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Thorax and Lungs #1

Chest/Lungs Physical and Exam

QuestionAnswer
What are the common or concerning symptoms in the respiratory history? Chest pain, dyspnea, wheezing, cough, hemoptysis
What does chest pain or discomfort raise concern about? Heart disease but often arise from structures in the thorax and lungs as well.
What could cause myocardial chest pain? Angina pectoris, myocardial infarction, myocarditis
What causes pericardial chest pain? Pericarditis
What causes aortic chest pain? Dissecting aortic aneurysm
What causes trachea and large bronchi chest pain? Bronchitis
What causes chest wall pain? Costochondritis, herpes zoster
What causes esphogeal pain? reflux esophagitis, esophageal spasms, esophageal tear
What are some causes of extrathoracic structures such as the neck, gallbladder, and stomach? cervical arthritis, biliary colic and gastritis
A clenched fist over the sternum suggests what? Angina pectoris
What does a finger pointing to a tender area on the chest wall suggests? musculoskeletal pain
A hand moving from the neck to the epigastrium suggests what? heartburn
pneumonia, pulmonary infarction, muscle strain from prolong recurrent coughing
The pericardium has few pain fibers. The pain of the pericardium stems from what? inflammation of the adjacent parietal pleura
Chest pain can also arise from what psychological condition? Anxiety
What is the most frequently cause of chest pain in children? anxiety and costochondritis
Dyspnea is a prominent symptom of what general class of diseases? cardiac and pulmonary
The degree of dyspnea in COPD patients predicts what? 5 year survival better than FEV1
When assessing dyspnea, what should be asked to find out when the symptom occurs? does it occur at rest/exercise, how much exertion is needed to produce onset, timing, setting, aggravating/alleviating factors
We should make every effort to determine the severity of dyspnea based on what? activities of daily living and lifestyle i.e. how many stairs, mopping the floor, carrying bags, distance walking
When does wheezing occur? partial airway obstruction from secretions, tissue inflammation in asthma or from a foreign body?
Cough can be a symptom of what kind of heart failure? left sided heart failure
What is the duration of an acute cough? <3 weeks
What is the duration of a subacute cough? 3-8 weeks
What is the duration of a chronic cough? >8 weeks
What is the most common cause of acute cough? viral upper respiratory illness (URI), acute bronchitis, pneumonia, LVH failure, asthma, or a foreign body
What occurs in a subacute cough? postinfection cough, bacterial sinusitis, asthma
What occurs in a chronic cough? post nasal drip, asthma, GERD, chronic bronchitis, bronchiectasis
Describe mucoid sputum. translucent white or gray
Foul smelling sputum is present in what? Tenacoius sputum in cystic fibrosis? anaerobic lung abscess; cystic fibrosis
What is tenacious sputum? thick and viscous mucus that obstructs the airway and promotes persistent bacterial infection
Large amounts of purulent sputum are present in what? bronchiectasis or a lung abcsess
What is bronchiectasis? a condition where the bronchial tubes of your lungs are permanently damaged, widened, and thickened
With a cough, what are other diagnostically helpful symptoms? fever, chest pain, dyspnea, orthopnea and wheezing
Hemoptysis varies from blood streaked phlegm to frank blood
Before using the term hemoptysis, we must try to confirm ________________. the source of the bleeding (mouth, pharynx, GI tract (including aspirated blood), nasopharynx,
Blood originating in the stomach is usually darker than blood from the ___________________________________. respiratory tract and may be mixed with food particles.
What are some important topics for health promotion and counseling related to the respiratory system? tobacco cessation and immunizations
What conditions are affected by smoking on health and disease? CAD, stroke, PVD, COPD, lung cancer
What are some reproductive risk factors related to smoking? infertility, preterm birth, low birth weight, sudden infant death syndrome
What are some risk factors smoking increase on non-smokers? lung cancer, respiratory infections, asthma, and residential fires
What are the 5 A's of assessing readiness to quit smoking? ask about use, advise to quit, assess willingess to make a quit attempt, assist in quit attemp, arrange follow-up
What are the stages of change model to assess readiness to quit smoking? precontemplation (I dont want to quit), contemplation (concerned but not ready to quit now), preparation (I am ready to quit), action (i just quit), maintenance (1 quit 6 months ago)
Stimulation of the nicotinic cholinergic receptors in the brain increases the release of what neurotransmitter? dopamine, that enhances pleasure and modulates mood.
Daily smokers inhale enough nicotine to almost complete ____________. receptor saturation
Cognitive therapy for smokers helps to recognize and design strategies to combat the features of _____________________. addiction, cravings, triggers such as stress or enviornmental cues and signs of withdrawal like irritability, poor concentration, anxiety and depressed mood.
