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What land marks do you look for when you want to auscultate?
- - apex of the lung
- - lowest extent of the lung (diaphragm)- ant, lat, post
- - lowest extent of the pleura posteriorally
- - horizontal fissure
- - oblique fissure (posterioraly)
- - tracheal bifurcation (carina)
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Information about normal breath sounds (vesicular)?
- - loudest @ topof lungs- bronchial breath sounds at trachea
- - air entry- air move in/ out
- - BS- what you hear with stethoscpe- adipose tissue may prevent you from hearing properly
- - when aus- talk about BS- good lungs = L= R, no added
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Bronchial breath sounds (bronchovesicular)- BBS
- - load over trachea
- - quiet at the base
- - but if there is a mass you will hear BBS at base
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Reduce or decreased BS?
- - quieter
- - know it is decreased by comparing to the otherside
- - anything fluid like will cause decrease BS
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What are the added sounds could be heard?
- - crackles (crepitations, rales)
- - wheeze (rhonchi)
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Crackles
- - sputum- coasre cracklings esp in larger airwats
- - equalisation of pressure- means alveoli are popping open and closed
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Wheezes
- - results of narrowing of airways
- - bronchoconstricition
- - mass
- - sputum
- - hearing a wheeze on expiration- as itis passive and everything is closing down
- Ausc: BS reduceded throughout, exp wheeze added or reduced
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Other noises heard during auscultation
- - pleural rub- hair near ear sounds, usually pleural inflam
- - pericardial rub- creaky gate
- - upper respiratory tract noises- gurgles
- - extrapulmonary noise- # rib- popping noise
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Technique of auscultation- Pt position
- - ideal sitting with feet supported
- - if someone is lying down- depress the bed and slide under to get to the back of their lungs
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Where do children usually have patholgy?
- - in the upper lobe
- - right
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What are the parts of the stethoscpe?
- - ear budon
- - conductionpart
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SEE notes as to where to put the stethoscope to listen to the different parts of the lobe
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When conduction ausculatation what do you get the pt to do?
- - pt to do a cycle of DB
- - compare sides
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