Which of the following assessments best confirms symmetric chest excursion (expandability)?

The manubriosternal angle is:

The articulation of the manubrium and the body of the sternum

Narrower than the right lung with two lobes

You assess a patient who reports a cough. The characteristic timing of the cough of chronic bronchitis is described as:

Productive cough for at least 3 months of the yr for 2 consecutive yrs.

What assessment best confirms symmetric chest expansion?

Placing hands on the posterolateral chest well with thumbs at the level of T9 or T10 and then sliding the hands up to pinch a small fold of skin between the thumbs

Absence of diaphragmatic excursion occurs with:

Pleural effusion or atelectasis of the lower lobes

You are auscultating breath sounds on a patient. Which of the following best describes how to proceed?

Hold the diaphragm of the stethoscope against the chest wall; listen to one full respiration in each location, being sure to do side to side comparison. 

How would you describe bronco vesicular breath sounds?

moderate-pitched, inspiration equal to expiration

After examining a patient, you make the following notation: increased respiratory rate, chest expansion, decreased on left side, dull to percussion over left lower lobe, breath sounds louder with fine crackles over left lower love. These findings are consistent with:

On examining a patient's nails, you note that the angle of the nail base is greater than 160 degrees and that the nail base feels spongy to palpation. These findings are consistent with:

Congenital heart disease and COPD

On auscultating a patient, you note a coarse, low-pitched sound during both inspiration and expiration. This patient reports pain with breathing. These findings are consistent with:

To use the technique of egoophony, ask the patient to:

Say "eeee" each time the stethoscope is moved

When examining for tactile fremitus, it is important to:

palpate the chest symmetrically

Arterial oxygen saturation of hemoglobin

A pleural friction rub is best detected by:

A patient has a barrel-shaped chest, characterized by:

Equal anteroposterior transverse diameter and rises being horizontal

3 to 4 cm above the inner third of the clavicles

Sixth rib, midclavicular line

Elliptic shape with an anteroposterior to transverse diameter in the ratio of 1:2 

Anteroposterior= transverse diameter 

sunken sternum and adjacent cartilages 

forward protrusion of the sternum with ribs sloping back at either side

lateral S-shaped curvature of the thoracic and lumbar spines

exaggerated posterior curvature of thoracic spine

Which of the following pairs correctly expresses the relationship to the lobes of the lungs and their anatomy position?

lower lobes-posterior chest

inspiration is primarily facilitated by which muscles?

Diaphragm and intercostals

percussion of the chest is:

helpful only to identify surface alterations of lung tissue 

what is a voice sound that would be a normal finding?

The "eeeee" sound is clear and sounds like "eeee"

What is included in the definition of the thoracic cage?

sternum, ribs, diaphragm, vertebrae

a common clinical manifestation in a patient with COPD is:

the function of the trachea and bronchi is to:

transport gases between the environment and the lung parenchyma

an increase in the transverse diameter of the chest cage is a pregnant woman due to a(n): 

the gradual loss of intra-alveolar septa and a decreased number of alveoli in the lungs of elderly adults cause:

decreased surface area for gas exchange

stridor is a high-pitched, inspiratory crowing sound commonly associated with:

increased tactile remits would be evident in an individual who has which condition?

musculotendinous septum that separates the thoracic cavity from the abdomen

hollow U-shaped depression just above the sternum, between the clavicles

the "breastbone" has three parts: manubrium, body, and xiphoid process. 

often called the "angle of Louis", the articulation of the manubrium and the body of the sternum, and it is continuous with the second rib. 

what's a good area to start counting ribs?

How are the intercostal spaces named?

the angle of Louis also marks the ........... of the right and left bronchi.

the right and left costal margins form an angle where they meet at the xiphoid process. Usually 90 degrees or less, this angle increases when the rib cage is chronically overinflated, as in emphysema

what are the anterior thoracic landmarks?

suprasternal notch, sternum, sternal angle, costal angle

what are the posterior thoracic landmarks? 

vertebra prominences, spinous processes, inferior border of the scapula, twelfth rib

at the base of ur neck, if head is bent it is the bony prominence. 

the bony prominences down the spine

the scapulae are located symmetrically in each hemithorax. The lower tip is usually at the seventh or eighth rib. 

inferior border of the scapula

what are the reference lines on the anterior chest?

