WEEK 4- LUNG AND THORAX

Question 1

Inspection

Answer 1

Assess thoracic cage
Measure respirations
Assess skin colour and condition
Evaluate patient’s position
Observe patient’s facial expression
Assess level of consciousness

Question 2

Palpation

Answer 2

Confirm symmetrical expansion
Assess tactile fremitus
Detect any lumps, masses, tenderness

Question 3

Percussion

Answer 3

Percuss over lung fields
Estimate diaphragmatic excursion

Question 4

Auscultation

Answer 4

Assess normal breath sounds
Note any abnormal breath sounds
If breath sounds are abnormal, perform bronchophony,
whispered pectoriloquy, and egophony
Note any adventitious sounds

Question 5

TACTILE FREMITUS

Answer 5

the vibration of the chest wall that results from sound vibrations created by speech or other vocal sounds.

Question 6

A man’s reason for seeking care is difficulty breathing. When you auscultate his lower lung fields, you hear bronchial sounds in his right and left lower lobes. What would this assessment indicate?

Answer 6

abnormal variation

Question 7

What is the most accurate way to auscultate the lungs?

Answer 7

Ask patient to breathe through the mouth, deeper than usual and out

Question 8

a normal variation

Answer 8

Upon inspection of Mr. Z, you note that his anteroposterior to transverse diameter ratio is 1:1. What would this indicate?

Question 9

What changes would you expect in an aging adult?

Answer 9

less distensible lungs

Question 10

Which is true regarding the auscultation? Select all that apply.

Answer 10

The stethoscope does not magnify sounds
The bell is best used for low-pitched sounds
The nurse cannot hear resonance when auscultating

Question 11

Expected assessment findings in the normal adult lung include the presence of

Answer 11

muffled voice sounds and symmetrical tactile fremitus

Question 12

Unequal chest expansion occurs when:

Answer 12

part of the lung is obstructed or collapsed

Question 13

The assessment of the lateral chest wall is:

Answer 13

Referred to as the forgotten lobe

Question 14

Auscultation of breath sounds is an important component of respiratory assessment. An accurate description of this part of the examination

Answer 14

Hold the diaphragm of the stethoscope against the chest wall; listen to one full respiration in each location, being sure to do side-to-side comparisons

Question 15

When examining for tactile fremitus it is important to:

Answer 15

palpate the chest symmetrically

Question 16

thoracic landmarks

Answer 16

Suprasternal notch
Sternal angle (angle of Louis/ manubriosternal angle)
Sternum, ribs & xiphoid process
Diaphragm
Costal angle
Intercostal spaces

Question 17

posterior thoracic cage

Answer 17

Vertebra prominens
C7 & T1
Spinous processes
Inferior border of scapula
Twelfth rib

Question 18

reference lines: anterior and posterior

Answer 18

Anterior (arms at side)
Midsternal line
Midclavicular line
Bisects center of each clavicle
Posterior (arms at side)
Vertebral line (midspinal)
Scapular line
Extends through inferior angle of scapula

Question 19

reference lines: lateral

Answer 19

Lateral (pt’s arm 90°)
Midaxillary line
Anterior axillary line
Posterior axillary line

Question 20

the lungs

Answer 20

Apex & base
Lobes
Trachea & bronchi
Acinus
Visceral & parietal pleurae
Pleural cavity
Potential space

Question 21

approach the client:

Answer 21

• maintain and provide privacy/hygiene
• curtain, draping, hand washing before and hand, clean equipment

Question 22

communicating w client

Answer 22

introduce yourself, first, last name, designation
- questions

Question 23

general survey

Answer 23

physical appearance,
body structure
mobility
behavior

Question 24

subjective data

Answer 24

Cough
Shortness of breath
Chest pain with breathing
History of respiratory infections
Smoking history
Environmental exposure
Self-care behaviors

Question 25

objective data

Answer 25

Preparation Sitting upright Draping Clean stethoscope Posterior, then Anterior Inspection, Palpation, Percussion, & Auscultation

Question 26

inspection-posterior

Answer 26

Position person takes to breathe Skin colour & condition Shape & configuration of chest wall Spinous processes Thorax & scapula Neck & trapezius muscles Anteroposterior diameter to transverse diameter

Question 27

palpation- posterior

Answer 27

Palpate chest wall Tenderness, temperature, moisture & masses/lumps Explore lesions noted upon inspection Symmetrical expansion Thumbs at T9/T10 Tactile fremitus Palpable vibration that should be symmetrical Ask client to say “99”

Question 28

percussion-posterior

Answer 28

Underlying structures Characteristic sounds How? Start at apices shoulders Interspaces Bilaterally Notes Resonance, hyperresonance and dull notes

Question 29

auscultation-posterior

Answer 29

-Position of client -Stethoscope -Client instructions -Full breath Findings Presence of air entry Lobes & bilateral Quality of air entry Clear (any adventitious sounds) Location of bronchial, bronchovesicular & vesicular breath sounds heard “Air entry clear in all lobes & equal bilaterally, no adventitious sounds” (also, important to note where bronchial, bronchovesicular & vesicular breath sounds heard)

