Thorax and Lungs HA Exam #3

productive/nonproductive
hemoptysis

coughing up something: blood, sputum
document what coughing up
purulent = gross

dry cough

coughing up blood

Dyspnea -> trouble breathing
Orthopnea -> dyspnea while laying down
Paroxysmal nocturnal dyspnea (PND) -> wake up gasping for air and sit up to find relief
chest pain with breathing

How many pillows do you sleep on at night?
Do you wake up short of breath?

recent infections
What do you smoke?
How many packs/day?
When you start smoking?
Second hand smoke exposure -> smoking reaction
Third hand smoke exposure -> being in the environment people smoke in (their house, car, etc)

around chemicals or fumes?
kindergarten teacher -> exposed to respiratory illness
country/ rural -> around pesticides

TB skin test (date/ results) ->immunocompromised pt, inmates, high risk communities
Influenza (flu) vaccine
Pneumonia vaccine (65+)

Upright (gown as needed)
Drape as needed

Stethoscope
Alcohol -> clean after putting on pt

POSTERIOR
- inspection
- palpation
- percussion
- auscultation
ANTERIOR ^
ALWAYS include Lateral Chest

Shape/configuration of chest wall
AP (anteroposterior diameter)
Position of person
Skin color and condition

shape of the chest anterior-posterior (front to back)
to
transverse (side to side)

Normal 1 to 2 (1:2)
Barrel Chest 1 to 1 (1:1) ( can be 2:2 but reduce 1:1
measure with hand across side and front of chest

palpate the chest
perform chest expansion -> put hands on back like a butterfly and hands should move as breathing in
NORMAL: symmetric
one side doesn't move -> may have collapsed lung or obstruction

>24 breathing rate
>22 would be increased rate
shallow breathing, rapidly

<10 breathing rate
regular pattern just slow

palpable vibration on the chest wall when talking
palm on hand of back and go down in a ladder fashion
tactile or vocal

loudest at apex
decreases as move down chest
symmetric

consolidated
usually means pneumonia

obstruction
emphysema

place middle finger of non-dominant hand o patient
rest hand OFF body
use middle finger of dominant hand to percuss
make sure that finger is firmly on the chest
use tip of finger and hit BELOW the fingernail using relaxed wrist motion
percuss 2-3 times at each location
dull -> organs
resonance -> ICS

breathing routinely has a sigh in it

Increased rate, increased depth
blowing off CO2
use paper bag to prevent blowing off CO2
diabetic ketoacidosis and shock

shallow breathing and spaced out breathing
overdose patient, lot of pain, too much anesthesia

regular pattern
waxing and waning

like Cheyne-Stokes but irregular

normal inspiration and prolonged expiration
COPD retain CO2

use of stethoscope
listen to lung sounds
step ladder pattern
thoroughly done is 9 spots

low pitch
breezy or rustling like sound of wind in trees
soft amplitude
Duration: Inspiration louder than expiration
Location: peripheral lung fields
stated as CLEAR breath sounds

moderate pitch and amplitude
mixed quality
Duration: Inspiration equals expiration
Location: over major bronchi; posterior-between scapulael antieror-upper sternum 1st-2nd ICS

high pitched
hard or tubular quality
loud amplitude
Duration: Expiration louder than inspiration
Normal: trachea or larynx

stethoscope tubing bumping together
patient shivering
patient's hairy chest
rustling of paper gown or paper drapes sound like crackling

extra lung sounds

hardening vessel walls

plaqueunk inside walls

kind of like hair rubbing together
very end of inspiration will hear
formerly called Rales

sounds like crunchy leaves
just after beginning of inspiration and little into expiration will hear
can clear a little with coughing but will come back

two pieces of leather rubbing together
grating sound
end of inspiration beginning of expiration
caused by inflammation between lung itself and sack lung is in*

sounds like a seal
inflammation in upper airway
toddler swallowing a penny

whistling
usually constriction -> asthma
very end of inspiration and all of expiration
wheezy whistle blowing out
High-pitched**

blowing bubbles in milk
on expiration
low-pitched**

ask patient to repeat "99" as listen over chest wall

soft, muffled, indistinct
shouldn't really be able to hear it

sounds more distinct over areas of increase density
consolidated areas = pneumonia, tumor

ask patient to repeat "E" (ee-eee-ee) while you listen over chest wall

soft, muffled, hear "E"

sounds louder, changes to "A" (aa-aa-aa) over area of consolidation

ask patient to whisper "1-2-3" as you listen over lungs

faint, muffled, almost inaudible

clear, distinct like whispering into the stethoscope over areas of consolidation

very loud

very low

long

booming

child's lung

loud

low

long

hollow

peripheral lung

loud

high

medium

drumlike

stomach

medium

high

medium

thudlike

liver

soft

high

short

extreme dullness

muscle