Term
| What are the vertical reference lines on the anterior chest? |
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Definition
| Midsternal Line is in the middle. Then there is a Left and Right Midclavicular line. |
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Term
| What are the posterior vertical reference lines on the posterior chest? |
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Definition
| Vertebral line is in the middle. Then there is a Left and Right Midscapular Line. |
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Term
| what are the vertical reference lines on the lateral chest? |
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Definition
| Midaxillary Line is in the middle down the lateral/side of the body. Then there is an Anterior and Posterior Axillary Line. |
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Term
| The apex of each lung extends slightly above the ______; the base is at the level of the _______. |
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Definition
| Apex=clavicle, base=diaphragm (the lungs are apex at top, base at bottom like you would naturally think. the heart is the opposite.) |
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Term
| The lungs are paired, but they are not completely symmetric. Both are divided into lobes by fissures. The right lung is made up of ___ lobes, whereas the left lung contains only ___ lobes. |
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Definition
| right lung = 3 lobes (right upper lung, right middle lung, right lower lung), left lung = 2 lobes (left upper lung, left lower lung). |
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Term
| During inhalation the diaphragm presses the abdominal organs ______ and ____. |
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Definition
| downward and forward. Just think, when you inhale the lungs are expanding so the diaphragm beneath this is obviously going to be pushed downward. |
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Term
| During exhalation the diaphragm _____ and _____ to the resting position. |
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Definition
| rises & recoils. When you exhale, the lungs are decreasing in size so the diaphragm is able to rise back up. |
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Term
| ____ Cancer is the leading cause of death in US. |
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Definition
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Term
| What are risk factors for lung cancer? |
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Definition
| cigarette smoking, genetic predisposition, beta carotene supplements, asbestos & radon exposure, exposure to workplace pollutants like radioactive ores, mining chemicals (arsenic, vinyl chloride, nickel, coal, mustard gas, chloromethyl esters and fuels such as gasoline), other environmental exposure: air pollution, passive tobacco smoke, marijuana smoking, history of previous lung cancer, recurring inflammation that leaves scars (TB, some pneumonias), AFRICAN AMERICAN HERITAGy <--especially men, Gender: WOMEN's LUNG CELLS MAY HAVE A PREDISPOSITION to lung cancer when exposed to smoke, a history of Hodgkin's Disease treated with chemo,radioation or both, smokers treated with chemo or radioation, eating a poor dieat with few fruits and vegetables. |
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Term
| ________ ____________ men have higher incidence and mortality rates for lung cancer. |
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Definition
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Term
| What would a normal thorax look like? |
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Definition
| The thorax should be symmetrical from R to L. Ribs should slope down at a 45 degree angle. Shoulders shouldbe equal height in a horizontal plane. The anterior and posterior surfaces of the thorax should be approximately equal if you were to take a tape measurer & measure it. The front & back should eb twice as big as the side measurement. So the anterior & posterior surfaces are twice as long as the lateral surfaces. AP:Lateral=2:1. |
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Term
| An increased curve in older clients is common. It is caused by loss of lung resiliency and a loss of skeletal muscle. What is this called? Is it normal? |
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Definition
| Kyphosis. Yes, it is normal. |
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Term
| Can the size of the thorax differ by race? |
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Definition
| Yes, it does differ by race and this is normal. Adult caucasians have a larger thorax and greater lung capacity then african americans, asians and native americans. |
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Term
| A _____ shape chest will make the AP: lateral ratio less than 2:1. The ribs appear horizontal at an angle greater then 45 degrees and there is an increased ratio between the anteroposterior-transverse diameter. This condition is commonly the result of emphysema d/t hyperinflation of the lungs. |
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Definition
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Term
| A _______ chest/breast is a congenital anomaly where the sternum and the xiphoid stick out. If it's severe it can cause cardiorespiratory problems. |
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Definition
| Pigeon. Think of a bird from the side, their chest sticks out. |
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Term
| _____ is a forward curving of the spine. It is the hump in the back that esp. older women get, usually a result of osteoporosis. If it is severe enough, it can displace the lungs and make breathing difficult. |
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Definition
| Kyphosis, it is a normal finding. |
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Term
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Definition
| It is forward bending and lateral bending. |
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Term
| How do you palpate for tactile fremitus? WHat is normal? |
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Definition
| Use the bony ball or side of your hand to feel VIBRATIONS, place hands in symmetrical spots on the chest, have client say "99" or "blue moon" while you feel in at least 5 places including surface of chest. Normal is the vibrations are equal from right to left, should be most intense over the major bronchi, and should decrease symetrically as you move down the chest. You shouldn't feel it lower, like at the bottom of the ribs. Fremitus should remain symmetric for bilateral positions. |
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Term
