Chapter Adventitious Lung Sounds And Assessment Of Respiratory – Flashcards
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Sigh
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Occasionally normal, frequent may indicate emotional dysfunction, hyperventilation and dizziness
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Tachypnea
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Rapid, shallow breathing. Increased rate of 24+, response to fever, fear, exercise, respiratory insufficiency, pneumonia, alkalosis, pleurisy and lesions in the pons
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Bradypnea
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Slow breathing, decreased but regular rate of 10 or less per minute. Seen with drug induced depression of respiratory system, diabetic coma and increased intracranial pressure
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Hyperventilation
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Increase in both rate and depth. Occurs width extreme exertion, fear, anxiety, hepatic coma, ketoacidosis, decreased CO2 level in blood
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Hypo ventilation
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Irregular shallow pattern caused by overdose of narcotics or anesthetics, prolonged bed rest or splinting of chest
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Cheyne-strokes respiration
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cycle in which respirations gradually wax and wane in a regular pattern, increasing in rate and depth and then decreasing. Breathing periods = 30-45 seconds w 20 seconds of apnea causes are heart failure, renal failure, drug OD
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T or F are cheyne-strokes respirations normal in infants or the elderly
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True
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Biot Respiration
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Cycle length of normal respirations with apnea variable. Caused by head trauma, heat stroke, spinal meningitis
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chronic obstructive breathing
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normal inspiration and prolonged expiration to overcome increased airway resistance. Can lead to dyspneic episode
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types of discontinuous sounds
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Fine crackles, coarse crackles, atelectatic crackles and pleural friction rub
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types of continuous sounds
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wheeze (high pitched), wheeze (low pitched) and stridor
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fine crackles
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high pitched, short crackling, popping sounds heard during inspiration that are not cleared by coughing. Seen with pneumonia, heart failure, COPD, bronchitis, asmatha, emphysema and changing from sitting to supine
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Coarse crackles
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loud, low pitched bubbling/gurgling sounds that start early in inspiration. May decrease with suctioning but re appear quickly. Velcro fastener sounds. Seen with pulmonary edema, pneumonia, pulmonary fibrosis, and the terminally ill
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Atelectatic crackles
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fine crackles that don't last and that are not pathologic, disappear after a few breaths. Seen in aging adults, bed ridden patients of people aroused from sleep
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Pleural friction rub
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Superficial sound that is course and low pitched, sounds like 2 pieces of leather being rubbed together. Seen with pleuritis along with pain with breathing
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Wheeze (high pitched)
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high pitched, musical squeaking sounds that are predominant in expiration but sometimes also in inspiration. Caused by diffused airway obstruction from acute asmatha or chronic emphysema
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Wheeze (low pitched)
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low pitched, single note musical snoring/moaning sounds heard more predominantly in expiration. Caused by bronchitis, single bronchus obstruction from airway tumor
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Stridor
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high pitched, monophonic inspiratory crowing sound, louder in neck than in chest. Seen with croup and acute epiglottis in children or foreign inhalation
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Atelectasis
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Collapsed shrunken section of alveoli or an entire lung as a result of an (1) airway obstruction (2) compression on the lung and (3) lack of surfactant Inspection- Cough, lag on expansion on affected side. Increased respiratory rate and pulse. Possible cyanosis. Palpation- Chest expansion decreased on affected side. Tactile fremitus decreased or absent over area. With large collapse, tracheal shift affected side. Percussion- Dull over area Auscultation- Breath sounds decrease vesicular or absent over area. Adventitious Sounds- None if bronchus is obstructed. Occasional fine crackles if bronchus is patent
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Lobar Pneumonia
