchus

A

wider, shorter and more vertical

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10
Q

common or concerning symptoms of thorax and lung analysis

A

dyspnea
wheezing
cough
hemoptysis
angina pectoralis
daytime fatigue
snoring

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11
Q

History to obtain for Dyspnea

A

-occurs at rest or exertion?
-pt’s daily exercise as a basis
-Timing, setting, any associated symptom and A/A factors
-

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12
Q

in dyspnea secondary to anxiety

A

-rest and exercise
-hyperventilation
-difficulty breathing/smothering sensation
-paresthesia around lips or extremities

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13
Q

Left sided heart failure

A

slow progression of dyspnea or sudden onset if pulmonary edema
associated symptoms: orthopnea, paroxysmal nocturnal dyspnea, sometimes wheezing

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14
Q

Chronic bronchitis

A

chronic productive cough
slowly progressive dyspnea
-recurrent respiratory infections, wheezing
-HX of smoking, exposure to air pollutants, COPD

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15
Q

COPD

A

-slowly progressive dsypnea
-cough with scant mucoid sputum
-hx of smoking, air pollutants, familial alpha1-antitrypsin deficiency

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16
Q

Asthma

A

reversible bronchoconstriction
-symptom free periods
-nocturnal episodes common
-wheezing, cough, tightness in the chest
-Aggravated by allergens, irritants, respiratory infection, exercise, cold and emotional

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17
Q

Diffuse Interstitial Lung Disease

A

progressive dyspnea with rate variable due to cause
-exertion aggravates
-weakness and fatigue
-cough is less common

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18
Q

Pneumonia

A

acute illness
-aggravated by exertions, smoking
-symptoms: pleuritic pain, sputum, fever (not present in much)

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19
Q

Spontaneous Pneumothorax

A

air pleural space w partial or full lung collapse
-sudden dyspnea
-pleuritic pain, non productive cough
COMMON: tall & young males, hx of emphysema

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20
Q

Acute Pulmonary Embolism

A

sudden dyspnea and tachypnea
-no associated symptoms
(sometimes: unilateral leg swelling, retrosternal oppressive pain, pleuritic pain, cough, syncope, hemoptysis, DVT)
-RISK FACTORS: Post-partum, Post-op, bed-rest, heart failure, COPD, fractures of the hips or legs, DVT, hypercoagubility

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21
Q

Anxiety with Hyperventilation

A

over breathing resulting in alkalosis
-@ rest
-symptoms: sighing, lightheadedness, numbness or tingling, palpitations, angina pectoralis