Question 30

normal breath sounds: 3

Answer 30

bronchial, bronchovesicular, vesicular

Question 31

bronchial breath sound

Answer 31

harsh, hollow, tubular, high, loud

Question 32

bronchovesicular breath sound

Answer 32

mixed, moderate

Question 33

vesicular breath sound

Answer 33

wind in the trees, rustling, low

Question 34

adventitious breath sound

Answer 34

Crackles Pneumonia, heart failure, pulmonary edema, bronchitis, asthma or emphysema Wheezes/ronchi Obstructed airways (e.g., asthma, emphysema or bronchitis, tumour) Stridor High pitched inspiratory sound in upper airways Croup, obstructed airway or epiglottitis Pleural fiction rub Superficial, course & low pitched sound (grating)

Question 35

crackles

Answer 35

Pneumonia, heart failure, pulmonary edema, bronchitis, asthma or emphysema

Question 36

wheezing

Answer 36

Obstructed airways (e.g., asthma, emphysema or bronchitis, tumour)

Question 37

stridor

Answer 37

High pitched inspiratory sound in upper airways Croup, obstructed airway or epiglottitis

Question 38

pleural fiction rub

Answer 38

Superficial, course & low pitched sound (grating)

Question 39

inspection- anterior

Answer 39

facial expression and LOC quality of respiration skin colour/condition lips, nail beds, lesions interspaces and accessory muscle shape and configuration wall

Question 40

palpation- anterior

Answer 40

Tenderness, temperature, moisture, skin mobility/turgour & masses Symmetrical chest expansion Tactile fremitus

Question 41

percussion-anterior

Answer 41

Notes Resonance Hyperresonance Dull notes How Start at apices supraclavicular Interspaces Bilaterally

Question 42

auscultation- anterior

Answer 42

Findings Presence of air entry Lobes and bilateral Quality of air entry Clear (any adventitious sounds) Location of bronchial, bronchovesicular & vesicular breath sounds heard “Air entry clear in all lobes and equal bilaterally, no adventitious sounds” (also, important to note where bronchial, bronchovesicular & vesicular breath sounds heard)

Question 43

abnormal findings

Answer 43

respiration less than 93%, Rate Tachypnea Bradypnea Rate and depth Hyperventilation Hypoventilation Cheyne-Stokes respiration

Question 44

developmental considerations- pregnancy

Answer 44

costal angle wides, increase in transverse diameter of thoracic cage

Question 45

infant lungs:

Answer 45

normal RR new born 30-40, lungs do not work untill birth

Question 46

developmental considerations- adult

Answer 46

calcification of cartilage lung becomes rigid (decrease in vital capacity and increase residual volume) - increase risk for shortness of breath

Question 47

cultural/social considerations

Answer 47

tuberculosis asthma and resp diseases COPD and women

Question 48

health promotion

Answer 48

cut off tobacco - stop smoking

Question 49

3. Identify the location of the apex & base of the lung anteriorly & posteriorly & locate landmarks for each lobe.

Question 50

4. Identify anterior & posterior landmarks where the trachea bifurcates

Question 51

2. Differentiate between the following percussion notes: dullness, resonance, hyperresonance & tympany.

Question 52

5. Identify locations of bronchial, bronchovesicular & vesicular on the posterior & anterior thorax.

Question 53

equipment

Question 54

7. Outline abnormal assessment findings. Barrel chest, pectus excavatum, pectus carinatum, scoliosis, kyphosis, tachypnea, bradypnea, hyperventilation, hypoventilation

Answer 54

Barrel Chest: This refers to a rounded, bulging chest shape that resembles the shape of a barrel. It's often associated with chronic obstructive pulmonary disease (COPD) or emphysema. Pectus Excavatum: Also known as "sunken chest," this is a deformity of the chest wall where the sternum and rib cage grow abnormally, causing a caved-in appearance of the chest. Pectus Carinatum: This is the opposite of pectus excavatum, where the sternum protrudes outward, creating a "pigeon chest" appearance. Scoliosis: This is a sideways curvature of the spine, which can vary in severity. It may cause the shoulders or waist to appear uneven. Kyphosis: This refers to an excessive outward curvature of the spine, causing a rounded upper back, often termed "hunchback" or "hunching." Tachypnea: This is an increased respiratory rate, meaning the person is breathing faster than normal. It can be a sign of various medical conditions such as respiratory distress, fever, anxiety, or metabolic acidosis. Bradypnea: Conversely, bradypnea is a slower than normal respiratory rate. It can be a sign of respiratory depression, neurological problems, or certain medications. Hyperventilation: This occurs when a person breathes at a faster rate or deeper than necessary, leading to decreased levels of carbon dioxide in the blood. It can be caused by anxiety, panic attacks, or medical conditions such as diabetic ketoacidosis. Hypoventilation: This is the opposite of hyperventilation, where breathing is too shallow or slow, leading to inadequate exchange of oxygen and carbon dioxide in the lungs. It can occur in conditions like sleep apnea, respiratory muscle weakness, or drug overdose. These abnormalities can indicate various underlying health conditions and may require further evaluation and management by healthcare professionals.