Midsternal and midclavicular 

this line bisects the center of each clavicle at a point halfway between the palpated sternoclavicular and acroclavicular joints. 

posterior reference points

what are the posterior reference points?

line extends down the anterior axillary fold where the pectoralis major muscle inserts

Axillary reference points

anterior, midaxillary and posterior

continues down from the posterior axillary fold where the latissimus doors muscle inserts

line runs down from the apex of the axilla and lies between and parallel to the other two

the middle section of the thoracic cavity containing the esophagus, trachea, heart and great vessels

the pleural cavities on either side of the mediastinum contain the:

in the anterior chest the ...., or highest points of lung tissue is 3-4 cm above the inner third of the clavicles. 

the ...., or lower border, rests on the diaphragm at about the 6th rib in the midclavicular line.

the ..... lung is shorter than the .... lung.

what organ is directly under the right lung?

what organ is the reason the left lung is narrow?

the heart, because it bulges to the left

how many lobes does the right lung have?

how many lobes does the left lung have?

on the anterior chest the ....... (major or diagonal) fissure crosses the 5th rib in the midaxillary line and terminates at the 6th rib in the midclavicular line

the right lung also contains the ............ (minor) fissure, which divides the right upper and middle lobes. extends from the 5th rib in the right midaxillary line to the 3rd intercostal space of 4th rib at the right sternal border.

lateral view of left side

The thin, slippery ...... are serous membranes that form an envelope between the lungs and chest wall

the ....... pleura lines the outside of the lungs, dipping down into the fissures. 

the visceral pleura is continuous with this pleura, that is the lining of the inside of the chest wall and diaphragm

potential space; when it abnormally fills with air or fluid, it comprises lung expansion

costodiaphragmatic recess

the ...... lies anterior to the esophagus and is 10-11 cm long in the adult. Begins at the level of the cricoid cartilage in the neck, and bifurcates just below the sternal angle into the right and left main bronchi.

the ..... and ..... transport gases between the environment and lung parenchyma

functional respiratory unit that consists of the bronchioles, alveolar ducts, alveolar sacs, and the alveoli. 

what are the four major functions of the respiratory system?

supplying oxygen to the body for energy production, removing CO2 as a waste product of energy reactions, maintaining homeostasis (acid-base balance) of arterial blood, and maintaining heat exchange (less important for humans)

How does respiration maintain pH?

by supplying oxygen to the blood and eliminating excess CO2

this causes CO2 to build up in the blood

rapid, deep breathing that causes CO2 to be blown off

what do our breathing patterns change in response to?

the involuntary control of respirations is controlled by:

the brainstem (pons and medulla)

the normal stimulus to breathe for most of us is an increase in CO2, or:

a decrease of O2 in the blood known as .........., also increases respirations but less than hypercapnia.

air rushes into the lungs as the chest size increases, which is the process of:

when air is expelled out of the lungs as the chest recoils

during inspiration the increasing size of the thoracic container creates a slightly ....... pressure in relation to the atmosphere.

expiration is a ....... process

as the diaphragm relaxes, elastic forces within the lung, chest cage, and abdomen cause it to dome up. this causes a ....... pressure within the alveoli and air flows out. 

what are the accessory neck muscles used in heavy breathing?

sternomastoids, scaleni, and trapezii

during which weeks does the lung bud emerge in fetal development

by .. weeks the conducting airways reach the same number as adults

at .. weeks surfactant is present in adequate amounts

the complex lipid substance needed for sustained inflation of the air sacs

prenatal exposure to smoke causes:

chronic hypoxia, premature delivery, and low birth weight

prenatal and postnatal exposure to secondhand smoke include:

sudden infant death syndrome (SIDS), lower resp. illnesses, acute and chronic otitis media, breathlessness, asthma, and adverse lung function throughout childhood. 

prenatal nicotine exposure: 

increases risk for ADHD and depression

in pregnant woman, how high does the uterus elevate the diaphragm?

the costal cartilage in aging adults can become .....; thus the thorax is less mobile

What subjective data should be collected?

cough, shortness of breath, chest pain, history of resp. infections, smoking history, environmental exposure, and patient-centered care

Confirm symmetric chest expansion by:

placing your warmed hands on posterolateral chest wall with thumbs at level of T9 or T10.

After confirming symmetric chest expansion, what is done?

Slide your hands medially to pinch up a small fold of skin between your thumbs; ask person to take a deep breath.

Your hands serve as mechanical amplifiers; as person inhales deeply, your thumbs should:

move apart symmetrically; note any lag in expansion.

what is tactile fremitus?

(vocal) palpable vibration

How do you feel vibrations such as tactile fremitus?

Sounds generated from larynx are transmitted through patent bronchi and through lung parenchyma to chest wall

How do you perform tactile fremitus?

