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44 Cards in this Set
- Front
- Back
What are some general inspections you can make for thorax and lungs?
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nasal flaring
pursed lip breathing purple complexion |
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Child flares nostrils while breathing. What might this indicate?
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nasal flaring is indicative of hypoxia
(usually accompanied by labored respriations) |
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Explain physiology of pursed lip breathing, and what the patient may have if he/she exhibits it.
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pursed lip breathing helps slow down expiration to keep alveoli open longer. (breathe in through nose, pursed lip expiration)
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A purplish complexion may indicate?
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COPD or CHF as a result of polycthemia. (compensatory mechanism for hypoxia)
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When inspecting the posterior thorax, what do you look for?
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- configuration - scoliosis
- use of accessory muscles - trapeziums - client positioning - tripod position |
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What is the tripod position? Where is itusually seen?
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patients with COPD often lean forward using arms to support weight to breathe
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When palpating the posterior thorax, what do you do?
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- tenderness, sensation - pain/warmth
- crepitus - surface lesions/masses - fremitus - chest expansion |
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What is crepitus? how does it occur?
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Crepitus is a crackling sensation that occurs when air escapes from lung to subcutaneous tissue.
- thoracic injury - chest tube - tracheostomy |
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How do you assess for fremitus?
What is it? |
Palpate with ball of hand. Patient says "ninety-nine" as you move hand to each area.
Fremitus is the normal vibrations felt during vocalization. it should be symmetrical bilaterally. |
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What increases fremitus?
What decreases fremitus? |
incr - consolidation
decr - bronch obstruction, air trapping, pleural effusion, pneumothorax |
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What causes unequal chest expansion?
Decreased chest expansion? |
unequal - part of lung is obstructed or collapsed as with pneumonia --> severe atelectasis, pneumonia,
trauma, pneumothorax decreased - COPD because of decreased diaphragm function |
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Percuss for what when examining posterior thorax?
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tone and diaphragmatic expansion
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What is hyperresonance? When is it found?
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lower-pitched, booming sound found when too much air is present; found in emphysema or pheumo-thorax
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How to percuss for diaphragmatic excursion?
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1. exhale forcefully, hold breath
2. percuss along scapular line from T7 3. note sound change from resonant to dull 4. inhale deeply, hold it 5. percuss from last point, downward 6. mark change to dullness |
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What is normal diaph excursion?
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3-5 cm in adults, bilaterally
up to 8cm in athletes |
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How to auscultate for breath sounds?
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1. place diaphragm on post chest wall
2. client breathe deep thru mouth 3. listen for bronchial, bronchovesi, and vesicular sounds 4. auscultate from apices to bases |
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How to auscultate for adventitious sounds?
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Breathe normally. Note locations of adventitous sounds, and where in breath cycle.
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Fine crackles found in
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late inspiration - pneumonia, congestive heart failure
early inspiration - (obstructive) - bronchitis, asthma, emphysema |
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Coarse crackles found in
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pneumonia, pulmonary edema, pulmonary fibrosis
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pleural friction rub found in
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pleuritis
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sibilant wheeze found in
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= high pitched wheeze
in acute asthma, chronic emphysema |
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sonorous wheeze found in
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bronchitis, sleep apnea
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What is stridor? Accompanied by?
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= honking wheeze
occurs with croup (barking cough) |
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How to auscultate voice sounds?
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bronchophony - say ninety-nine
- distinct voice over consolidations egophony - say ee - sounds like A over consolidations whispered pectoriloquy - whisper 1-2-3 - - distinct voice over consolidations |
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What is the normal shape of a thorax?
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anteropost diam : transverse diam = 1:2
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What are some abnormal findings in the sternum?
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pectus excavatum - sunken sternum and adjacent cartilages
pectus carinatum - protruding sterum and adjacent ribs |
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labored noisy breathing found in
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asthma. bronchitis
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tachypnea
describe, and clinical indication |
rapid shallow breathing
- fever, anxiety, exercise - alkalosis, pneumonia, pleurisy |
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bradypnea
describe, and clinical indication |
slow and regular depth
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hyperventilation
describe, and clinical indication |
increase rate and depth
- fear, exercise, anxiety (ie Kussmal respiration - diabetic ketoacidosis) |
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hypoventilation
describe, and clinical indication |
decrase rate, dec depth, irregular pattern
narcostics and anesthetics |
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hypoventilation vs bradypnea
hyperventilation vs tachypnea |
bradypnea - slow, but normal pattern
hypoventilation - slow, dec depth, irregular tachypnea - fast and shallow hyperventilation - fast and deep |
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Regular pattern of breathing interrupted by periods of apnea (no breathing)
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cheyne-stokes respiration
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irregular pattern and varying depth breathing, interrupted by periods of apnea
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Biot's respiration
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orthopnea found in
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heart failure
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PND found in
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heart failure
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Differenitate cough frequencies and their associated diseases.
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continuous - acute infection
early morning - bronchial inflammation/smoking evening - sinusitis (postnasal drip) |
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nonproductive cough found in
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upper respiratory infection
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white sputum
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viral infections, common cold
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yellow or green sputum
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bacterial infections
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blood in sputum
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hemoptysis
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rust colored sputum
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tuberculosis, pneumococcal pneumonia
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pink frothy sputum
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pulmonary edema
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GERD found in
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gastroesophageal reflux disease - often seen in asthma patients
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