thorax assessment

Question 1

where do the lungs lie?

Answer 1

by the costals

Question 2

subjective data for ROS can include?

Answer 2

cough, dyspnea, chest pain w/ breathing, history of respiratory infections, smoking history, environmental exposure

Question 3

how long do you auscultate the lungs?

Answer 3

for a full inspiration and expiration

Question 4

thorax equipment needed

Answer 4

stethoscope, alcohol wipes, patient gown

Question 5

inspection of anterior chest

Answer 5

landmarks, shape and symmetry, skin color and condition, note patient’s facial expression, assess level of consciousness, assess quality of respirations, count rate obtrusively

Question 6

what should you inspect FOR?

Answer 6

airway obstruction (prolonged expiration, stridor, cough)

Question 7

what should you do if a patient complains of dyspnea?

Answer 7

take SPO2, it porvides valuable information about the effectiveness of respirations

Question 8

when do you usually require supplemental oxygen

Answer 8

when pulse ox is under 93%

Question 9

tachypnea

Answer 9

rapid breaths, over 24 breaths per minute

Question 10

bradypnea

Answer 10

rate of 10 or less per minute

Question 11

hypoventilation

Answer 11

often at a rate less than the expected range

Question 12

hyperventilation

Answer 12

rapid, deep breathing at a rate of greater than 24 breaths per minute

Question 13

cheyne stokes breathing

Answer 13

usually a sign of death, start-stop pattern

Question 14

ataxic breathing

Answer 14

periods of apnea, irregular breathing with varying depths of respiration and periods of apnea

Question 15

anteroposterior diameter

Answer 15

compare transverse and AP diameter; should be 2:1 ratio

Question 16

expected findings of inspections

Answer 16

symmetrical thorax; AP diameter 2:1, downward facing ribs, no cyanosis or pallor, eupneic, comfortale, trachea midline

Question 17

unexpected findings

Answer 17

skeletal deformities; barrel chest, AP diameter 1:1, ribs horizontal, cyanosis, brady/tachypnea, work of breathing, trachea deviated

Question 18

barrel chest

Answer 18

caused from hyperinflation of lungs due to COPD

Question 19

funnel chest

Answer 19

marked sunken sternum and costal cartilage, does not cause any respiratory distress

Question 20

pigeon chest

Answer 20

protrusion of sternum, should not cause respiratory distress

Question 21

palpation tactics

Answer 21

symmetric expansion, tactile fremitus, checking for tenderness/crepitus

Question 22

tactile fremitus

Answer 22

vibration of chest wall, result of sound transmitting through lung tissue, repeated phrase

Question 23

causes of decreased fremitus

Answer 23

excess air in lungs, increased thickness of chest wall

Question 24

cause of increased fremitus

Answer 24

lung consolidation, air in healthy lung replaced with something else (exudate, blood, pus, cells, etc.)

Question 25

expected findings of palpation

Answer 25

equal chest expansion, symmetrical vibrations with tactile fremitus

Question 26

unexpected findings of palpation

Answer 26

unequal chest expansion, pain with inspiration, unsymmetrical vibrations, decreased fremitus, increased fremitus, crepitus

Question 27

percussion of thorax

Answer 27

tapping chest to determine consistency, predominant note should be resonance, dullness or hyperresonance can occur

Question 28

auscultation of thorax

Answer 28

evaluate presence and quality of normal breath sounds both anterior and posterior; note description of characteristics and location of breath sounds

Question 29

types of breath sounds

Answer 29

bronchial/tracheal, bronchovesicular, vesicular

Question 30

what are the loudest breath sounds

Answer 30

bronchial and tracheal, closest to airway

Question 31

what are the quietest breath sounds

Answer 31

vesicular, farthest from airway

Question 32

adventitious lung sounds

Answer 32

crackles - fine or course atelectatic crackles pleural friction rub wheeze - sibilant or sonorous rhonchi stridor

Question 33

stridor

Answer 33

medical emergency, signifies upper airway obstruction

Question 34

common abnormalities of physical findings

Answer 34

asthma, atelectasis (alveoli are collapsed), bronchitis, pleurisy, COPD, pneumonia

Question 35

what is pleurisy

Answer 35

sharp chest pain with inspiration

Question 36

what are signs of COPD in physical findings

Answer 36

barrel chest, accessory muscle use, reduced vesicular sounds

Question 37

pneumonia physical findings

Answer 37

crackles, dyspnea, cough with sputum

Question 38

abnormal respiration patterns

Answer 38

sigh, tachypnea, hyper/hypoventilation, bradypnea, biot's repiration, cheyne stokes, chronic obstructive breathing

Question 39

adventitious breath sounds (similar to lung sounds)

Answer 39

crackles, rhonchi, wheezes, friction rub, stridor

Question 40

summary checklist thorax and lungs

Answer 40

inspect thoracic cage, respirations, skin color, condition palpate and confirm symmetric expansion and tactile fremitus, detect lumps, masses, or tenderness percuss lung fields and estimate diaphragmatic excursion ausculate and assess breath sounds, not any abnormal/adventitiouss breath sounds

Question 41

common diagnostic tests

Answer 41

white blood cell count, sputum culture, arterial blood gas, chest x-ray, pulmonary function tests, V/Q scan

Question 42

white blood cell count

Answer 42

blood tells us that there is an infection, not specific

Question 43

sputum culture test

Answer 43

in petri dish, tells us what bacteria is growing, helps determine which antibiotic

Question 44

arterial blood gas test

Answer 44

gives us blood pH, amount of CO2, and amount of bicarbon, tells us how well we are oxygenating

Question 45

chest x-ray

Answer 45

pneumonia, collapsed lungs, image that gives us air and bone

Question 46

pulmonary function test

Answer 46

helps diagnose asthma, COPD

Question 47

V/Q scan

Answer 47

gold standard for pulmonary embolisms, ventilation and perfusion

Question 48

red flags in pulmonary exam

Answer 48

- respiratory distress, cyanosis, severe wheezing, stridor, hypoxia - vital signs and pulse ox, auscultate lungs, administer oxygen, elevate HOB, limit converstaion to conserve energy

Question 49

acute respiratory symptoms

Answer 49

tripod position, nasal flaring, cyanosis (peripheral or central)

Question 50

chronic respiratory symptoms

Answer 50

tripod position, barrel chest, clubbed fingernails, pursed lip breathing