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22
Q

Duration of Coughs

A

Acute: < 3 weeks
subactute: 3-8 weeks
Chronic: >8 weeks

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23
Q

Color of Sputum

A

Yellow/green=bacterial
Clear/white= viral

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24
Q

Foul odor of sputum

A

indicates lung absess

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25
Symptoms to help determine cause of a cough
fever, wheezing, chest pain, dyspnea, orthopnea
26
Hemopytsis
-determine the volume, setting and activity, and associated symptoms
27
Cough and Hemoptysis
seen with pneumonia, chronic bronchitis, bronchiectasis, TB, lung abscess, lung cancer, PE -
28
Pink frothy sputum seen with
left heart failure
29
What to ask with chest pain
location of pain -attributes of chest pain
30
Tearing from the front of the chest to the back
aortic dissection
31
Initial Survey signs of Respiratory Distress
tachypnea Cyanosis or pallor clubbing of fingernails Audible breath sounds accessory muscle use tracheal displacement shape of chest
32
Tracheal displacement is seen in
tension pneumothorax, pleural effusion, atelectasis
33
Inspection checks for
deformities or asymmetry in chest expansion intercostal retractions impaired respiratory movements
34
Palpation Identifies
Areas of tenderness palpable crepitus (grating sound) Masses Test fo chest expansion Vocal fremitus
35
Palpation Process
-Chest expansion (front and back- check how far your thumbs expand) -Tactile Fremitus (say 99 and use ulna down the chest. 4 on the back and 3 down the front) -assess for masses
36
Causes of Unilateral Decrease in chest expansion
chronic fibrosis pleural effusion lobar pneumonia pleural pain with splinting unilateral bronchial obstruction paralysis of hemi-diaphragm
37
Causes of asymmetric decreased tactile fremitus
chest impeded by thick chest wall obstructed bronchus COPD pleural effusion fibrosis pneumothorax malignancy asthma
38
cause of asymmetric increased tactile fremitus
unilateral pneumonia
39
Percussion process
Percuss the back (14 total, 5 down the middle, 2 on the sides) Diaphragmatic excursion
40
Flat percussion sound examples
pleural effusion
41
Dull percussion sound
lobar pneumonia atelectasis pleural effusion hemothorax tumor
42
Resonant
Healthy lung sound! Chronic bronchitis asthma (between attacks)
43
Hyperresonant
Unilateral with pneumothorax COPD Asthma attack
44
Tympanitic
Large pnuemothorax
45
Diaphragmatic excursion
Identify the diaphragm and then find the dullness mark the dullness at full inspiration and full expiration
46
Normal diaphragmatic excursion
3-5.5cm
47
Auscultation
Ask for the pt to breath through their mouth -ladder position, 14 on the back, 12 on the front Go through Egophony, bronchophony and whispered pectoriloquy
48
Vesicular Breath Sounds
Inspiratory > Expiratory soft low pitch heard over both lungs
49
Broncho-Vesicular breath sounds
inspiratory = expiratory intermediate sound intermediate pitch -in the 1st and second interspaces and between the scapula
50
Bronchial Breath sounds
Expiratory > inspiratory Loud high Pitch over the large proximal airways
51
Tracheal breath sounds
inspiratory=expiratory very loud high pitch over the trachea
52
Crackles (Rales)
popping -dots in time, non musical, brief -Fine=high pitched -Coarse= louder and lower pitched
53
Wheezing Breath Sounds
Asthma, COPD, airway obstruction -dashes in time -high pitched
54
Rhonchi
"snoring" secretions in the large airways -dashes in time -low pitched
55
Crackles is caused by
abnormalities of the lungs pneumonia lung disease pulmonary fibrosis heart failure bronchitis and bronchiectasis
56
Wheezing is caused by
narrowed airways of asthma COPD bronchitis
57
Egophony
ask pt to say "eee" negative ("eee") positive ("aye") positive= lung consolidation
58
Whispered Pectoriloquy
ask pt whisper "99" normal (heard faintly) abnormal (words heard clerarly) Indicates= tissue has lost air (pneumonia)
59
Bronchophony
ask pt to say "99" normal (sounds are muffled and indistinct) abnormal (sounds are clear) High pitched sounds indicates lung tissue has lost air
60
Egophony, bronchophony and whispered pectoriloquy are seen in
lobar consolidation and pneumonia
61
Normal adult chest inspection
Lateral Diameter > AP diameter 0.7-0.9 ratio Increases with age
62
Funnel Chest
Pectus excavtum -depression in lower portion of the sternum -cause murmurs and heart compression
63
Pectus Carinatum
Pigeon chest Sternum displaced anteriorly, increases the diameter of AP -costal cartilages near sternum are depressed
64
Barrel Chest
increased AP diameter -normal during infancy and old age -COPD
65
Traumatic Flail Chest
Multiple rib fractures cause paradoxical movement of the thorax -Inspiration: injured area caves inward -expiration: it moves outward
