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The condition of having too much carbon dioxide circulating in the blood
What is a normal costal angle?
- 90 degrees or less
- the angle increases when the rib cage is chronically overinflated, as in emphysema
Why are fractures of the right ribs dangerous?
Because it could potentially hit the liver
Are fractures more rare on the posterior or anterior side
Label the Anterior Reference lines:
- A: anterior axillary line
- B: Mid clavicular line
- C: Mid sternal line
Label the Posterior Reference lines
- A: Vertebral Line
- B: Scapular Line
label the lateral reference lines:
- A: Mid axillary line
- B: Anterior Axillary line
- C: Posterior Axillary Line
Anteriorly the lungs expand to the _th and _th rib
7th and 8th
Posteriorly, the location of __ __ marks the apex of lung tissue, and __ __ usually corresponds to the base. Deep inspiration expands the lungs, and their lower border drops to the level of __ __.
Where is the Right Middle Lobe located
Mid clavicular, 5th intercostal space,
Normal breathing is known as
What is Bradypnea and what could it be caused by?
- Less than 12 Respirations per minute
- Anesthesia or pain meds
What is Cheyne Stoke Breathing?
- Hyperventilation with periods of apnea
- Usually seen in pts who are dieing or have head injury
What is Kussmal Breathing
Seen in patients with unmanaged diabetes. deep labored breathing
Time to play.... What color is Your Sputum?!?
If you have an infection...
If you have Tb....
If you have fluid in your lungs
- your sputum will be green/yellow
- your sputum will be rusty red
- your sputum will be frothy... full of fluid and air
What are the history questions you would ask about during a pulmonary assessment? (7)
- Ask about the cough. Do you have a cough? when did it start? How long? Any time of day?
- Do you have shortness of breath
- Do you have chest pain with breathing
- Do you have a past history of respiratory infection
- Do you have a past history of allergies
- Do you smoke
- Are there environmental factors we should be concerned about
What is the normal anterior/posterior diameter
Name 3 abnormal rib shapes.
- Pectus Excavatum (funnel chest)
- Pectus Caranatum (pigeon chest)
- Barrel Chest
The normal stimulus for humans to breath is an increase in CO2
A decrease of oxygen in the blood (hypoxemia) also increases respirations but is less effective than hypercapnia
When evaluating symmetric chest expansion, where should your fingers be placed?
- Posterior; T9 and T10
- Anterior; costal margins
What is crepitus?
if someone has had chest surgery, people may get air in subcutaneous tissue. If you touch chest around incision it will sound like rice crispies. Or in a pt with a chest tube and pt got air in subcutaneous tissue.
In what scenario may thumbs move assymetrically or not move at all when evaluating chest expansion
- If pt has a collapsed lung
- If pt has asthma
When testing fremitus, what is a normal finding
Fremitus normally decreases as you progress down because more and more tissue impedes sound transmission.
- occurs when anything obstructs transmission of vibrations
- (e.g., obstructed bronchus, COPD, tumor, very thick chest wall, or emphysema).
- Any barrier that comes between the sound and your palpating hand will decrease fremitus.
- occurs with compression or consolidation of lung tissue (e.g., lobar pneumonia).
- This is present only when the bronchus is patent and when the consolidation extends to the lung surface. Note that only gross (large) changes increase fremitus. Small areas of early pneumonia do not significantly affect fremitus.
When auscultating the lungs posteriorly....
- –Listen to lung areas from apices at C7 to bases at T10, and laterally from the axilla down to the
- 7th or 8th rib.
- ask pt to breath in and out of mouth
Bronchial breath sounds are ____________
And are found ___________
- short, high pitched, and loud. inspiration is less than expiration
- over the trachea and larynx on the anterior side
Broncovasicular sounds are ________ and are found ___________
- moderate pitched and inspiration and expiration are =
- over major bronchi (just outside the sternum and just outside of the upper spine)
Vesicular breath sounds are ________ and found ________
- Low pitched, soft, and inspiration is longer than expiration
- Found over peripheral lung fields where small bronchioles and alveoli are
Adventitious refers to
added breath sounds
Crackles or Rales are
- caused by air passing through moisture in air passages
- usually inspiratory, not usually cleared by coughing
- fine rales=sm. airways;
- course rales=lg. airways
- found in the patient with pulmonary edema and Congestive Heart failure
Ronchi refers to
- caused by passage of air through an airway obstructed by thick secretions, muscular spasm or new growth.
- rumbling or snoring sound
- heard on inspiration or expiration, but usually expiration
- originates in larger airways
- coughing may alter sound or clear it
- usually from bronchitis
Wheezes refers to
- caused by air trying to squeeze through a passage narrowed by bronchospasm, tumor or a foreign body.
- high-pitched, musical sound
- usually expiratory, but can be expiratory or inspiratory
- occurs with asthma or pneumonia
caused by foreign body, tumor or severe bronchospasm
- musical sound of constant pitch that is predominantly inspiratory, sounds like a crowing sound
- often louder in the neck than over the chest wall
- *can be caused by child who swallows a penny etc
Pleaural Friction Rub
- caused by rubbing together of inflamed or roughened pleural spaces
- grating sound with the quality of old leather crackling; can also be a squeaky sound
- heard on inspiration and expiration
What are some "self care" promotions that would increase pulmonary health?
- Stop smoking
- Radon tests
- influenza vaccine
- pneumonia vaccine
- PPD test
You should receive the pneumonia vaccine if you are:
- 65 years old +
- In a long term care facility
- on meds that decrease the immune system
- a smoker
- or a victim of chronic illness