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Health Assessment Module 3 Chapter 18
Terms in this set (55)
Angle of Louis/Manubriosternal angle/sternal angle
-Normal is 90 degree angle
-Anteriorly Location of where trachea bifurcates into the lungs
- Anteriorly at articulation of manubrium and sternum and continuous with 2nd rib
- Anteriorly corresponds with upper border of atria of the heart
- Posteriorly lies above thoracic vertebra on back
Hollow U-shaped depression just above sternum between clavicles
Angle of Louis increases beyond 90 degrees due to chronically overinflated lungs
Start of where you can feel spine - Spinous process of C7
- Apex of lung tissue posteriorly
Highest point of lung tissue
3 to 4 cm above inner third of clavicles
Bisects center of each clavicle at a point halfway between palpated sternoclavicular and acromioclavicular joints
Bottom of lungs
Rests on diaphragm at about 6th rib in midclavicular line
-Shorter because of liver
-has 3 lobes
- Narrower because of heart
- has 2 lobe
- Almost completely lower lobe
- Lower lobes begin around T3 or T4 and extend to T10 on expiration and T12 on inspiration
- Upper lobes from apices at T1 down to T3 or T4
- Right middle lobe does not project at all
4 Major Functions of Respiratory System
- Supply oxygen to the body for energy production
- Removing carbon dioxide as a waste product of energy reactions
- Maintaining homeostasis of arterial blood (acid-base balance)
- Maintaining heat exchange
Slow, shallow breathing causes CO2 to build up in blood. Occurs: overdose of narcotics or anesthetics, prolonged bed rest, or conscious splinting of the chest to avoid respiratory pain.
Rapid, deep breathing causes CO2 to be blown off. Occurs: extreme exertion, fear, anxiety, diabetic ketoacidosis (Kussmaul respirations)
Signs of Respiratory Distress in child
Sinking in of chest and visual rib cage
Increased respiratory rate infant
Can signify: Atelectasis, pneumonia, asthma, and acute airway obstruction
Abnormal infant assessment
Rapid resp rate- PNU, fever, pain, heart disease, and anemia
Tachypnea (50-100) during sleep may be sign of early heart failure
Asymmetric expansion occurs with diaphragmatic hernia or pneumothorax
Crepitus is palpable around fractured clavicle, which may occur with difficult forceps delivery
Diminished breath sounds- PNU, atelectasis, pleural effusion, pneumothorax
Infant abnormal breath sounds
Persistent fine crackles that are scattered over the chest occur with pneumonia, bronchiolitis, or atelectasis
Crackles only in upper lung fields occur with cystic fibrosis
Crackles only in lower lung fields= heart failure
Expiatory wheezing= lower airway obstruction (asthma and bronchitis)- when unilateral may be foreign body
Persistent peristaltic sounds with diminished breath sounds on same side= diaphragmatic hernia
Stridor (high-pitched inspiratory crowing sound heard without stethoscope)= upper airway obstruction (croup, foreign body aspiration or acute epiglottis)
-Enlarging uterus elevates diaphragm 4 cm- decreases vertical diameter of thoracic cage but compensated for by increase in horizontal diameter
- Increase in estrogen level relaxes chest cage ligaments
- Costal cartilages become calcified = less mobile thorax
- Lung is more rigid and is harder to inflate
- Decreased intra-alveolar septa and number of alveoli= surface area
- Bases become less ventilated due to closing off of a number of airways
- Increased risk of post op complications like pneumonia due to shallow breathing
Characteristics of Sputum
White or clear- colds, bronchitis, viral infections
Yellow or green- bacterial infections
Rust colored- TB, pneumococcal pneumonia
Pink, frothy- Pulmonary edema, some sympathomimetic medications
Characteristics of cough
Hacking- mycoplasma pneumonia
Dry- early heart failure
Congested- colds, bronchitis, pneumonia
Orthopnea- difficulty breathing when supine
Paroxysmal nocturnal dyspnea- awakening from sleep with SOB and needing to be upright to achieve comfort
Coughing up blood and can sometimes indicate early heart failure
Sunken sternum and adjacent cartilages also called funnel breast
Forward protrusion of the sternum also called pigeon breast
S-shaped curve of spine
Exaggerated posterior curvature of t-spine also called humpback
Thoracic cage inspection
Anteroposterior diameter should be less than transverse diameter
Abnormal Thoracic Cage Inspection
COPD patients- will be barrel chested appearance - the AP=transverse diameter (due to hyperinflation of the lungs
AP=transverse is also NORMAL in children before age of 6- after 6 may be present in chronic asthma and cystic fibrosis
Unequal chest expansion
Marked atelectasis, lobar PNU, pleural effusion, thoracic trauma (fx ribs or pneumothorax)
Should be equal bilaterally- asymmetric findings suggest dysfunction that you can asses further with stethoscope
Obstructed bronchus, pleural effusion or thickening, pneumothorax, or emphysema. Caused by any barrier between the sound and your palpating hand.
