Card Set Information

2011-06-17 21:51:58
bates ch8

thorax & lungs
Show Answers:

  1. What is the top center of the manubrium termed
    suprasternal notch
  2. What is the space termed where the manubrium & sternum meet
    sternal angle
  3. The cardiac notch of the left lung is in what interspace
    4th interspace
  4. What is the space termed for the angle btwn the 2 ribs
    costal angle
  5. How should you describe the abnormalities of the chest wall
    • vertical axis
    • circumference of the chest
  6. How do you determine the vertical locations
    • count the ribs & interspaces
    • sternal angle best guide
  7. What intercostal space is used for needle insertion for tension pneumothorax
  8. What intercostal space is used for chest tube instertion
  9. What spinous process is the lowest margin for endotrachial tube on chest x-ray
  10. Which ribs articulate with the sternum
    1st seven
  11. Which ribs articulate with the costal cartilages superior to them
  12. Name the floating ribs
  13. Where is the inferior tip of the scapula
    7th rib interspace
  14. how do you locate findings around chest circumference
    vertical lines
  15. Which two lines are precise
    midsternal & vertebral
  16. where does the midclavicular line drop to
    midpoint of clavicle
  17. where does the ant & post axillary lines drop
    vertically from ant & post axillary folds
  18. where does midaxillary line drop
    apex of axilla
  19. vertebral line overlies what
    spinous processes
  20. scap line drops
    inf angle scapula
  21. How high does the apex of each lung go
    2-4 cm above inner 3rd clavicle
  22. how low does lower border of rib go
    • crosses 6th ribs at midclavicular line
    • 8th ribs midaxillary line
    • post=T10
  23. What divides the lungs in half
    oblique (major) fissure
  24. Additionally the right lung is further div by
    horizontal fissure (minor)
  25. Fissures div lungs into
  26. What is the approximated location of the oblique fissure
    T3 down & around chest 6th ribs midclavicular line
  27. What is the approximated location of the horizontal fissure
    ant=4th ribs meets obl fiss at midax line 5th rib
  28. where does the trachea bifurcate into mainstem bronchi
    level of sternal angle ant & T4 post
  29. A serous membrane that cover outer surface of each lung
    visceral pleura
  30. what covers the inner rib cage & upper surface of diaphragm
    parietal pleura
  31. What are the common or concerning symptoms of the thorax
    • chest pain
    • dyspnea
    • wheezing
    • cough
    • hemoptysis
  32. What should your intial question be for chest pain
    Do you have any discomfort or unpleasant feelings in chest & have them point to location of pain. try to elicit 7 attributes symptom
  33. Chest pain may come from other areas besides the lungs including
    • cardiac
    • vascular
    • GI
    • musclesk
    • skin
    • anxiety
  34. How is pain in the lungs determined
    inflammation of adj parietal pleura
  35. What does a clenched fist over sternum suggests
  36. A finger pointing to a tender area on chest wall suggests
    muscle sk pain
  37. A hand moving from neck to epigastrum suggests
  38. Most frequent cause of chest pain in children
    anxiety or costochondritis
  39. what is dyspnea
    shortness of breath
  40. A nonpainful but uncomfortable awareness of breathing that is inappropriate to level of exertion
  41. How do you start your questioning with dyspnea
    Have you had any difficulty breathing
  42. How do you determine the severith of dyspnea
    by patients daily activities=quantify for example how many stairs they can walk up before pausing for breath
  43. Musical resp sounds that may be audible to the patient or to others
  44. What does wheezing suggests
    partial airway obstruction-secretions, tissue inflammation;foreign body
  45. A reflex response to stimuli that irritate receptors in larynx, trachea or lrg bronchi or cardiovasc orgin
  46. A cough may be a symptom of what type of heart failure
  47. A good question to ask about cough
    Does the cough produce sputum, phlegm or is it dry
  48. What is important for patient to explain to the clinician about cough
    vol sputum & its color odor, consistency
  49. what is most common cause of acute cough
  50. Coughing up blood from the lungs
    hemoptysis & it varies from blood streaked phlegm to frank blood
  51. How you should as the clinician address the patient about hemoptysis
    have them describe vol blood produced & sputum Battributes
  52. Blood originating in the stomach will look how
    darker than blood from resp tract
  53. What are some important topics for health counseling & promotion
    • tobacco cessation
    • immunizations
  54. When addressing tobacco cessation how should you go about addressing the issue of usage
    • Ask about smoking
    • Advise them to stop
    • Assess their readiness to quit
    • Assist them with stop dates & educational resources
    • Arrange follow-up visits
  55. how often should you advise patients to get a flu shot
    1 dose annually in fall or winter
  56. how often should you adive patients to get a pneumococcal vacine
    • 65 years & older if 1st dose was given prior to age 65 & 5 yrs have elapsed since 1st dose
    • 2-64 with chronic illnesses
    • anyone w/cochlear implant
    • immunocompromised
    • native americans
  57. how often should patients get a Tdap
    never had one or dealing with infants younger than 12mos, healthcare personnel,over 65 with risk indicator
  58. how should you examine post thorax
    patient sitting
  59. how should you examin ant thorax
    patient supine
  60. How should you proceed in an orderly fashion
    • inspect
    • palpate
    • percuss
    • ausculatate
  61. What is the intial survey of respiration & the thorax
    observe rate, rhythm, depth, effort of breathing
  62. What do yo want to look for when inspecting for signs of resp difficulty
