Thorax, Lungs and Respiratory System Flashcards Preview

Health Assessment > Thorax, Lungs and Respiratory System > Flashcards

Flashcards in Thorax, Lungs and Respiratory System Deck (39)
Loading flashcards...
1

history present health status

1. do you have any chronic illnesses? - COPD, CHF, Asthma
2. Do you have allergies - anaphylaxis
3. difficulty breathing during daily activities? - SOB dyspnea
4. difficulty breathing when you sleep? - 3 pillow orthopnea, apnea

2

paroxisysmal nocturnal dyspnea

wake up at night hungry for air - CHF

3

orthopnea

trouble breathing when laying, positional

4

do you take any medications?

immediate:
- albuterold - rescue drug for wheezing
- steroids - maintenance/preventative daily drug
- oxygen is considered a med

5

pack years

smoking
- 3 ppd x 5 years = 15 pack years

6

family history lung issues

- TB - proximity
- cancer and cystic fibrosis - genetics
- emphysema and asthma - smoking

7

home environment

- air pollution
- allergens at home, pets
- type of heating, dust
- hobbies - wood working, plants, metal
- exposure to others smoking at home
2nd hand - other person smokes by you
3rd hand - smoke lingers in home and car

8

travel

areas within US and other countries have different irritants than in colorado
- histoplasmosis in southeast and midwest (spores and fungus breathing in)
- schistosomiasis or severe acute resp syndrome (parasites)
- SARS in southwest asia, caribbean and asia (viral)
- histoplasmosis - mississippi

9

OPQRSTU

Pain history checklist
OPQRSTU:
Onset of pain (time, duration)
Palliative factors for pain
Quality of pain (throbbing, stabbing, dull, etc.)
Region of body affected
Severity of pain (usually scale of 1-10)
Timing of pain (after exercise, in evening, etc.)
U: How does it affect 'U' in your daily life?
· May wish to expand to OPPQRRSTTUVW, with the extra letters representing:
Provocative factors
Radiation (how does pain spread)
Treatments tried
Deja Vu: Has this happened before?
Worry: What do you think or fear that it is?

10

sputum

clear white - virus
green/yellow - bacteria
rusty/bloody - TB
frothy/pink - heart failure

11

chest pain with breathing

Triage:
1. MI, Emobolism
2. pleural friction rub - visceral parietal plura, fluid between pliers and inflammation cases layers to rub together
3. pulmonary embolism
4. heart attack
5. GI and reflux, heart burn
- punctured lung
- pulled muscles, fractured ribs
- anxiety attack - tight crushing in chest

12

resp - special populations

children
- more than 4-6 colds per year, more than 6 is immune compromised
- allergies

elderly
- SOB and fatigue with activities of daily living
- energy level, effects on ADL

13

topographic markers, anterior chest wall

- nipples - 5th rib
- suprasternal notch - top of sternum
- manubriosternal junction - angle of louie, 2nd rib identification
- midsternal line - middle of sternum
-costal angle - bottom of ribs, no more than 90 degrees
- calvicles - lung tissue above
- midlcavicular line -

14

topographic markers, lateral chest wall

anterior axillary lines
posterior axillary lines
midaxillary lines

15

topographic markers, posterior chest wall

vertebra prominens: spinous process of C7 is palpable when head is bent forward

vertebral line: line down vert in back

scapular lines: parallel to vertevral line on right and left through scapulas

16

physical exam, respiratory

INSPECT
- general appearance, posture, breathing effort
- observe respirations
- nails, skin, lips: cyanosis, clubbing
- anterior and posterior thorax

PALPATE
- trachea, thoracic muscles, expansion of thoracic wall
- tactile fremitis - vibration over areas of congestion
- hyperresonance = pregnancy, COPD

PERCUSS
- for tone and diaphragmatic excursion - resonance

AUSCULATATE
- anterior, posterior and lateral thorax
- sometimes vocal resonance

17

bronchophony

patient's voice remains loud during '99' even though it should get softer. picks up pneumonia

18

egophony

increased resonance of voice sounds heard when auscultating the lungs, often caused by lung consolidation and fibrosis.

19

whispered pectorilouqy

refers to an increased loudness of whispering noted during auscultation with a stethoscope on the lung fields on a patient's torso
- lung consolidation

20

INSPECT

- general appearance, posture, breathing effort (accessory muscles)
- shape and configuration of chest wall ( barrel chest)
- postioning for breathing (tripod)
- skin color - blue, pallor

21

Respirations - rate, breathing patterns

- eupnea - normal within 12-20 reps per min
- bradypnea - slow breathing, 5 per min
- tachypnea - more than 20 breaths per min
- hypervent - faster and deeper, increase co2, increased acidic blood
- kussmal resp - fast, very deep, resp/metabolic acidosis, diabetic acidosis
- biot - sick or dying
- chayne stokes

22

clubbing

6 months - 1 year after hypoxia

23

unequal posterior chest expansion

pneumonia atatlectasis

24

tactile femitis

palpate and do "99" test, vibration
- decreased: any obstruction
- increased: compression or consolidation of lung tissue ( only big changes, not small areas of pneumonia or anything like that)
- rhonchal: thick broncial secretions
- pleural friction: inflammation of pleura
- crepitus: course, crackling sensation palpable over the skin surface, emphysema, after open thoracic surgery

25

normal lung sounds

BRONCHIAL: high pitch, loud, louder during expiration, found in trachea and larynx

BRONCHIOVESICULAR: moderate pitch, insirpation and expiration equally, over major bronchi where fewer alveoli are located

VESICULAR: low pitch, soft, greater during inspiration, peripheral lung field where air flows through smaller bronchioles and alveoli

26

abnormal lung sounds

DECREASED SOUNDS: obstruction in bronchial tree, emphysema loss of elasticity
INCREASED: consolidation or compression

27

Adventitious lung sounds

CRACKLES: discontinuous, high pitched, short crackling, pooping sounds heard during inspiration

PLEURAL FRICTION RUB: course and low pitched, two pieces of leather being rubbed together, inspiratory and expiratory

WHEEZE: high pitched, muscle, squeaking, may occur in both inspiration and expiration.

STRIDOR: high pitched, monophonic, inspiratory, crowing, louder in neck than chest wall

28

special populations, infants and children

- hyperresonance normal over lungs
- 1:1 chest ratio
- fine crackles normal in immediate newborn

29

special population, older adults

fatigue quickly
kyphosis, lordosis

30

special populations, pregnant women

- wider thoracic cage
- wider costal angle
- deeper respriations = more estrogen, relaxes muscles, sideways lungs