| What are abnormal findings for fremitus? |
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Definition
| fluid & masses usually increase the vibration, if it is not equal from R to L that is abnormal. Fluid at base of lung would increase vibration and it would not be symmetrical. Unequal is usually the result of consolidation (which increases vibration) or bronchial obstruction, air trapping in emphysema, pleural effusion, or pneumothorax (which all decrease fremitus). Diminished fremitus even w/ a louder spoke voice may be an obstruction of tracheobronchial tree. |
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Term
| What is the correct technique for percussing the lungs? |
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Definition
| Start at the apices of the scapula and percuss across the tops of both shoulders. Then percuss the intercostal spaces across and down, comparing sides. Percuss to the lateral aspects at the bases of the lungs, comparing sides. You will place ND hand on skin, take all fingers off except middle off the skin, hyperextend the middle so that only the 1st joint (very tip) is in contact w/ skin and press down firmly. With the very tip (not the pad) of finger use "wrist action" (not whole arm) to tap the finger on skin. Close your eyes & you're less likely to miss. |
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Term
| Can you percuss the anterior thorax? |
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Definition
| Yes, always compare identical spots by moving side-to-side and then moving down no more than 5 cm, percuss in the right and left midclavicular lines, percuss between the ribs, move breast tissue so you aren't percussing through it, be sure to completely percuss lateral surfaces. |
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Term
| What are the normal percuss tones heard from the posterior thorax? |
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Definition
| Resonance should be heard throughout over the healthy lungs, flat over bones (scapula) and dull on liver. |
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Term
| What percussion tones should be heard on anterior thorax? |
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Definition
| Normal: Resonance over lungs, flat over muscle and bone, cardiac and liver dullness and stomach tympany. |
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Term
| Explain technique for a diaphragmatic excursion: |
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Definition
| Ask client to EXHALE forcefully and hold the breath. Beginning at the scapula line (T7), percuss intercostal spaces of the right posterior chest wall. Percuss downward until the tone changes from resonance to dullness. Mark this level and allow the client to breathe. Next ask client to INHALE deeply and hold it. Percuss the intercostal spaces from the mark downward until resonance changes to dullness. Mark the level and allow the client to breathe. Measure distances of the two and do on both sides of posterior thorax. Excursion should be equal bilaterally and measure 3-5 cm in adults. The level of the diaphragm may be higher on the right because of the liver. In well-conditioned people, excursion can be up to 7-8 cm. |
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Term
| When ausculating breath sounds what is the normal pitch, quality, amplitude, duration and location? |
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Definition
| Normal Respirations: 12-20/min in adults (don't let client know), Rhythm: regular cycle of inspiration & expiration, Depth: symmetrical from R to L, Character: thoracic or abdominal (both are normal). |
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Term
| When would depth no be symmetrical when ausculating breath sounds? |
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Definition
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Term
| Describe normal breath sounds in BRONCHIAL area. Where do you assess? What is the pitch, quality, amplitude, duration and location? |
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Definition
| Assessed on the trachea and thorax on posterior thorax. Pitch: High, Quality: Harsh or Hollow, AMplitude: Loud, Duration: Short inspire + Long expire. |
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Term
| Describe normal breath sounds in the BRONCHOVESICULAR area. What is the normal pitch, quality, amplitude, duration and location? |
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Definition
| Pitch: Moderate, Quality: mixed, Amplitude: moderate, duration: same during inspiration and expiration, location: over all the major bronchi. in posterior: between the scapula. in anterior: around the upper sternum in the first and second intercostal spaces. |
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Term
| Describe normal breath sounds in the VESICULAR area. What is the normal pitch, quality, amplitude, duration and location? |
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Definition
| Pitch: Low, Quality: Breezy, Amplitude: Soft, Duration: Long inspiration and short expiration, Location: Peripheral Lung Field. |
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Term
| breath sounds are considered normal heard in other spots then noted? |
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Definition
| No, breath sounds are considered normal only in the area specified. Heard elsewhere, they are considered abnormal sounds. For example, bronchial breath sounds are abnormal if heard over the peripheral lung fields. |
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Term
| Tests like Bronchophony (client repeats 99), Egophony (client repeats letter E) and Whispered Pectoriloquy (whispers 1, 2, 3)... what is normal and what are you testing for? |
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Definition
| YOu are ausculating the voice sounds. 99=voice transmission is normally soft, muffled and indistinct. the sound of the voice can be heard, but actual phrase cannot distinguish. E=voice transmission will be soft and muffled but the letter E shouldn't be distinguishable, Whispered numbers= transmission sound is very faint and muffled, it may be inaudible. |
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Term
| Correct technique for ausculating the lungs goes where? |
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Definition
| posterior thorax: back and forth 5 times on each side, start to go lateral, loop back around and go down lateral sides back and forth. Use the DIAPHRAGM of the stethescope. Use the same side to side then down technique as for percusion being sure to listen above the clavicles and on the lateral surface. ask pt. to take a deep breath through the mouth every time you place the stethescope. |
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Term
