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Pt Assessment Test 2

WillWallace Patient Asst 3/08 Test 2

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
Created by: annabannana