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chronic brohchitis characterized by a history of productive cough for 3 month of the year for 2 years in a row Hemoptysis Bloody sputum cold, bronchitis, viral infections white or clear mucoid bacterial infection yellow or green TB, pneumococcal Pna rust colored pulmonary edema pink frothy mycophasma pna hacking cough early heart failure dry cough croup barking cough cold, bronchitis, pneumonia congested cough Orthopnea the difficulty breathing when supine. state mumber of pilow needed to achieve comforts ex two pillow orthopnea paroxysmal norcturnal dyspnea awakening from sleep with SOB and needing to be upright to achieve comfort diaphoresis SOB episodes associated with night sweats ventilation is distribution of gas inot and out of the pulmoary airways (good air in bad air out) Internal respiration the exhange of gases at teh alvelolar level and the capillary level Normal adult chest te thorax has an ellipitacl shape with an nateroposterior to transvers diameter 1:2 or 5:7 barrel chest note equal anteroposterior to trasverse diameter and that ribs are horizontal instead of the normal downward slope. this is associated with normal aging and also with chronic emphysema and asthma as a rsult of hyperinflataion of lungs pecus excavatum a markely sunken sternum and adjacent cartilages (also called funnel breast). depression begins at the second intercostal space to xiphoid with body of sterum. more noticeable on inspiration. Congential, not symptomatic. Pecus Carinatum a forward protrustion of the sternum, with ribs sloping back at either side and vertical depression along cosochondral junctions(pigeon breast) less common thatn pecus excavautm , but is a minor deformity and requires no treatment Scoliosis a later S-shaped curvaturs of the thoracic and lumabar spine. Note unequal shoulder and scapular height and unequal hip levels (adolescents) Kyphosis an exaggerated posterior eurvature of teh thoracic spine (humpback) that causes significant back pain and limited mobility (aging) sigh occasional sighs puncutated the normal breathing pattern and are purposeful to expand alveoli. frequent sigh indicate emotional dysfunction or may lead to hyperventilation and dizziness tachypnea rapid shallow breathing over 24 resp per min bradypnea slow breathing. a drecreased by regular rated (less than 10) durg induced depression or respiratory center of medulla cheyn-stokes respiration a cycle in which respiration gradulally wax and wane in a regular pattern , incrasing in rate and depth and then decreasing. period las 30-45 sec, with period of apnea lasting 20 sec. hyperventilation increased in both rate and depth . normally occurs with extreme exertion, fear or anxity. Blow off carbon dioxide and causing a decreased level in teh blood (alkalosis) hypoventilation an irregular showllow pattern caused by an overdose of narcotic or anethetics. Biot's Respiration similar to cheyn-stokes, expcet the at the pattern is irregular. A series of normal resp 3-4 is floowed by period of apnea. cycle lenght is variable lasting anywhere for 10 sec to 1 min. Chornic Obstructive Breathing normal inspiration and prolonged expiration to overcome incrased airway resistance. In a person with CO lung disease and situation calling for incrased heart rat may lead to dyspneic episode be cause don't have enough time to fully expiraton dyspneic air trapping crakles (fine) discontinuous HIGH pithced shor crackling popping sounds heard durign inspiration that CAN NOT clear with cough crakles (coarse) Loud, LOW pitched bubbling and gurgling sound that start i early inspirtation and my contiue through expiration Atelectatic crackles sounds like fin crackles byt do not last and arenot pathologic; disappear after the first few breaths; hear in axillae and bases (usually depent) of lungs :leural friction rub A very superficial sound that is course and Low pitched; it has a grating quailty as if two pieces of leather are being rubbed together; sound just like crackles but close to ear; sound are louder if you push tehe stethoscope harder onto the chest . Heard on INSPIRATION and EXPIRATION Wheez (high-pitched) Sibilant High ptich musical squeaking sound that sound polyphonic. Predominate in expiratrion byt may occur on both inspiration and expiration Wheez (low ptiched) (sonorous rhonchi) Low pithced; monohonic single note, snoring , moaning sounds. Heard through out the cycle but predominate on expiration; may clear some with cough Stridor High pitched, inspirator crowing sound louder in the neck than over the chest Resonance Percusion sound heard over the lungs when should you check kids lungs befor you make them cry wet hair on