Term
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Definition
Right: 3 lobes
Left: 2 lobes |
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Term
| Anterior thoracic reference lines |
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Definition
Midsternal line (MSL)
Midclavicular line (MCL) |
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Term
| Posterior thoracic reference lines |
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Definition
Vertebral line: straight down spine
Midscapular line: MSL |
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Term
| Lateral thoracic reference lines |
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Definition
Anterior axillary line (AAL)
Midaxillary line (MAL)
Posterior axillary line (PAL) |
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Term
| Anterior thoracic landmarks |
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Definition
Lung apices: 3-4 cm above clavicles
Lower lungs: rest on diaphragm about 6th rib MCL
Trachea bifurcation: T4
Angle of Louie marks 2nd rib |
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Term
| Posterior thoracic landmarks |
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Definition
Apices: C7
Lower lungs: T10 |
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Term
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Definition
Diaphragm: main muscle, moves down
Intercostal muscles: lift sternum and ribs
Accessory neck muscles: forced or heavy inspiration |
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Term
|
Definition
Usually a passive process: muscles relax, thorax gets smaller, pushes air out
Accessory muscles: forced expiration: abdominal muscles contract to push viscera up, force air out |
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Term
|
Definition
number of packs of cigs daily x number of years smoking = pack years
(20 cigs in a pack) |
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Term
| Lung history: sputum quality |
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Definition
Quality: color, consistency, amount
Green: infectious
Blackish/greyish: cigarette smoking
Red: blood, TB, cancer, too much coughing
Frank: bright red, acute blood |
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Term
| Lung history: change in voice |
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Definition
| Hoarseness: shouting, smoking, nodules |
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Term
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Definition
| Shortness of breath when laying down |
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Term
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Definition
| Hemoptysis (bloody sputum), night sweats, weight loss |
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Term
| Lung history: paraoxysmal nocturnal dyspnea (PND) |
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Definition
| Difficulty breathing that awakens the patient |
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Term
| Lung history: vaccinations |
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Definition
Pneumovax: every 5 years after age 60
Flu shot: annual |
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Term
|
Definition
History of prematurity (lung problems later)
Vent support (higher chance of devel lung disease)
Recurrent hospitalizations for pulmonary infection |
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Term
| Physical exam: inspection |
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Definition
Pattern and symmetry of resps
Shape of chest: slope of ribs, deformities (barrel chest?)
Use of accessory muscles
Bulging or retraction of ICS |
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Term
| Palpation: evaluate bilateral respiratory excursion (symmetric expansion) |
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Definition
- Place hands on each side near 10th rib
- Have patient take deep breath
- Measure distance between thumbs with expiration |
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Term
| Palpation: tactile fremitus |
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Definition
The vibrations that are transmitted through lung tissues and chest wall when a vocal sound is made
- Place ball of hand over chest and have patient say "99" |
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Term
| Palpation: tactile fremitus decreased |
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Definition
When anything obstructs transmission of vibrations
- Obstructed bronchus
- Pleural effusion
- Pneumothorax
- Emphysema |
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Term
| Palpation: tactile fremitus increased |
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Definition
Occurs with compression or consolidation of lung tissue
- Lobar pneumonia
- Tumor
- Atelectesis (collapse of part or all of lung)
- Pulmonary fibrosis |
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Term
|
Definition
Moves chest wall and tissues to produce audible sounds and palpable vibration
Demonstrates quality of air space below chest wall (air/fluid/solid) |
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Term
|
Definition
-Resonance: over normal lung
-Hypersonance: over hyperinflated lung (emphysema, pneumothorax)
- Flatness/dullness: over dense tissue or bone (pleural effusion, lobar pneumonia)
Tympany: think "tight drum" |
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Term
| Auscultation: breath sounds decreased/absent when... |
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Definition
- Air flow is decreased
- Fluid or tissue obstruct air passage
- Emphysema r/t lost elasticity and hyperventilation |
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Term
| Auscultation: breath sounds increased when... |
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Definition
- Expiratory wheezes (asthma)
- Consolidation
- Compression |
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Term
| Auscultation: auditory fremitus |
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Definition
- Normal voice transmission is sort, muffled, decreases as you go down chest
- Place diaphragm over chest and have pt say "99"
- Sound transmission enhanced: leng density increased |
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Term
|
Definition
Sounds are louder and clearer over airless tissue
- Pleural effusions
- Thickening
- Areas of consolidation |
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Term
|
Definition
| "ee" changes to "aa" over areas of consolidation |
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Term
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Definition
| Whispered "99" sounds clearer over areas of consolidation |
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Term
| Abnormal breath sounds: crackles (rales) |
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Definition
Fluid in small area
- Small airway moisture, does not clear with cough, at end of inspiration
- PNE or CHF |
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Term
| Abnormal breath sounds: wheezes |
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Definition
Lungs are clamping down
- Moisture or debris in larger airway
- Louder than crackles
- Inspiratory: reactive airway disease, asthma |
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Term
| Abnormal breath sounds: rhonci |
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Definition
Gook in big airways, like snoring or clearing mucus
- Usually clears with cough, low pitch gurgling |
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Term
| Abnormal breath sounds: pleural friction rub |
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Definition
low grating noise in peripheral and lateral chest, couch does not clear
- Noticed on inspiration/expiration: plurisy |
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Term
|
Definition
| High-pitched sound on inspiration and exhalation, indicating laryngeal obstruction |
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