Glossary of thoracic and lungs assessment

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The strongest stimulus to breathe ?
an increase of carbon dioxide.
types of posterior chest configurations.

barrel chest
IF you hear an abnormal sound during auscultation, what should the nurse have the client do?
have the client cough, then listen again and note any change.
Breath sounds heard when assessing the posterior chest?
vesicular and bronchovesicular
Breath sounds heard while assessing the anterior chest ?


adventitious sounds

hyperresonance is elicited in cases of ?
pneumothorax or emphysema
When is dullness elicited?
when fluid or solid tissue replaces air in he lungs or occupies the pleural space.
Examples of dullness can be heard in clients who have?
lobar pneumonia

pleura effusion

external respirations
Elderly consideration

Dyspnea related to activity
loss of elasticity
fewer functional capillaries
loss of lung resiliency
Dyspnea that occurs with edema or angina could indicate ?
a cardiovascular problem
Gradual onset dyspnea could indicate
Sudden onset of dyspnea is associated with?
viral or bacterial infection
Orthropnea is associated with ?
congestive heart failure
Paroxysmal nocturnal dyspnea is associated with ?
congestive heart failure
Where can the pain sensitive nerve endings be found?
parietal pleura

thoracic muscles

tracheobronchial tree
Chest pain associated with pulmonary origin may be associated with ?
pulmonary disease
continuous coughs are associated with?
acute infections
coughs occurring early in the morning are associated with ?
chronic bronchial inflammation or smoking
coughs late in the evening are associated with?
exposure to irritants
coughs occurring at night are associated with?
postnasal drip or sinusitis
non-productive coughs are associated with ?
upper respiratory irritation or early congestive heart failure

Elderly considerations
coughs becomes less productive due to weaker muscles and increased rigidity of the thoracic wall
white or mucoid sputum is associated with ?
common cold
viral infections
yellow or green sputum is associated with ?
bacterial infections
blood in the sputum AKA hemoptysis is associated with?
serious respiratory conditions
Rust colored sputum is associated with ?
pneumococcocal infection
Pink, frothy sputum may indicate?
pulmonary edema
Wheezing indicates?
a narrowing of the airway due to spasm or obstruction
Wheezing is associated with ?
congestive heart failure= CHF

asthma=reative airway disease

excessive secretions
Asthma symptoms may mimic the symptoms of ?
emphysema or heart failure
Thoracic surgery can alter ?
the appearance of the thorax and changes in the respiratory sounds .
Truama to the thorax can cause ?
lung tissue changes
Respiratory responses that are associated with allergic reactions are ?
Second hand smoke puts an individual at risk for ?
emphysema or lung cancer later in life
Inhaling dust contaminated with Histoplasma capsulatum may cause?
histroplamosis a systemic fungal infection
Lung cancer

African American men
have a higher incidence and mortality rate
Lung cancer risk reduction teaching tips.
stop smoking
diet=low cholesterol adequate vit. E and lutein
limited exposure to pollution
wear protective mask when necessary
The average age of lung cancer diagnosis ?
60 years old
Survival rate of lung cancer if detected early?
5 year survival rate is 42% but only 15% of the cases are detected early
How many years does it take for a smoker's who quits lungs to return to normal ?
10 to 15 years.
If a client is using oxygen at home the nurse should evaluate the client's ?
knowledge of proper usage
and ability to afford the therapy
an increased curve of the thoracic spine, is common is older adult. Results from a loss of skeletal muscle : it may be a normal finding
Barrel chest
Ribs appearing horizontal at an angle of greater than 45 degrees with the spinal column are often the result of an increased ratio between the anteroposterior-transverse diameter
Barrel chest is common is clients with?
emphysema due to hyper-inflation of the lungs
To inspect the clients posterior chest configuration and scapulae the client is in what position?
sitting with back to the nurse with arms at the side.
A normal scapulae finding is ?
non-protruding, shoulders and scapulae are at equal horizontal positions.
What race have a larger thorax and greater lung capacity?
adult Caucasians
The use of trapezius, or shoulder, muscles are used in cases of ?
atelectasis or chronic airway obstruction
Tripod position is used by clients who suffer from?
Pain over the intercostal spaces indicates?
inflamed pleurae
Pain over the ribs, especially at the costal condral junctions is a symptom of ?
fractured ribs
Increased warmth while palpating the thorax indicated
local infection
What should a nurse do if he/she palpates an unusual mass?
refer client to doctor for further evaluation
How does the nurse palpate fremitus ?
use the ball or ulnar of the hand starting left midline at the level of the scapula and proceeding from side to side areas just above the waist.

