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).
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.
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.
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.
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.
- Dorsal curved of thoracic spine which lead to decrease lung capacity.
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.
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.
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.
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)
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...
- 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.
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.
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.
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.
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.
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)
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.
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.
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.
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"
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.