Jarvis Chapter 18 Study Guide 5iv57

Jarvis Chapter 18 Study Guide Lungs and Thorax

Medical terminology: Alveoli small outpouchings along the walls of the alveolar sacs and alveolar ducts; through them, gas exchange takes place between alveolar gas and pulmonary capillary blood. Apnea cessation of breathing, especially during sleep. Asthma Reactive Airway Disease is an allergic hypersensitivity to certain inhaled allergens, irritants, microbes, stress or exercises. Produces complex response characterized by bronchospasm and inflammation, edema in walls of bronchioles and secretion of highly viscous mucus into airways. These factors greatly increase airway resistance, esp. during expiration. Symptoms: wheezing, dyspnea and chest tightness. Atelectasis, Collapsed shrunken section of alveoli or an entire lung as a result of airway obstruction, compression of the lung, lack of surfactant Angle of Louis an anatomical landmark located on the sternum; it can be felt as a notch or ridge at the top of the sternum. Bradypnea slow breathing. A decreased but regular rate (<10 per minute), as in drug induced depression of the respiratory center in the medulla, increased intracranial pressure, and diabetic coma. Bronchiole: one of the successively smaller channels into which the segmental bronchi divide within the bronchopulmonary segments. Bronchitis is an acute infection of the trachea and larger bronchi characterized by cough (lasting up to 3 weeks, for acute). Acute is viral, chronic caused by smoking. Bronchophony: Increased intensity and clarity of voice sounds heard over a

Consolidation - lung as it fills with exudate in pneumonia. Crackles discontinuous, popping sounds heard over inspiration. Crepitus: coarse, crackling sensation palpable over the skin surface. It occurs in subcutaneous emphysema when air escapes from the lung and enters the subcutaneous , as after openthoracis injury or surgery. Dyspnea: breathlessness or shorthess of breath; labored or difficult breathing. It is a sign of a variety of disorders and is primarily an indication of inadequate ventilation or of insufficient amounts of oxygen in the circulating blood Egophony: auscultation of chest while person phonates a long “ee-ee” sounds Emphysema caused by destruction of pulmonary connective tissue; characterized by permanent enlargement of air sacs distal to terminal bronchioles and rupture of interalveolar walls. Airway resistance on expiration increased, producing a hyperinflated lung. Fremitus: a vibration perceptible on palpation or auscultation; Pleural friction rub: 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. Hypercapnia: excessive carbon dioxide in the blood Hyperventiliation: abnormally fast and deep breathing, the result of either an emotional state or a physiological condition Hypoxemia: deficient oxygenation of the blood

bronchus surrounded by consolidated lung tissue. Normal – voice is muffled and indistinct; abnormal – words distinct and sound close to heart. Bronchovesicular over major bronchi where fewer alveoli are located.

Intercostal space: the space between two adjacent ribs. Orthopnea: difficulty breathing when supine Paroxymal Nocturnal Tachypnea is awakening from sleep with SOB and needing to be upright to achieve comfort Vesicular breath sounds: the gentle rustling sounds of normal breathing heard by auscultation over most of the lung fields; the inspiratory phase is usually longer than the expiratory. Wheezes: a continuous musical sounds heard over expiration.

List subjective questions are important to ask when obtaining a health history: 1. COUGH  Is there cough, when did it start, gradual or sudden, how long, how often, what time of day or night?  Phlegm or sputum, how much, what color  Cough up blood? If so, streaks or frank blood? Is there foul odor?  Describe cough: hacking, dry, barking, hoarse, congested, bubbling?  Does cough seem to come with anything (activity, position, fever, congestion, talking, anxiety)? Does activity make it better or worse?  Which treatment has been tried (prescription or OTC, vaporizer, rest, position change). Does the cough bring any pain in chest or ear? Is it tiring? 2. SHORTNESS OF BREATH (SOB)  Have you had any shortness of breath, do you have it now, or in the last day?  When did it start, what brings it on, how severe is it, how long does it last?  Is it affected by position (lying down)?  Does it occur at any specific time of day or night?  SOB episodes associated with night sweats? diaphoresis  Or cough, chest pain, bluish color arp9ound lips or nails?  Episodes related to food, pollen, dust, animals, season, emotion or exercise?  What do you do in a hard-breathing attack? (special position pursed lips breathing, oxygen, inhalers or medications?)  How does SOB affect your work or home activities? 3. CHEST PAIN W/BREATHING