66
Thoracic Kyphoscoliosis
Abnormal spinal curvatures vertebral rotation deform the chest
67
Special Techniques
6-minute walk test Forced Expiratory Time (FET) Fractured rib test
68
6 minute walk test
measures the distance a patient can walk on hard, flat, for 6 minutes -100 ft minimum -predictor of clinical outcome of COPD
69
FET
PT: deep breath in and out as quickly as possible with mouth open Listen over the trachea slow expiratory time >5 seconds
70
Pts >60 yo and FET of >9 seconds are
4x more likely to have COPD
71
Identification of a Fractured Rib
Compress the chest in the AP plane -one hand on sternum and one on the thoracic spine and squeeze -pain distal to your hands=rib fracture
72
Normal Physical Findings
Resonant Trachea Midline Vesicular Breath sounds No adventitious sounds Normal tactile fremitus and voice sounds
73
Left sided heart failure physical findings
Resonant midline trachea vesicular breath sounds Late inspiratory crackles possible wheezing normal tactile fremitus and voice sounds
74
Chronic Bronchitis Physical Findings
Resonant Midline trachea Vesicular breath sounds no adventitious sounds (sometimes scattered wheezing, crackles or rhonchi) normal tactile fremitus
75
Lobar Pneumonia Physical Findings
Dull Midline Trachea Bronchial sounds (Over affected lobe) Late inspiratory crackles Increased tactile fremitus Abnormal egophony, bronchophony and whispered pectorlioquy
76
Partial Lobar Obstruction (atelectasis) Physical findings
Dull Tracheal shift (toward injured side) Absent breath sounds No adventitious sounds absent tactile fremitus and transmitted voice sounds
77
Pleural Effusion Physical findings
Dull to flat shifted trachea toward the unaffected side Decreased breath sounds No adventitious sounds (sometimes wheezes, crackles, rhonchi) Decreased tactile fremitus or voice sounds
78
Pneumothorax Physical Findings
Hyperresonant/tympanitic Shifted toward opposite side (in tension) Decreased breath sounds over the pleural air No adventitious sounds Decreased tactile fremitus and voice sounds
79
COPD physical findings
Diffusely hyperresonant Midline trachea Decreased breath sounds (w delayed expiration) No adventitious sounds (unless assoc. w chronic bronchitis) normal tactile fremitus and voice sounds
80
Asthma physical findings
Resonant to diffusely hyperresonant Midline trachea Breath sounds obscured by wheezing Wheezing, rales Decreased tactile fremitus and voice sounds
81
Example of normal Inspection documentation
Breathing is easy without signs of distress. Chest wall is symmetric without deformity. No retractions.
82
Palpation example of normal documentation
No areas of tenderness to palpation. No palpable masses. Symmetric lung expansion A and P. Tactile fremitus is symmetric A and P.
83
Percussion normal documentation example
Percussion is resonant to all areas of the lung anteriorly and posteriorly. Diaphragmatic excursion is 5cm L and R.
84
Auscultation normal documentation example
Vesicular breath sounds are heard throughout the lung fields anteriorly and posteriorly with good aeration. There are no adventitious sounds noted. No abnormalities of egophony, bronchophony, or whispered pectoriloquy detected.
85
Example of a normal lung exam
Breathing is easy without signs of distress. Chest wall is symmetric without deformity. No retractions. No areas of tenderness to palpation. No palpable masses. Symmetric lung expansion A and P. Tactile fremitus is symmetric A and P. Percussion is resonant to all areas of th elung A and P. Diaphragmatric excursion is 5 cm L and R. Vesicular breath sounds are hear throughout the lungs fields A and P with good aeration. There are no adventitious sounds noted. No abnormalities of egophony, bronchophony, or whispered pectoriloquy.
86
Emphysema
pathologic DX, permanent enlargment of respiratory zone. -older and thin -severe dyspnea -quiet chest -Xray- hyperventilation with flattened diaphragm
87
Chronic bronchitis
clinical dx of daily productive cough for 3 or more months for 2 years. -overweight and cyanotic -elevated hemoglobin -rhonchi and wheezing -edema
88
Typical Community Acquired Pneumonia
Acute infection of lung parenchyma -from hospital -Fever, cough, sputum, rigors, pleuritics, dyspnea, tachycardia Bronchiol breath sounds Rales Egophony positive whispered pectoriloquy increased tactile fremitus Streptococcus pneumonae is most common
88
Exudative Pleural Effusion
occurs due to inflammation and icnreased capillary permeability -pneumonia, cancer, TB, automimmune high protein and LDH Yellow
88
Transudative Pleural Effusion
increased hydrostatic pressure or low plasma oncotic pressure (CHF, cirrhosis, nephrotic syndrome, PE, Hypoalbuminemia) Low in protein and LDH Clear color

Patient Assessment (20 decks)

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