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Normal breathing rate and pattern
Increased respiratory rate
Decreased respiratory rate
Absence of breathing
Normal rate, but deep respirations
Tachypnea and hyperpnea
Prolonged inspiratory phase with shortened expiratory phase
- [bron - co - fanny]
- Abnormal transmission of sounds from the lungs or bronchi.
- Ask the pt to say "Ninety Nine"
- Normally, the sound of the pt's voice becomes less distinct and muffled as the auscultation moves peripherally; bronchophony is the phenomenon of the patient's voice remaining loud at the periphery of the lungs or sounding louder than usual over a distinct area of consolidation, such as in pneumonia, as fluids transmit the sounds better.
- refers to an increased loudness of whispering noted during auscultation with a stethoscope on the lung fields on a patient's back.
- Ask the pt to whisper "Ninety Nine"
- Usually sounds of this volume would not be heard when whispered. It is a test to evaluate for the presence of lung consolidation, which could be caused by cancer or pneumonia.
- is an increased resonance of voice sounds often caused by lung consolidation and fibrosis. It is due to enhanced transmission of high-frequency noise across fluid, such as in abnormal lung tissue, with lower frequencies filtered out.
- Ask the Pt to say the letter "e"
- A higher pitched sound that sounds like the letter "a" indicates pneumonia.
- is a vibration felt on the patient's chest during low frequency vocalization.
- Ask the Pt to repeat a phrase while you feel for vibrations by placing a hand over the pt's chest or back.
- Phrases commonly used in English include, 'boy oh boy' and 'toy boat' as well as 'blue balloons'.
- Tactile fremitus is normally more intense in the right second intercostal space, as well as in the interscapular region, as these areas are closest to the bronchial bifurcation.
- Tactile fremitus is pathologically increased over areas of consolidation and decreased or absent over areas of pleural effusion or pneumothorax (where there is liquid or air instead of usual lung).
- Hard: ↑
- Wet: ↓ or absent
is a vibration felt on the chest when the pt coughs.
- Ataxic respirations: abnormal pattern of breathing characterized by groups of quick, shallow inspirations followed by regular or irregular periods of apnea.
- Caused by damage to the medulla oblongata due to strokes or trauma or by pressure on the medulla