Occurs with compression or consolidation of lung tissue (lobar pneumonia ). Is present when the bronchus is patent and the consolidation extends to the lung surface. Only noted in gross changes- small areas of PNU do not significantly affect it.
Palpable with thick bronchial secretions; vibration felt when inhaled air passes through thick secretions in the larger bronchi. May decrease somewhat by coughing.
Pleural Friction Fremitus
Palpable with inflammation of the pleura; Coarse grating sound; also called palpable friction rub.
Coarse, crackling sensation palpable over the skin surface. It occurs in subcutaneous emphysema when air escapes from the lung and enters the subcutaneous tissue, as after open thoracic injury or surgery.
Low-pitched, clear, hollow sound that predominates in healthy lung tissue in the adult
Lower-pitched, booming sound found when too much air is present
Occurs: emphysema or pneumothorax
Dull (in percussion)
Soft, muffled thud signals abnormal density in the lungs.
Occurs: pneumonia, pleural effusion, atelectasis, or tumor
Abnormally high level of dullness and absence of excursion
Occurs: pleural effusion or atelectasis of the lower lobes
Normal breath sounds
Bronchial (trachea)- high-pitched, loud, ins<exp, harsh/hollow/tubular, heard over trachea and larynx
Bronchovesicular- moderate, moderate, insp=exp, mixed quality, heard over major bronchi
Vesicular- low, soft, insp>exp, rustling, over peripheral lung fields
Decreased or absent Breath sounds
When bronchial tree is obstructed (by secretions, mucus plug, or a foreign body); emphysema; when anything obstructs transmission of sound (pleurisy or pleural thickening or air (pneumothorax) or fluid (pleural effusion)
Increased breath sounds
Ex. bronchial sounds heard over abnormal location - Occur when consolidation (pneumonia) or compression (fluid in the intrapleural space) yields a dense lung area that enhances the transmission of sound from the bronchi.
Discontinuous popping sounds heard over inspiration that are not cleared by coughing
Late inspiratory: occur with restrictive disease, pneumonia, heart failure, and interstitial fibrosis
Early inspiratory: occur with obstructive disease, chronic bronchitis, asthma, and emphysema
Postural induced (PICs): appear with a change from sitting to the supine position or with a change from supine to supine with legs elevated
Coarse Crackles (coarse rales)
Loud, low-pitched bubbling and gurgling sounds that start in early inspiration and may be present in expiration; may decrease somewhat by suctioning or coughing but reappear shortly; sound like Velcro.
Occurs: Pulmonary edema, pneumonia, pulmonary fibrosis, and the terminally ill who have a depressed cough reflex.
High-pitched Wheezes (sibilant)
Continuous high-pitched, musical squeaking sounds that sound polyphonic - predominate in expiration but may occur in both
Occurs: Diffuse airway obstruction from acute asthma or chronic emphysema
Low-pitched Wheezes (sonorous rhonchi)
Continuous low-pitched; monophonic, single note, musical snoring, moaning sounds; heard throughout the cycle, more prominent on expiration; may clear somewhat by coughing.
Occurs: bronchitis, single bronchus obstruction from airway tumor
Continuous high-pitched, monophonic, inspiratory, crowing sound; louder in neck than over chest wall
Occurs: Croup and acute epiglottis in children and foreign inhalation, obstructed airway may be life-threatening
Atelectatic crackles (atelectatic rales)
No pathologic - short popping, crackling sounds that last only a few breaths. Disappear after first few breaths or a cough.
Occurs: Aging adults, bedridden patients, or in patients who just woke up
Pleural friction rub
Very superficial sound- coarse and low pitched; has grating quality like 2 pieces of leather; sounds louder if you push the stethoscope harder onto the chest wall; sound is inspiratory and expiratory.
Occurs: Pleuritis, accompanied by pain with breathing (rub disappears after a few days if pleural fluid accumulates and separates pleurae)
Rapid, shallow breathing- >24. Normal response to fever, fear, or exercise. Also increases with respiratory insufficiency, pneumonia, alkalosis, pleurisy, and lesions in the pons.
Slow breathing- decreased rate <10. Occurs: drug-induced depression of the respiratory center in the medulla, increased intracranial pressure, and diabetic coma.
Respirations gradually wax and wane in a regular pattern, increasing in rate and depth and then decreasing. Lasts 30-45 seconds with periods of apnea (20 seconds) alternating the cycle. Occurs: severe heart failure, renal failure, meningitis, drug overdose, and increased intracranial pressure. Occurs normally in infants and aging people when they sleep.
Pattern is irregular. A series of normal respirations (3-4) is followed by a period of apnea. The cycle length is variable, lasting anywhere from 10 seconds to 1 minute. Occurs: head trauma, brain abscess, heat stroke, spinal meningitis, and encephalitis.
Chronic Obstructive Breathing
Normal inspiration and prolonged expiration to overcome increased airway resistance. Occurs: COPD, increased heart rate from exercise
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