chest for men with hairy chest what should you do the drease extraneous noise high pithces the sound of most breath sounds diaphragm what part of the stethoscope is use for breath sounds heart assess heart or breath first complete ventilatory cycle when ausculttaon breath , listen to ______________ ventilatory cycle 1. side 2. side compare breath sound _______to________ Tactile Fremitus A palpabe virbration on the chest how is tactile Fremitus assessed have the patient say 99 and feel the vibration , sound generated for the larynx is trasmitted through the lungs where examiner can feel the vibration sound travels eaisly throught solid structures than air, the vibration produced sounds are percceptible when transmitted throught solid structures creptius a course crackling caused by fine bead of air palpable under skin surface; casued by air leak into the SQ tissue. Campares to the sound of crumpling cellophane action if creptius is heard Report ASAP areas of INCREASED fremitus present in condisiton that cause consolidation of thissure or incrased density of tissue ; tumor, pulmonary fibrosis, pnx areas of DECRASED fremitus presen when condition exist causing absence of air movement , obstructs transmission of vibrations; emphysema, copd, atelectasis, pneumothorax fine crackles originate in alveoli, are often end-inspiration . Not cleared with cough. sounds like rolling hair between finger coarse crackles loud, bubbly noise , originate inteh larger airways , being mid inspiraton, may be slightly altered by cough ut will reappear shortly atelectatic crackles few crackles in teh bases disappears after first few breaths. not patologic heard only in the periphery dependent areas of the lungs normal voice sounds vocal resonance is heard as muffled, non distinct abnormal voice sounds pathology that incrase lung density enhances transmission of voice when is voice sound used if any abnormalities have been detected during inspection, palpation or auscultation decreased vocal resonance asthma, atelectasis, emphysema, pneumothorax increased vocal resonance pnx, plumonary fibrosis drug with resp SE epinephrine, beta blockers, narcotic, NSAOD and ASA Epinephrine and beta blockers, NSAIDS and ASA these drugs cause bronchospasm Narcotic these drugs cause respitory depression eupnea normal breath breathing Hyperresonance a lower pitched booming sound found when too much air is present as in emphysema or pneumothorax dull a not (soft , muffled thud) signals abnormal diensity in the lungs as with pnx, pleural effusion, atelectasis or tumor Bronchial breath sounds heard around trachea, loud, inspiration is shor and expiration is longer Bronchovesicular breath sounds eard of the 2 main bronchi at 1st and 2nd ICSaath the sternal borader and posterior between scapulae, sound moderate, inspiration =expiration (coarse breath sounds) Vesicular breath sounds heard over the periphery the lungs, soft, breezy, inspiration is longer thatn expiration Bronchophony listen to posterior chest as patient says "99", normal to hear muffuled non distinct abnormal to hear distinct and understandable Egophony listen to patient while saying (ee-ee-ee), sound like nondistinct "ee" if you hear "a-a-a" document E changed to A whisper pectoriloquy listen to person whispering :1-2-3", barely audible, abn with only small amount sof consolidation whipsered voice is clear and distincly, but still faint(soft) would sound like wishing directly into stethoscope Adventitous sounds sound not normally heard in the lungs or noral sounds auscultated in an abnormal place. Superimpose on normal breath sounds. Asthma, emphysema, atelectasis breath sound may be absent or diminished suprasternal notch feel this halow U-shaped depression just abofe the sternum in between th clavicles sternum the breast bone the manubrium, the body and xiphoid preocess sernal oagleor angle of louis is the articulation of the manubrium and the body of he sternum and is continuous to the the second rib. The site of treacheal bifurcation into the right and left main bronchi. midsternal line center of chest midclavicular line bsects the cner of each clavicle at a point halfway between the palpated sernoclavicular and acromioclavicular joint anterior axillary line line do the joint of the shoulder midaxillary line line runs down from the apex ofhte axilla and lies between and parallel to the other two anterior and posterior posterior axillary line continuse down for them posterior axillary fold where the latissius dorsi muscle inserts apex of lung highest poin of lung tissue 3 or 4 cm above the inner third of the clavicles base of lung lower border rests on the diaphragm at about the sixth ribin the midclavicluar line.