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Is there chest pain, point exact location to distinguish from cardiac origin chest pain and heartburn chest pain.  When did it start, constant or comes and goes?  Describe pain: burning, stabbing?  What brought it on: resp.infection, coughing, trauma? Is it associated w/fever, deep breathing, unequal chest inflation  What have you done to treat it? (medication, heat application) 4. HISTORY OF RESP. INFECTIONS  Any past history of breathing trouble or lung diseasessuch as bronchitis, emphysema, asthma, pneumonia?  Any unusually frequent or severe colds?  Family history of allergies, TB or asthma? 5. SMOKING HISTORY  Do you smoke cigarettes/cigars? At what age did you start? How many packs per day do you smoke now? How Long?  Have you ever tried to quit? What helped? Why do you think it did not work? What activities do you associate with smoking? Do you live with someone who smokes? 6. ENVIRONMENTAL SMOKE  Are there any environmental conditions that may affect your breathing? Where do you work? At a factory, chemical plant, coal mine, farming, outdoors in a heavy traffic?  Do you do anything to protect your lungs (mask or ventilator system at work)? Do you do anything to monitor your exposure? Do you have periodic examinations, pulmonary function tests, x-ray image?  Do you know which specific symptoms to note that may signal breathing problems? 7. PATIENT CENTERED CARE  Last TB skin test, chest x-ray study, pneumonia vaccine or influenza immunization?  CHILDREN: what have you done to child-proof your home and yard? Is there any possibility of the child inhaling or swallowing toxic substances? Has anyone reviewed with you that small things are choking hazards? Has anyone taught you emergency care measures in case of accidental choking or a hard-breathing spell? Any smokers in home or car w/child?  AGING ADULT: SOB or fatigue with daily activities? Tell me about your usual amount of physical activity. (History of COPD, lung cancer or TB): How are you getting along each day? Any weight change in the past 3 months? How much? How about energy level? Do you tire more easily? How does your illness affect you at home or work?  Do you have any chest pain w/breathing? Any chest pain after a bout of coughing? After a fall? Know how and why a nurse would apply the following “objective” assessments:

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Anterior/posterior to transverse ratio- What would a barrel chest signify? How does the AP/Transverse ratio change with a barrel chest? Barrel chest occurs in COPD because the lungs are chronically overinflated with air, so the rib cage stays partially expanded all the time. This makes breathing less efficient and aggravates shortness of breath. The anteriorposterior diameter (AP) should be less than the transverse diameter (.70 to .75 in adults). In barrel chest AP=transverse.

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Skin color, condition and patient position: Skin color should be consistent with person’s genetic background, with allowance for sun-exposed areas on chest and back. No cyanosis or pallor should be present. Any lesions should be noted, inquire about any change in a nevus on the back (where the persona may have difficulty monitoring). Cyanosis occurs with hypoxia. Chest expansion: Symmetric chest expansion confirmed by placing your warmed hands sideways on posterolateral chest wall with thumbs pointing together at the level of T9 or T10. Slide your hands medially to pinch up a small fold of skin between your thumbs, ask the person to take deep breath. Hands serve as a mechanical amplifier as person inhales deeply, your thumbs should move apart symmetrically. Note any lag in expansion. Unequal chest expansion occurs with marked atelectasis, lobar pneumonia, pleural effusion, thoracic trauma such as fractured ribs or pneumothorax. Pain accompanies deep breathing when pleurae are inflamed.

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Tactile fremitus: Access tactile or vocal fremitus, this is a palpable vibration. Use either ball of fingers or ulnar edge of one hand and touch the person’s chest while he or she repeats the words “ninety nine” or “blue moon”. Start over lung apices and palpate from one side to another. Symmetry is most important – vibrations should feel the same in the corresponding area on each side. Avoid palpating over scapulae because bone will damp out sound transmission. Fremitus is most prominent between the scapulae and around the sternum (where major bronchi are closest to the chest wall), and normally decreases as you progress down because more and more tissue impedes sound transmission. Decreased fremitus occurs with obstructed bronchus, pleural effusion or thickening, pneumothorax, or emphysema. Increased fremitus occurs with compression or consolidation of lung tissue (like in lobar pneumonia). Rhoncal fremitus is palpable with thick bronchial secretions. Pleural friction fremitus is palpable with inflammation of the pleura.

Percussion: when and why would resonance and dullness be present? Resonance is the low-pitched, clear, hollow sound that predominates in healthy lung tissue in the adult. However, it is a relative term and there is no constant standard, i.e. it may be duller in an athlete with heavily muscular chest wall or in a heavily obese adult with subcutaneous fat. Asymmetry in percussion is important as it indicates underlying disease. Hyperresonance is a lower-pitched, booming sound found when too much air is

present (emphysema or pneumothorax). A dull note, soft, muffled thud, signals pneumonia, pleural effusion, atelectasis or tumor. Understand where to auscultate for normal bronchial, broncho-vesicular and vesicular breath sounds. Bronchial (tracheal) – trachea and larynx Bronchiovesicular – over major bronchi where fewer alveoli are located:  Posterior - between scapulae (esp. on right)  Anterior – around upper sternum in 1st and 2nd intercostal spaces Vesicular – over peripheral lung fields where air flows through smaller bronchioles and alveoli