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| Flap 2 | |
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| Adventitious Breath Sounds | (abnormal Breath Sounds) Crackles/rales, Rhonchi, Wheeze, Pleural Friction Rub, Stridor, Diminished |
| Auscultation of the lungs | Listening for normal-abnormal breath sounds-listen over thorax-listen in sequence, deep inhale, passive exhale- all lobes, top to bottom, side to side-include lateral and anterior, assesses condition and response to therapy |
| bilateral chest expansion | even movement, but not 3-5 cm, caused by neuromuscular or COPD |
| Bronchial Breath Sounds | (normal breath sounds) E = I Heard over sternum, trach and main stem bronchi, loud - high pitched |
| bronchophony | (99 or 123 will be louder) increased intensity and clarity of vocal resonance, more tissue density than air (consolidation), easier to detect unilaterally, dull percussion, increased vocal fremitus |
| bronchovesicular breath sounds | (normal breath sounds) moderate pitch, moderate intensity, around upper part of sternum between scapula and right apex, I=E |
| thorasic expansion | normal chest expands symmetrically in I, anterior=thumbs toward xiphoid process, posterior= thumbs toward T-8 on I, thumbs should move equally 3-5 cm on deep I |
| crackles/rales | (adventitious BS) bubbling-crackling sounds, mainly on I, air flow through fluid, discontinuous-specific locations, does not clear with cough. caused by pulmonary edema, pneumonia, emphysema, atelectasis, pulmonary fibrosis |
| crepitus | sensation of crackling felt when palpated skin of subcutaneous emphysema |
| decrease tactile fermitise | decreased vibrations, caused by pleural effusion, fluid, pneumothorax |
| diminished breath sounds | (adventitious BS) decreased breath sounds caused by end stage COPD or pneumothorax |
| Dullness | (hyporesonance percussion sound) medium sound, more tissue than air, caused by atelectasis, consolidation, pleural effusion, pleural thickening, pulmonary edema |
| egophony | increased consolidation, patient says "eee"= sounds like "aaa" |
| flatness | (hyporesonance percussion sound) low volume more tissue than air, caused by massive pleural effusion, massive atelectasis, or pneumonectomy |
| Hyperresonance | (percussion sound) loud, high pitched, produced over area with more air than tissue, caused by COPD, emphysema, pneumothorax, air filled stomach, asthma |
| Hyporesonance | (percussion sound) decreased resonance caused by atelectasis, consolidation, pleural thickening, pleural effusion |
| Increased tactile fermites | increased vibrations, caused by atelectasis, pneumonia, lung mass |
| Normal breath sounds | vesicular, bronchial, bronchovesicular, tracheal |
| Palpation | touching the chest wall to evaluate underlying structure and function, evaluates vocal fremitus, estimate thoracic expansion and assesses skin ans subcutaneous tissue, hands on back, breath in, measures thoracic expansion, skin=temp, damp, cool, dry etc. |
| Percussion | tapping on surface to evaluate underlying structure, vibrations and sound help to evaluate lung structure, produces 5 sounds, hyperresonance and tympani, resonance, hyporesonance-dullness &flatness. |
| Pleural Effusion | decreased vibrations (tactile fremitus) dullness-medium-more tissue than air, caused by abnormal collection of fluid in the plural space |
| Pleural Friction Rub | (adventitious BS) clicking or grating sound caused by friction of the parietal and visceral rubbing, very painful heard on I & E, caused by pleural effusion and pleurisy |
| Pneumonia | inflammation of the lung parincima, usually caused by infection |
| Pneumothorax | air in the plural space |
| resonance | (percussion sound) low pitch, equal air and tissue, normal lung tissue |
| Rhonchi | (adventitious BS) ruble sound, fluid filled large airways heard on E, clears with cough, caused by asthma, emphysema, mucus plug, stenosis |
| strider | (adventitious BS) DO NOT NEED A STETHOSCOPE TO HEAR, barking sound on I, heard when upper airways are constricted, caused by croup, epiglottis, post extubation |
| subcutaneous emphysema | air leaks from lung into subcutaneous tissue, fine bubbles produce crackling sensation when palpated, sensation produced is called cepitus |
| Tactile Fremitis | Fremitus (voice vibrations)that can be felt. increased by solids like consolidation and atelectasis, decreased by obesity, pneumothorax, emphysema, COPD |
| Tracheal Breath Sounds | (normal breath sounds) High pitch, loud intensity, harsh, located over trachea, I & E equal or E may be slightly longer |
| Tracheal Positioning | thumbs on ea side of trachea-look for shift, away from affected side=tension pneumothorax, large pleural effusion, massive atelectasis. toward affected side= atelectasis, spontaneous pneumothorax |
| Tympani | (hyperresonance percussion sound) drum like sound (tinny) caused by tension pneumothorax |
| Unilateral reduction in chest expansion | Not evenly reduced, caused by atelectasis, pneumothorax, pleural effusion |
| vesicular breath sounds | (normal breath sounds) low pitch, soft intensity-gentle, peripheral lung areas, longer I, clear sounds |
| vocal fremitus | vibrations created by the vocal cords during speech |
| tactile fremitus | fremitus that can be felt |
| wheeze | (adventitious BS) Rhonchi (rumble) with musical tone, constricted airways, mainly on E, does not clear with cough, caused by asthma and CHF |
| Whispering Pectoriloquy | (99 or 123) normal lung sounds muffled, consolidation sounds clear |