    • color
    • breathing
    • neck
  63. how do you want to assess the patients color
    looking for cyanosis which could signal=hypoxia
  64. What is a high pitched wheeze that is an obvious sign of airway obstruction in larynx or trachea
    audible stidor
  65. Inspiratory contraction of SCM & scalens at rest signifies
    severe difficulty in breathing
  66. Lateral displacement of trachea could signal
    • pneumothorax
    • pleural effusion
    • atelectasis
  67. Why is it important to observe the shape of the chest/Ap diameter
    Ap diameter may increase in COPD
  68. How do you want to inspect the posterior chest
    note the shape chest & way it moves
  69. What to look for with palpation
    abnormalities & tender areas
  70. How do you test for chest expansion
    thumbs at 10th rib & fingers loosely grasping & parallel to lat rib cage watch the distance btwn thumbs as they move apart during inspiration
  71. What does fremetis refer to
    palpable vibrations transmitted through bronchopulm tree to chest wall as the patient speaks
  72. What does percussion help to establish
    underlying tissues are air-filled, fluid-filled or solid
  73. What are the different percussion notes
    • flat
    • dull
    • resonance
    • hyperresonance
    • tympany
  74. What type of percussion do you want to use
    lightest that produces a clear note
  75. How do you want to percuss
    • side to side to assess for asymmetry
    • strike using tip of your finger
  76. Healthy lungs have what type of percuss sound
  77. gastric air bubble or puffed out cheek sound with percuss
  78. Thigh produces what kind of percuss sound
  79. liver produces what kind of percuss sound
  80. What replaces resonance when fluid or solid tissue replaces air containing lung or occupies pleural space beneath percussing fingers
  81. pathologic example of flatness
    lrg pleural effusion
  82. pathologic example of dullness
    lobar pneumonia
  83. pathologic example of resonance
    simple chronic bronchitis
  84. pathologic example of hyperresonance
    copd & pneumothorax
  85. pathologic example of tympany
    lrg pneumothorax
  86. Diaphragmatic excursion
    estimate extent by the descent of diaphragm to determine level of diaphragmatic dullness in quiet respiration=5-6cm
  87. most important examination for assessing air flow through tracheobronchial tree
  88. What does auscultation & percussion assess
    condition of surrounding lungs & pleural space
  89. What are the normal breath sounds
    • vesicular
    • bronchial
    • bronchovesicular
  90. soft & low pitched heard over most of both lungs
  91. louder & higher in pitch usually heard over manubrium
  92. intermediate intensity & pitch heard over 1st & 2nd interspaces
  93. very loud harsh sounds heard over trachea
  94. What are the adventitious sounds
    • crackles
    • wheezes
    • rhonchi
  95. discontinous intermittent nonmusical & brief sounds
  96. continious musical prolonged but not persisting throughout resp cycle
    wheezes & rhonchi
  97. wheezes suggest narrowed airways as in
    • asthma
    • copd
    • bronchitis
  98. What does rhonchi suggest
    secretions in lrg airways
  99. How to exam the anterior chest
    inspect & auscultate
  100. spoken ee heard as ay suggest
  101. whispered words louder & clearer
    whispered pectoriloquy
  102. how is tactile fremetis in a normal air filled lung vs airless lung with the case of lobar pneumonia
    • normal=normal
    • airless=increased due to alveoli filled w/fluid, rbc's, wbc's=consolidation
  103. what are some other causes of increased tactile fremitus
    pulm edema or hemorrhage
  104. Tactile fremitis is normal in what conditions
    • normal
    • chronic bronchitis
    • left side Heart failure
  105. Tactile fremitus is decreased in the following conditions
    • pleural effusion
    • pneumothorax
    • COPD
    • Asthma
  106. What conditions produce a resonaut sound with percussion
    • normal
    • chronic bronchitis
    • left side heart failure
  107. what conditions produce a dull over airless area with percussion notes
    • consolidation
    • atelectasis=lobar obstruction
  108. what condition produces a percussion note of dull to flat over fluid
    pleural effusion
  109. what condition produces a percussion note of hyperresonaut or tympanitic over pleural air
  110. what condition produces a diffusely hyperresonaut percussion note
  111. what condition produces a resonaut to diffusely hyperresonant percussion note
  112. The trache stays in midline in all of the following conditions
    • normal
    • Chr Br
    • LSHF
    • cons
    • COPD
    • Asthma
  113. trachea may be shifted toward involved side in what condition
  114. trachea is shifted toward opposite side in large effusion in what condition
    pleural effusion
  115. trachea is shifted toward opposite side if much air in what condition
  116. normal breath sound
  117. Chronic bronchitis breath sound
  118. LSHF breath sound
  119. consolidation breath sound
  120. atelectasis breath sound
    • absent=bronchial plug persists
    • other=tracheal maybe
  121. pleural effusion breath sound
    decreased to absent but bronchial near top
  122. pneumothorax & copd breath sounds
    decreased to absent
  123. asthma breath sounds
    often obscured by wheezes
  124. normal cond advent sounds
    none but maybe transciet crackle at lung base
  125. Chr Bron adven sounds
    none or scattered crackles in early inspriation/exp or wheezes/rhonchi
  126. adventious sounds in LSHF
    late insp crackles w/possible wheezes
  127. adventious sounds in consolidation
    late insp crackles
  128. advent sounds in atelectasis
  129. pleural effusion & pneumothorax advent sounds
    none except possible pleural rub
  130. advent sounds of copd
    none or crack,wheeze/rhonchi of associated chr bron
  131. advent sounds asthma
    wheezes possibly crackles