Start over lung apices and palpate from one side to another

movement of tactile fremitus

Decreased fremitus occurs with:

obstructed bronchus, pleural effusion or thickening, pneumothorax, or emphysema 

increased tactile fremitus:

occurs with compression or consolidation of lung tissue (lobar pneumonia)

low-pitched, clear, hollow sound that predominates in healthy lung tissue in the adult.

a lower pitched, booming sound found when too much air is present, such as in:

emphysema or pneumothorax

a dull note during percussion should indicate:

pneumonia pleural effusion, atelectasis, or tumor

First, ask the person to “exhale and hold it” briefly while you percuss down scapular line until sound changes from resonant to dull on each side. This estimates level of diaphragm separating lungs from abdominal viscera; it may be somewhat higher on right side because of presence of liver. Mark the spot

bronchial, bronchovesicular, vesicular

high-pitched, loud, inspiration < expiration, harsh, hollow tubular, located in the trachea and larynx

moderate-pitched, moderate amplitude, inspiration=expiration, mixed quality, and over major bronchi where fewer alveoli are located

low-pitched, soft amplitude, inspiration > expiration, rustling sound, over peripheral lung field

number of seconds it takes for the person to exhale from total lung capacity to residual volume. 

a forced expiration of ... seconds or more occurs with obstructive disorders

the thorax has an elliptical shape with an anteroposterior-to-transverse diameter documented as 1:2 or 0.70.

note equal AP-to-transverse diameter and that ribs are horizontal instead of the normal downward slope. Associated with normal aging and also with chronic emphysema, and asthma as a result of hyperinflation of lungs

sunken sternum and adjacent cartilages. depression begins at second intercostal space, becoming depressed most at junction of xipohid with body of sternum. noticeable on inspiration. 

forward protrusion of the sternum, with ribs sloping back at either side and vertical depressions along costochondral junctions. Less common than pectus excavated. requires no treatment

lateral S-shaped curvature of the thoracic and lumbar spine, usually with involved vertebrae rotation. unequal shoulders, scapular height, and unequal hip levels, rib interspaces flared on convex side. Adolescent age-groups. 

an exaggerated posterior curvature of the thoracic spine (humpback) that causes significant back pain and limited mobility. severe- affects cardiovascular function. 

vibration felt when inhaled air passes through thick secretions in the larger bronchi. This my decrease somewhat by coughing.

produced when inflammation of the parietal or visceral pleura causes a decrease in the normal lubricating fluid. The opposing surfaces make a coarse grating sound when rubbed together during breathing. 

pleural friction fremitus

How is chronic pneumonia diagnosed?

chest radiography, chest CT, bronchoscopy/bronchoalveolar lavage, culture or biopsy. 

How is idiopathic fibrosis diagnosed? 

chest radiography, chest CT, bronchoscopy or biopsy. 

Peak flow, spirometry, chest radiography, PFT

How is pleural effusion diagnosed?

chest radiography, spirometry, PFT

how to diagnose chronic pulmonary emboli?

D-dimer, ventilation/ perfusion scan, CT angiography, echocardiography, right heart catheterization

collapsed shrunken section of alveoli or an entire lung as a result of (1) airway obstruction (2) compression on the lung (3) lack of surfactant.

infection in lung parenchyma leaves alveolar membrane edematous and porous; thus red blood cells and white blood cells pass rom the blood to the alveoli. alveoli progressively fill up with bacteria, solid cellular debris, fluid, and blood cells, which replace alveolar air. decreases surface area- hypoxemia

an acute infection of the trachea and larger bronchi characterized by a cough, lasting up to 3 weeks. 

proliferation of mucus glands in the passage ways, resulting in excessive mucus secretions. 

caused by destruction of pulmonary CT; characterized by permanent enlargement of air sacs distal to terminal bronchioles and rupture of inter alveolar walls. 

an allergic hypersensitivity to certain inhaled allergens (pollen), irritants (tobacco, ozone), microbes, stress, or exercise that produces a complex response characterized by bronchospasm and inflammation, edema in walls of bronchioles, secretion of highly viscous mucus into airways. 

collection of excess fluid in the intrapleural space, with compression of overlying lung tissue. 

pump failure with increasing pressure of cardiac overload causes pulmonary congestion or an increased amount of blood present in pulmonary capillaries. 

free air in pleural space causes partial or complete lung collapse. air in pleural space neutralizes the usual negative pressure; can be spontaneous or traumatic

virulent form of pneumonia is a protozoal infection associated with AIDS. 

Pneumocystis jiroveci (P. caring) Pneumonia

inhalation of tubercle bacilli into the alveolar wall starts: (1) initial complex is acute inflammatory response (2) scar tissue forms, lesion calcifies and shows on X-ray (3) reactivation of previously healed lesion. 

undissolved materials originating in legs or pelvis detach and travel through venous system, returning blood to right heart, and lodge to occlude pulmonary vessels

How do you assess symmetrical chest expansion?

How do you assess symmetrical chest expansion quizlet?

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