Procedure 19-12 Asessing chest and lungs
Terms
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- What are 3 things you should assess when observing respirations?
- rhythm, depth and symetry of the chest movement.
- what do you inspect the anteroposterior chest for?
- lateral ratio, costal angle, spinal deformity, respiratory effort and skin condition.
- What is a newborns respiratory rate?
- 40-90. the rate gradually declines as the child matures.
- respirations should be ____ with a _____ rhythm and depth
- quiet, regular
- What are some things that may increase respiratory rate?
- activity, smoking, fever, pain, anemia
- What may sternal and intercostal retractions indicate?
- it is an abnormal finding. It may indicate hypoxia, respiratory distress, and airway obstruction.
- What might cause asymmetrical chest movement during breathing?
- rib fractures, pneumothrax, atelectasis. ...the effected area might not move at all.
- What might cause chest asymmetry?
- musculoskeletal disorders of the spine like Kyphosis or Scoliosis.
- What is the normal adult AP lateral ratio?
- 1:2
- What is the normal AP lateral ratio in infants?
- AP is equal to lateral diameter
- What is the normal costal angle?
- <90 degrees
- What would an abnormal costal angle be? What would it suggest?
- >90 degrees. COPD ...and it would be a barrel chest
- What SHOULD the spine look like?
- straight without lateral curvatures or deformit
- What is scoliosis?
- lateral curvature of the spine
- What is Kyphosis
- excessive thoracic curvature
- When would sternal and intercostal retractions be seen?
- in severe hypoxia or respiratory distress
- When assessing the skin of the chest wall, what color might indicate hypoxia?
- cyanosis
- Where should the trachea be?
- midline
- What might cause trachea diviation?
- a mass in the neck--thyroid enlargement, or from excess pressure in the lungs
- When palpating the chest, what are you looking for?
- tenderness, masses, or crepitus
- What is crepitus?
- crackling under the skin due to air in the subcutaneous tissue.
- When palpating chest excursion, where do you place your hands, and how far apart do you place them?
- Place your hands at the base of the clients chest with fingers stread and thumbs about 5cm (2 in) apart. If doing it anteriorly its at the costal margin, ...if posteriorly its at the 8th to 10th rib.
- What might asymmetrical chest excursion indicate?
- airway obstruction, pleural effusion, or pneumothorax.
- What is pneumothorax?
- collapsed lung!!
- What is fremitus?
- tactile vibration on the human body--usually from vocal stimulation.
- Where SHOULD fremitus be diminished in vibrations?
- midthorax ....also may be diminished if the chest wall is very thick or the voice is very soft.
- What are normal findings when palpating for fremitus?
- should be equally bilateral on the anterior and posterior chest and deminished in the thorax.
- How do you palpate for fremitus?
- use the palmar surface of your hands, but raise the fingers off the clients chest so that you palpate with the bony metacarpophalangeal joints of your hands.
- What are the best areas for detecting vibrations?
- bony promonances
- What should you have the client do when your palpating for vibrations?
- say 99
- In what case would increased fremitus be normal?
- in thin adults or in children
- What would increased fremitus indicate?
- fluid in the lungs (like pulmonary edema)
- What would decreased or absent fremitus indicate?
- decreased air movement or tissue consolidation--like in emphysema and asthma
- How do you assess for fremitus in infants
- place your hand over their chest while they are crying.
- Where do you percuss on the chest?
- over the intercostal spaces rather than the ribs
- Where is the anterior chest resonant to?
- the 2nd Intercostal space on the left and teh 4th intercostal space on the right.
- Where is the lateral chest resonant to?
- the 8th intercostal space
- Where is the posterior chest resonant to?
- T12..or 12th thorasic.
- What would dullness mean when percussin the lungs?
- when there is fluid or masses in the lungs
- What would hyperresonance mean when percussing the lungs?
- air that is trapped in there, like with emphysema
- Do you use direct or indirect percussion when percussing the lungs?
- indirect
- how should you percuss the chest for diaphragmatic excursion?
- start by having the client exhale and hold his breath. start percussing just below the scapula moving down toward teh diaphragm. The sound will become dull at the diaphragm. mark this with a pen, and then repeat the same thing after the client has inhaled and held his breath.
- what is the length of diaphragmatic excursion?
- 3-6 cm between the two marks.
- when would you auscultate for normal voice sounds?
- if there is evidence of lung congestion.
- how do infants breath sounds differ from that of adults?
- they are louder
- how do you assess for bronchophony?
- have the client say 1,2,3 as you listen over the lung fields
- how do you assess for egophony?
- have your client say eeee as you listen over the lung fields
- how do you assess for whispered pectoriloquy?
- have the client whisper 1,2,3 as you listen over lung fields
- What would indicate bronchophony?
- if the 1,2,3 is clearly heard over the lungs
- what would indicate egophony?
- if the sound you hear is "ay" instead of eeee
- what would indicate whispered pectoriloquy?
- if you hear 1,2,3 clearly.
- when auscultating the chest, what should you instruct the client to do?
- take slow, deep breaths through his mouth as you listen to each site through one full respiratory cycle.