symmetric expansion
use both hands, thumbs together and fingers apart on the client's back below the lungs
papating for sensations, lumps, and masses should be done with what part of the hands?
tactile fremitus may best be felt with ?
heel of the hands or the base of the fingers
Crepitus is AKA subcutaneous emphysema
can be felt is air escapes from the lung or other airways into the subcutaneous tissues occurs with open thoracic injury or tracheostomy, or around a chest tube
crepitus can be described as ?
a crackling sensation - like hair or bones rubbing together. it occurs when air passes through fluid or exudate.
If crepitus is palpated the nurse should ?
mark he margins and monitor to note any decrease or increase in the crepitant area.
IS crepitus a normal or abnormal finding ?
What is fremitus ?
vibrations of air in the bronchial tubes transmitted to the chest wall, felt by the examiner when the client says "ninety-nine"
Normal fremitus is ?
felt symmetric for bilateral positions.
decrease in the intensity as the examiner moves downward.
symmetrical and easily identified in the upper regions.
Unequal fremitus is usually the result of ?
consolidation that increases fremitus or bronchial obstruction, air trapping in emphysema, pleural effusion, or pneumothorax that decreases fremitus.
Diminished fremitus even when spoken with a loud voice may indicate?
an obstruction of the tracheobronchial tree.
What should the nurse do if she cannot
palpate fremitus on either side?
ask the client to speak louder.
hands on the posterior chest wall
thumbs at the level of t9 or t10
ask client takes deep breath
observe movement
thumbs move 5-10 cm.
palpte chest expansion
decreased chest expansion at the base of the lungs is associated with?
chronic obstructive pulmonary disease.
unequal chest expansion is associated with ?
severe atelectasis
chest trauma
or pneumothorax
How does the nurse percuss for tone on the posterior chest wall?
start at apices above the scapula
across tops of both shoulders
percuss the intercostal spaces across and down.
compare sides
Is resonance a normal or abnormal finding ?
What is the normal tone that should be heard when percussing the chest?
hyperresonance is elicited in cases of?
trapped air

examples are= emphysema or pneumothorax
Dullness is percussed in cases of ?
fluid or solid tissue replaces air in the lung or occupies the pleural space
examples are= lobar pneumonia, pleural effusion, or tumor
diminished or absent breath sounds often indicate?
little or no air movement in or out of the lungs being auscultated may indicate obstruction as a result of secretions, mucus plug, or a foreign object and may indicate abnormalities of the pleural space
Sometimes breath sounds may be hard to hear because of ?
a client is obese or heavily muscled due to increased distance to underlying tissue
Diseases related to decreased or absent breath sounds ?
pleural thickening
pleural effusion
pneumothorax emphysema
When would a prominent sternum and ribs be a normal finding ?
when assessing an elderly client. due to loss of subcutaneous fat.
If the level of the diaphragm is higher on the right is this a normal or abnormal finding ?
normal because of the position of the liver
labored and noisy breathing is seen in clients with ?
severe asthma
chronic bronchitis
normal respiration range
10- 20 per minute
Cheyne-Stokes breathing is heard in clients with ?
congestive heart failure
drug overdose
increased cranial pressure
renal failure
Biot's breathing is associated with ?
severe brain damage
> 24/min and shallow
normal response to fever, anxiety, or exercise.
also occur with respiratory insufficiency alkalosis, pneumonia, or pleurisy
< 10/min and regular
normal in athletes
can occur with medication-induces coma, neurologic damage
increased rate and increased depth
occurs w/ exercise, fear, anxiety

can occur w. disorders of central nervous system, overdose of the drug salicylate, or severe anxiety
Kussmal's respirations is a type of hyperventilation see in clients with ?
diabetic ketoacidosis
Wheezes (sibilant) are heard in client's with ?
acute asthma
chronic emphysema
Wheezes (sonorous) are heard in client's with?
bronchitis or single obstructions and snoring before an episode of sleep apnea.
Stridor is a harsh honking wheeze heard in clients with severe?
broncholaryngospasm such as croup
Pleural friction rub
sound of the rubbing of two inflamed pleural spaces = pleuritis
When is a pleura friction rub not heard?
not heard if the client holds their breath.

client say ninety-nine
the words are easily understood and louder over areas of increased density.

indicates consolidation from pneumonia, atelectasis, or tumor

client says "E"
over areas of consolidation or compression the sound will be louder and change to the letter "A"
whispered pectoriloquy
client whispers he phrase one-two-three
over areas of consolidation or compression the sound will be transmitted clearly and distinctly
auscultating the posterior thorax the nurse starts ?
the apex of the lung at C7
client will breathe deeply through his or her mouth for each area of auscultation.
auscultate from C7 to T10 and laterally from the axilla down to the seventh or eighth rib
to auscultate the anterior thorax where does the nurse start?
apices of the lungs, above the clavicles to the bases of the lungs at the sixth rib
pectus excavatum
funnel chest= sunken sternum= seldom causes problems
pectus carinatum
pigeon chest= sternum protrudes = requires no treatment
bronchial breath sounds are heard?
over the trachea and larynx
bronchovesicular sounds are heard ?
over the major bronchi

posterior= around the upper sternum
anterior = around the upper sternum in the first and second intercostal space.
where are vesicular sounds are heard?
peripheral lung fields
thick and sticky secretions
interventions for cough and thinning
bronchial breath sounds

short during inspiration
long during expiration
bronchovesicular breath sounds

even on inspiration and expiration
vesicular breath sounds

long during inspiration

short during expiration
crackles (fine)

high pitched
short popping sounds during inspiration
not cleared with cough
sounds like hair rubbing together
crackles (coarse)

bubbling moist
persist from early inspiration to early expiration
velcro separating
crackles (fine)

the source of?
inhaled air suddenly opens the small deflated air passage that are coated and sticky with exudate
crackles (coarse)

inhaled air comes in contact with secretions in the large bronchi and trachea
Wheeze (sibilant)

high pitched
during expiration
Wheeze (coarse)

low pitched
snoring or moaning
may clear with coughing
sudden severe pain with dyspnea
pursed lip breathing is associated with ?
or chronic heart failure

it is a physiological response to slow down breathing
nasal flaring is associated with ?
SOB w/ mild exertion i.e. flight of stairs
grade 1
sob walking a short distance, level ground
grade 2
SOB minimal activity, i.e. shaving
Grade 3
SOB @ rest
Grade 4
Orthopnea, SOB while supine
Grade 5

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