NURS612 Key Points to Review for Exam 2 . Complete Study Guide.Week 5
Key Point to Review – Chest / Lungs STUDENT NOTES
What are examples of appropriat
... [Show More] e history of present illness questions you may ask a patient with a chief complaint of a respiratory issue? • When did this issue start?
• Has it gotten worse, if so how?
• Have you had this problem in the past?
• Do you have a cough?
• Do you have shortness of breath?
• What time of day do these symptoms occur?
• What makes your symptoms worse?
• What makes your symptoms better?
Describe how you would inspect the chest. How do you describe the size shape (A/P diameter) and symmetry of the chest? What are the thoracic landmarks? • Have the patient sit upright and unclothed to the waist.
• Note the shape and symmetry of the chest (back and front)
o Back to the front, the costal angle, the angle of the ribs, and the intercostal spaces
• Clavicles should be prominent superiorly, the sternum usually flat.
• AP diameter: Lateral is usually 1:2
• Landmarks include: suprasternal notch, clavicles, angle of louis, costal angle, C7, and T1
• Thorax, sternum should be midline and not deviated
Describe how you assess the rate and quality of respirations? What is normal and abnormal? • Count the RR after palpating the pulse.
• Resp: Pulse = 1:4
• Normal is approx 12-16 bpm
• Note the pattern
o Should be easy, regular, and without distress, even, neither too shallow nor too deep.
Describe your assessment of peripheral areas such as the lips and nails as this relates to a respiratory assessment. What is normal and abnormal? • Observe the lips & nails for cyanosis, lips for pursing, fingers for clubbing, and the nostrils for flaring.
• There should be no cyanosis, lip pursing, clubbing of the fingers, and flaring of the nostrils
Describe how you palpate the chest and trachea. What are normal and abnormal findings? What is tactile fremitus? What is thoracic expansion? • Palpate thoracic muscles and skeleton, feeling for pulsations, areas of tenderness, bulges, depressions, masses, and unusual movement
• Expect bilateral symmetry and some elasticity to rib cage
• The sternum, xiphoid, and thoracic spine should be rigid
• Abnormal:
o Crepitus, vibration
• Thoracic expansion: stand behind pt, during resp place your thumbs along the spinal processes at the 10th rib w/ your palms lightly in contact w/ the posterolateral surfaces. Watch your thumbs move apart. Abnormal: loss of symmetry, no expansion, or hands moving closer to each other
• Tactile Fremitus: using palms or ulnar aspect place hands at the bifurcation of the bronchus anteriorly and posteriorly and have the patient say “99” or “mickey mouse”. Use light touch and palpate each side simultaneously. Abnormal: decreased or absent fremitus, increased fremitus, tremulous fremitus.
Describe how you percuss the chest. What are normal and abnormal findings? What do the findings indicate? • First, have the patient sit up, lean forward with arms crossed in front: percuss by striking your middle finger of your nondominant hand with the middle finger of your dominant hand.
• 2nd, have the patient lift arms while percussing lateral and anterior sides.
• Move from superior to inferior and medial to lateral.
• Normal: resonance should be heard over all aspects of lungs
• Abnormal:
o hyperresonance is assoc. with hyperinflation which may indicate emphysema, pneumothorax, or asthma
o dullness or flatness suggests pneumonia, atelectasis, pleural effusion, or asthma
How do you measure diaphragmatic excursion? What is a normal and abnormal finding? What do the findings indicate? • Ask the patient to take a deep breath and hold it
• Percuss along the scapular line until you locate the lower border, mark the place where it changes from resonance to dullness
• Ask pt to breathe, exhale and hold exhale
• Percuss again and mark when there is a change from resonance to dullness.
• Measure the distance in cm which should be 3-5cm.
• Do this on both sides
• If less than 3-5cm then it could mean emphysema, massive ascites, tumor, or fractured rib
What are the 3 types of normal breath sounds? Where are they located on the chest and describe the sounds. • Vesicular:
o Low-pitched, low-intensity heard over all lobes of the lungs
o Soft and short expirations
• Bronchovesicular:
o Moderately-pitched, moderate-intensity heard over the major bronchi
o Expiration equals inspiration
• Bronchial:
o High-pitched, high-intensity heard over the trachea only
o Loud and long expirations, sometimes a bit longer than inspiration
Name and describe abnormal breath sounds and what these breath sounds may indicate as a differential diagnosis. • Fine crackles:
o High pitched, discrete, discontinuous crackling sounds heard during the end of inspiration; not cleared by cough
o Atelectasis, bronchiectasis, congestive heart failure, pulmonary fibrosis
• Medium crackles:
o Lower, more moist sound heard during the midstage of inspiration; not cleared by cough
o Atelectasis, bronchiectasis, congestive heart failure, pulmonary fibrosis
• Coarse crackles:
o Loud, bubbly noise heard during inspiration; not cleared by coughing
o Atelectasis, bronchiectasis, congestive heart failure, pulmonary fibrosis
• Rhonchi (sonorous wheeze):
o Loud, low, course sounds like a snore most often heard continuously during inspiration and expiration; coughing may clear sound
o usually means mucus accumulation in trachea of large bronchi
o COPD, acute and chronic bronchitis, asthma, bronchiectasis, pneumonia
• Wheeze (sibilant wheeze):
o Musical noise most often heard continuously during inspiration and expiration: usually louder during expiration
o COPD, acute and chronic bronchitis, asthma, bronchiectasis, pneumonia
• Pleural friction rub:
o Dry, rubbing, or grating sound, usually caused by inflammation of pleural surfaces; heard during inspiration or expiration; loudest over lower lateral anterior surface
o Inflamed pleura; pneumonia, pleuritis, malignancy [Show Less]