| How long do you listen in each ausculated spot? |
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Definition
| one full respiratory cycle |
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Term
| If oyu hear abnormal sounds during ausculation, always have the client ____, then listen again and note any changes. |
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Definition
| cough, it may clear the lungs |
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Term
| These abnormal breath sounds are high-pitched, short, popping sounds on inspiration. SOunds like hair in front of your ear. These are heard in pneumonia, congestive heart failure, asthma, emphysema. |
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Definition
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Term
| These abnormal breath sounds are low-pitched, bubbling, moistest sound on inspiration. they may continu into early respiration. Sounds like the lungs are really wet. |
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Definition
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Term
| These abnormal breath sounds can be High or Low pitched. Usually occur during expiration. Hgih pitched heard in acute asthma attacks & emphysema. |
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Definition
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Term
| What respiration pattern has more than 24/min and is shallow? |
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Definition
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Term
| What respiratory pattern has less then 10/min and is regular? |
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Definition
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Term
| what respiratory pattern has increased rate & depth? |
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Definition
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Term
| What respiratory pattern is characterized by alternating periods of deep, rapid breathing followed by periods of apnea? |
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Definition
| Cheyne-Stokes Respiration. Can be caused by severe congestive heart failure, durg overdose, increased intracranial pressure or renal failure. May be noted in elderly sleep w/o other conditions. |
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Term
| What breath sound has a ratio of 1:2? Expiration sounds twice as long as inspiration. |
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Definition
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Term
| What breath sounds is 1:1? equal inspire to expire? |
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Definition
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Term
| what breath sound ration is 2:1. Longer inspiration to expiration. |
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Definition
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Term
| What lymph node is on the axillary fold of armpit? |
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Definition
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Term
| What lymph node is on the arm above armpit? |
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Definition
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Term
| WHat lymph nodes are below the armpit Central Midaxillary and are more lateral then towards the breast? |
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Definition
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Term
| What lymph nodes are below the armpit, but towards the breast more then lateral? |
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Definition
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Term
| What are the 2 lymph node groups on neck, down low by chest really? |
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Definition
| Supraclavicular and infraclavicular. |
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Term
| What is the most common cancer in women? |
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Definition
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Term
| What is the 1st leading cause of death in African American women? |
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Definition
| Breast Cancer. The incidence of breast cancer rates continue to rise. |
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Term
| What are the risk factors for breast cancer? |
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Definition
| Genetics/Heredity, Age (risk increases 40-65 is at greatest risk), Diet (high fat, obesity, high hip to waist ratio, 2-5 drink a day), early menarche, no natural children, no breast feeding, oral contraceptive use, regular alcohol intake, HIGHER education & socioeconomic status, Hormone replacement therapy with progesterone, wet ear wax, |
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Term
| How & When to perform a breast self exam? |
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Definition
| Monthly throughout life beginning in late adolescence. Important for women to feel confident doing a breast self exam... not feeling confident prevents women from doing it. But 90% masses women find themselves. Lie down & put pillow underneath. Use flat pads or 3 fingers to palpate. Palpate using 1 of 3 methods: circular, wedge (out from center) or vertical (up & down). can choose whichever, but have to palpate every square inch of the breast. |
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Term
| When should women have mammograms? |
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Definition
| Baseline at 35-40 yrs old and then every 2 years between 40-49. Annually after 50. If risk factors are present, mammography is recommended earlier & more often. Mammography detects masses less then 1/2 cm. They DO NOT detect all masses. |
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Term
| On the anterior thorax in the right lung... the goes down to the __th rib at the sternum and the __th rib at the midaxillary line. |
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Definition
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Term
| on the anterior thorax in the right lung... the middle lobes runs from the __th rib at the sternum to the __th rib in the midclavicular line. |
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Definition
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Term
| To count spinous processes, know that they align to corresponding ribs until __, then they angle downward from own vertebral body and can be palpated over the vertebral body & rub below. |
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Definition
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Term
| Most lung tissue in the upper lobes is located on the __________ surface of the chest. Lower lobes of both lungs are primarily on ________ surface of chest. (the right middle lobe of the lung does not extend to posterior side of thoracic wall and must be assessed from anterior surface.) |
