228 Thorax & Lungs (19)

Bronchovesicular breath sounds are ______ in pitch

moderate in pitch

Bradypnea/Tachypnea vs. hypoventilation/hyperventilation

bradypnea- decreased breathing rate <10 hypoventilation- decreased breathing rate and depth tachypnea- increased breathing rate >24 hyperventilation- increased breathing rate and depth

Pursed lip breathing helps slow down expiration, and can be seen in ______, ______, and _______

asthma, emphysema, and CHF

Bronchitis is characterized by excess ____ _______ and _____ ______

excess mucus production and chronic cough

Discontinuous sounds: Fine crackles are _____-pitched Course crackles are ____-pitched

fine crackles are high-pitched course crackles are low-pitched

Dull percussion is indicative of:

fluid-filled/solid tissue, pneumonia, plural effusion

Bronchial breath sounds are ______-pitched

high-pitched

Biot respiration

irregular pattern, varying depth and rate of respirations followed by periods of apnea

Spinal deformities: -large ribcage -crooked spine laterally -rounded thoracic spine

large ribcage- barrel chest crooked spine laterally- scoliosis rounded thoracic spine- kyphosis

Elderly considerations

may hyperventilate and become dizzy lung expansion may be diminished sternum and ribs more prominent

What is indicative of labored respirations and hypoxia?

nasal flaring

best area to hear lungs

posteriorly

Cheyne-Stokes respiration

regular pattern, deep, rapid breathing followed by periods of apnea

_________ is the percussion tone elicited over normal lung tissue

resonance

Normal angle b/w nail base and skin should be ______ degrees, whereas clubbed fingers is a ______ degree angle

160 degree normal 180 degree clubbing

Bronchophony Egophony Whispered pectoriloquy

Bronchophony- Egophony- Whispered pectoriloquy-

When auscultating a p/t lungs, the nurse hears a sound like Velcro being pulled apart over the p/t right middle lobe. How should this be documented?

Coarse crackles

Crepitus

SQ emphysema (trapped air) air is trapped in tissues

Thoracic expansion test: place hands on these vertebrae ___-___, and look for movement of thumbs ___-___cm apart

T9-T10 5-10cm

In chronic airway obstruction or atelectasis, these accessory muscles may be used:

Trapezius, shoulder muscles, scalenes, sternocleidomastoid, abs (COPD), internal intercostal muscles (COPD)

Stridor

shrill harsh sound during inspiration due to laryngeal obstruction

Continuous sounds: sibilant wheezes sound _______ sonorous wheezes sound like _____

sibilant wheezes sound musical sonorous wheezes sound like snoring

Vesicular breath sounds are ____ in pitch

soft in pitch

Grunting

sound in infants related to air hunger

This position is indicative of difficulty breathing

tripod position