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Infection in lung parenchyma that leaves alveolar membrane porous causing RBC's and WBC's to pass to the alveoli. Alveoli fill up with debris which replaces alveolar air History- Fever, cough with pleuritic chest pain, blood tinged sputum, chills, SOB, fatigue Inspection- increased respirations 24+, lag expansion on infected side w/ nasal flaring Palpation- Chest expansion decreased on affected side. Tactile fremitus increased if bronchus patent, decreased if obstructed Percussion- dull over lobar pneumonia Auscultation- Tachycardia w/ loud bronchial breathing Adventitious sounds- Crackles: fine-medium
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Acute Bronchitis
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an acute infection of the trachea and larger bronchi characterized by cough, lasting up to 3 weeks. Epithelium of bronchi are inflamed and damaged. Large airways become narrowed from capillary dilation, increased mucus, lack of cilia Inspection- Cough is productive or nonproductive. Sore throat, low grade fever, postnatal drip, fatigue Palpation- No pain or increased fremitus Percussion- Resonant Auscultation- May be clear an equal Adventitious sounds- No crackles
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Chronic Bronchitis
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Proliferation of mucus glands in the passageways resulting in excessive mucus secretion, inflammation of the bronchi, Chronic bronchitis caused by smoking. Inspection- Hacking, rasping cough with thick sputum, cyanosis, clubbing dyspnea Palpation- Fremitus normal Percussion- Resonant Auscultation- Normal vesicular Adventitious sounds- crackles over deflated areas w/ possible wheeze
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Emphysema
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Caused by destruction of pulmonary connective tissue causing permanent enlargement of air sacs. Caused mainly by cigarette smoking Inspection- Barrel chest, accessory muscles used, tripod position, SOB, tachypnea Percussion- Hyper resonant Auscultation- Decreased breath sounds. May have pro-longed expiration, muffled heart sounds. Adventitious sounds- none, occasional wheeze
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Asthma
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Allergic hypersensitivity to certain allergens, irritants, microbes or exercise. Causes complex bronchospasm and inflammation in walls of bronchioles. Inspection- SOB w audible wheeze, accessory neck muscles, cyanosis, chronic= barrel chest Palpation- Tactile fremitus decreased, tachycardia Percussion- Resonant Auscultation- Breath sounds decreased Adventitious sounds- Bilateral wheezing on expiration
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Pleural effusion
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Collection of excess fluid in the intrapleural space, with compression of overlying lung tissue. Gravity causes fluid to settle in dependent areas of thorax Inspection- increased respirations, dyspnea, tachycardia, cyanosis, abdominal distention Palpation- Tactile fremitus decreased or absent. Tracheal shift away from affected side and chest expansion decreased on affected side Percussion- dull Auscultation- Breath sounds decreased or absent Adventitious Sounds- Crackles, pleural rub
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Heart Failure
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Pump failure with increasing pressure of cardiac overload causes pulmonary congestion or an increased amount of blood in pulmonary capillaries. Inspection- Increased respirations, SOB on exertion, orthopnea, paroxysmal nocturnal dyspnea, nocturia, ankle edema Palpation- Moist, clammy. Tactile fremitus normal Percussion- Resonant Auscultation- Normal vesicular, S3 gallop Adventitious sounds- Crackles at lung bases
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Pneumothorax
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Free air in pleural spaces causes partial or complete lung collapse. Can be (1) spontaneous, (2) traumatic- enters through injury or (3) tension Inspection- Unequal chest expansion, tachypnea, cyanosis Palpation- Tactile fremitus decreased or absent Percussion- Hyper resonant Auscultation- Breath sounds decreased or absent Adventitious sounds- none
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Lung Cancer
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Fatal, major cause is tobacco smoking followed by secondhand smoke exposure. Subjective- Fatigue, nausea, vomiting, persistent cough, anorexia, dull localized chest pain Inspection- Weight loss, clubbing, anemia, hemoptysis Auscultation- Wheezing, atelectasis
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Where do the lower lobes reach down to upon expiration/inspiration
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Expiration: T10 Inspiration: T12
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4 major functions of respiratory system
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1) supplies oxygen 2) removes CO2 3) maintains homeostasis 4) maintains heat exchange
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Bronchial breath sounds
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Heard over trachea and larynx
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Bronchovesicular breath sounds
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anteriorly heard at bifurication posteriorly heard at C7-T5
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Vesicular breath sounds
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heard in complete areas of the lungs
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Accessory neck muscles
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sternomastoids, scalene and trapezii
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T or F right lung has 3 lobes and is shorter than left
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True
