lungs assessment.txt

  1. What are the common landmarks to know for lungs/thorax examination?
    • Manibrium of the sternum.
    • Suprasternal notch.
    • Manubrial sternal point: this is the place where we start counting intercostal spaces , and it is the first one.
    • Xyphoid process.
    • Costal angle: If the costal angle is very wide, it could indicate chronic obstructive pulmonary disease (COPD).
    • Image Upload 1
  2. When auscultating the lung in the anterior, posterior, lateral chest, what are parts of the lungs are there?
    • Anterior: Rt side= upper, middle, and a little of the lower. Lt= Upper and a little of lower. (left lung doesn't have a middle lobe.
    • Posterior: most of the lower lobes, a little bit of the upper, and almost none of the RML.
    • lateral: Can hear all of the lobes.
  3. What are the muscle use in respiration? what is retraction?
    • Intercostal and diaphram are the most common.
    • Retraction: when pts have difficulty breathing, they use accessory muscles to breath, such as the intercostal muscles. (usually u can see the skin sucking in b/t the ribs, or in the clavicle, if they are using the clavicular muscle to breath)
    • Usually the higher up of the muscles they are using, the more problems breathing they are having.
  4. How are the main bronchus branched? equally?
    • Left main bronchus is branched a littl bit more in an lateral angle.
    • Right main bronchus is more straight.
  5. What are common differences of the lungs in older adults?
    • Alveoli is less elastic, which causes fatigue and dyspnea on exertion.
    • Decreased vital capacity and increase residual.
    • Barrel chest from lost of muscle strength in the thorax and diaphragm.
    • hyperresonance.
    • Dorsal curved of thoracic spine which lead to decrease lung capacity.
  6. What are common differences of the lungs in childbearing women?
    • Changes in respiration due to enlargement of the uterus and progesterone increase. ,
    • Diaphragm rises above usual position (this could be a prob since it is the muscle that does the main part in breathing) 
    • RR no change.
  7. Common changes in the lungs of infants?
    • Lungs expand at birth, surfactant (kind of a lubricant) help with the expansion.
    • Have a more rounded chest.
    • they are nosebreathers, and andominal breathers.
    • less alveoli.
    • airway diameter is much smaller.
    • Distress: nasal flaring, retractions, grunting.
  8. Health promotion: tobacco cessation - the 5 As
    • Ask abt smoking at each visit.
    • Ask pts regularly to stop smoking using a clear, personalized msg.
    • Assess pt. readiness to quit.
    • Assess pt to set stop dates and provide educational materials for self-help.
    • Arrange for follow-up visits to monitor and support pt progress.
  9. What is the order of the examination of the lungs? what is the most important while auscultating the lungs?
    • Inspect, palpate, percuss, auscultate.
    • To compare one lung to the other (URL w ULL)
  10. What are some clues or signs of distress?
    • Peropheral clues may suggest pumonary or cardiac difficulties --
    • fingers (clubbing): chronic hypoxia
    • breath (odor): maybe airways issues.
    • skin-nails-and lips (cyanosis or pallor)
    • Lips (pursed lip breathing): emphysema
    • Nostrils flaring: trying to make their airway larger.
    • Respiratory patterns--
    •  Retractions: intercostal, subcostal, subclavicular, supra...
    • SOB.
    • Increased WOB (work of breathing): like going up the stairs.
    • Nasal flaring.
    • Paradoxical breathing or flair chest: usually means that there is some air trapped in, like a pneumothorax.
  11. What is crepitus?
    • It is the ricekrispy sound or palapable.
    • It usually indicates that there is air in places they are not supposed to be.
  12. What is tactile fremitus? what could be happening when less, and more?
    • Palpable vibration of the chest wall that resultrs from speech or other verbalizations. ("ninety-nine")
    • less vibrations: air trapped somewhere, maybe a pneumothorax.
    • More vibrations: could be pneumonia.
  13. what is thoracic expansion for? What could the results mean?
    • To test chest expansion. both hands should move evenly to chest that the lungs are expanding evenly.
    • Assymetric: maybe pneumothorax, tumor, that is not permitting that side of the lungs to expand.
    • Symmetric: it is normal.
  14. Indirect Percussion? what are the sounds that you hear?
    • Do not percuss in the bone.
    • Resonance: Normal and healthy.
    • Hyperresonance: hyperinflation of the lung, trapped air, like in emphysema.
    • Dullness: diminished air exchange, effusions, like in pneumonia, tumor, anything fluid or solid filled.
  15. Diaphragmatic excursion is used for? what are some results?
    • to check compliance of the lungs.
    • Decreased movement: lungs are not as compliant.
    • Increased movement: Some some very healthy.
    • Normal movement it is usually 5 cm (in athletes maybe it could be higher)
  16. why is auscultation important? How many positions should you choose?
    • It is the most important technique for assessing air flow through the tracheobronchial tree.
    • Should pick from 8 to 10 location, laterally about 4.
  17. What are normal breath sounds?
    • Vesicular: soft and low pitched, usually heard over most of both lungs. (primary hearing through the lungs)
    • Bronchial: louder and higher pitch; usually heard over the manubrium, if at all. (over the bronchiole tree)
    • Bronchovesicular: intermediate intensity and pitch; usually heard over the 1st and 2nd interspace anteriorly and over the scapula.
  18. What are adventitious Sounds?
    • They are added bad sounds, such as ...
    • Crackles: fine, medium, an coarse, fluid, does not clear w cough (like risekrispy)
    • Wheezes: high-pitched musical in expiration.
    • Ronchi: deeper, rumbling. air through thcik secretions. clear w cough.
    • Stridor: musical in inspiration, obstruction.
    • Friction: rub-dry crackly, outside respiratory tree.
  19. what is vocal resonance? bronchophony? Pectoriloquy? Egophonly? whats normal and abnormal?
    • It is a test using spoken transmitted through lung fields. Abnormal sounds indicate that the lung is airless.
    • Bronchophony: have the pt say 99. Normal is voice is muffled. abnormal is when the voice is clear.
    • Pectoriloquy: have the pt whisper "1,2,3". N= is hardly heard. AbN= whisper is loud an clear.
    • Egophonly: have the pt say "eee". N= is hear a muffled e. AbN= e's sound like "aaa"
  20. What are some special notes abt infants?
    • Another test is to measure the head and chest when they are little. chest is usually 2-3 cm less than head.
    • Infants breath irregularly sometimes, and w apneic spells, but should not last more than 10-15 secs.
    • Stridor may indicate foreign body in airway or croup.
    • Coughin is not usual in newborn, but sneezing is.
    • Not all the asthmatics wheeze. chronic cough variant maybe asthma.
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lungs assessment.txt