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Definition
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Term
| Older clients may experience _______ with activities related to aging changes of the lungs (loss of elasticity, fewer capillaries, loss of lung resiliency) |
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Definition
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Term
| Chest pain related to pleuritis may be absent in elderly b/c of age related alterations in ______ perception. |
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Definition
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Term
| Elderly may not be able to ______ effectively b/c of weaker muscles and increased rigidity of thoracic wall. |
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Definition
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Term
| There could be a genetic component linked to ______ cancer and smoking. Lung cancer is lower in Fiji & areas in S. Pacific despite similar smoking rates. ________ American men have higher incidence then white men for mortality with lung cancer. Lung cancer rates for Hispanics are 1/2 of those non-Hispanics. |
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Definition
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Term
| Some clinicians prefer to assess the thorax in which order? |
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Definition
| inspect the thorax, then palpate anterior & posterior thorax, then percuss and ausculate anter. & post. thorax. |
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Term
| Kyphosis is common in elderly. is this normal? |
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Definition
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Term
| Can the size of the thorax differ with race? Who has the largest? |
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Definition
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Term
| What part of hand is best for assessing tactile fremitus? WHy? |
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Definition
| Ball of hand, best for feeling vibrations |
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Term
| Why might a clients thoracic expansion be decreased? It should always still be symmetric though! |
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Definition
| Decreases b/c of costal cartilages and loss of accessory musculature, older lcient's thoracic expansion could be decreased... |
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Term
| Breath sounds are considered normal only ___________________. |
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Definition
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Term
| Deep breathing can be difficult for elderly clients. what should you do? |
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Definition
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Term
| if you hear an abnormal breath sound, ask the client to ______ and then listen again. |
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Definition
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Term
| Sternum and ribs are more or less prominent in elderly? Why? |
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Definition
| More, loss of subcutaneous fat |
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Term
| It is more objective to ______________ the breathing pattern, rather then labeling the pattern when assessing respiratory patterns. |
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Definition
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Term
| How can you best assess the right middle lobe lung? |
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Definition
| anterior thoracic PALPATION |
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Term
| When assessing for fremitus on a female patient, should you just go on top of the breast b/c it is there? |
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Definition
| No, don't palpate the breast - it dampens the vibrations |
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Term
| We are told never to listen through the gown. BUT if the client has lots of ____, listening through a thin t-shirt to decrease extraneous sounds that could be mistaken as crackles. |
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Definition
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Term
| Tenderness or pain at the __________ junction of ribs is seen with fractures, especially with osteoporosis. |
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Definition
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Term
| Older clients might notice decrease in the size & firmness of their breasts. This is natural and due to ....... |
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Definition
| decreased estrogen levels. Glandular tissue decreases and fatty tissue increases. a well fitted bra can reduce discomfort. they have more pendulous, less firm and saggy breasts. |
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Term
| How can you tell a client to remember to do their BSE? |
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Definition
| Pick a set date they will remember each month! tell older clients to do this, esp. if they don't menstruate. |
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Term
| HIghest incident of breast cancer occurs in ____ and _____. |
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Definition
| US & Europe. Lowest rates = native americans, saudi arabia, Japan, Singapore. |
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Term
| There is a lower incidence of breast cancer correlating with women who have _____ ear wax. |
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Definition
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Term
| _________ __________ have highest adjusted deathrates form breast cancer in US. |
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Definition
| African Americans. followed by non Hispanic whites. |
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Term
| Patterns of veins radiating horizontally and toward axilla (transverse) and longitudinally will vary among cultural groups. What is normal? |
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Definition
| Both are normal and transverse predominates. |
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Term
| Older clients may have smaller, flatter nipples that are less erectile on stimulation. Older clients breasts may feel more _______, and the inflammatory ridge may be more easily palpated as it thickens. |
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Definition
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