Quit rates double when counseling is combined with pharmaco therapies such as ____________________________. nicotine replacement, bupropion and verencycline
What is Bupropion (Wellbutrin)? antidepressant medication used to treat major depressive disorder and seasonal affective disorder. The Zyban brand is used to help people stop smoking by reducing cravings and other withdrawal effects
What is varencycline (Chantix)? a medication used to treat nicotine addiction. It reduces both craving for/decreases the pleasurable effects of tobacco products. It's high-affinity partial agonist for the α4β2 nicotinic acetylcholine receptor subtype that leads to the release of dopamine and has the capacity to reduce craving & withdrawal
What are the two types of influenza vaccines? the inactivated vaccine (dead virus) injections and the nasal-spray vaccine contating attenuated live viruses approved for healthy people (5-49 yrs old)
Because the flu viruses changes from year to year, each vaccine contains _____________________. 3 strains and is modified annually
The flu vaccine is recommened by CDC for all people >6 mos to include high risk populations such as: those with chronic pulmonary/medical conditions, immunosuppressed, morbidly obese, women who will pregnant during flu season, nursing home and LTACs residents, American Indians, Alaska natives, healthcare professionals, household contacts and caregivers of children <5yr
What organism causes pneumonia and meningitis and can lead to sepsis and death? Streptococcus pneumonia
What are the two pneumonia vaccines used in adults the inactivated Pneumococcal Polysaccharide Vaccine (PCV13 or Prevnar 13) and the inactive Pneumococcal Conjugate Vaccine (PPSV23 or Pneumovax23)
CDC recommends vaccination with PCV13 for: All children <2 yrs, all adults >65 yrs and people 2 - 64 yrs old with certain medical conditions
CDC recommends vaccination with PPSV23 for: All adults >65, people 2 - 64 yrs old w/certain medical conditions and adults 19 - 64 yrs old who smoke
Adults who need the PCV13 only get a single dose. The vaccine helps protect against what? 13 types of pneumococcal bacteria that most commonly cause serious infections in children and adults. It can also help prevent ear infections and pneumonia caused by the same types of pneumococcal bacteria
Doctors give a single dose of PPSV23 to people who need it. CDC recommends 1-2 additional doses for people with certain chronic medical conditions. This vaccine helps protect against what? serious infections caused by 23 types of pneumococcal bacteria. It can help prevent infection in those receiving trochlear implants and those who are immunocompromised (HIV/AIDS, steroids, radiation/chemo)
What is the orderly fashion in which you examine the lungs? inspect, palpate, percuss and auscultate
When assessing the patient's color, cyanosis suggests ____________. Hypoxia
Clubbing of the nails suggestes hypoxia. It occurs in what diseases? bronchiectasis, congenital heart disease, pulmonary fibrosis, cystic fibrosis, lung abscess and malignancy
What is stridor? a high pitched wheeze that's an omninous sign of and upper airway obstruction in the larynx or trachea
Accessory muscles (sternomastoid, scalene muscle and supraclavicular retraction) use in COPD signals what? difficulty breathing
Lateral displacement of the trachea occurs in what disease processes? pneumothorax, pleural effusion or atelectasis
The AP diameter may increases with what? age and in COPD
Asymmetric or delay in lung expansion occurs with __________. pleural effusions, chronic fibrosis, lobar pneumonia
Lung retraction occurs in severe ______________________. asthma, COPD or upper airway obstruction
Unilateral impairment or lagginging indicates: pleural disease from abestosis or silicosis. It's also seen in phrenic nerve damage or trauma
When palpating the chest, intercostal tenderness and bruising may indicate: inflamed pleura and rib fractures
Sinus tracts are blind, inflammatory, tubelike structures opening onto the skin. Although rare, what do they indicate? infection of the underlying pleura and lung (TB, actinomycosis)
What is tactile fremitus? the palpable vibrations transmitted thru the bronchopulmonary tree to the chest wall
How is tactile fremitus detected? use the ball or the ulnar surface of the hand to optimize the vibratory sensitivity of the bones in the hand and ask the patient to repeat "99"
Fremitus is decreased or absent when? the voice is higher pitched, soft, or when the transmission of vibrations from the lyryx to the surface of the chest is impeded by a thick chest wall, an obstrcted bronchus, COPD, or pleural changes from effusions, fibrosis, pneumothorax (air) or an infiltrating tumor
What is the pleximeter finger? the middle finger that hyperflexed at the distal interphalangeal joint and placed firmly on the surface to be percussed
What is the plexor finger? the right middle finger used to strike the pleximeter finger
If a louder note is needed for percussion, what should be done? apply pressure with the pleximeter finger. This is more effective than tapping harder with the plexor finger
What are the 5 percussion notes? flat, dull, resonant, hyperresonant and tympanic
What produces a flat percussion sound? thigh, large pleural effusion
What produces a dull percussion sound? liver, lobar pneumonia
What produces a resonant percussion sound? healthy lung, simple chronic bronchitis
What produces a hyperresonant percussion sound? COPD, asthma, pneumothorax. (nothing really sounds like this)
What produces a typmpanic percussion sound? gastric air bubble, puffed out cheek, Large pneumothorax
Generalized hyperresonance may be heard over hyperinflated lungs
Unilateral hyperresonance in the lungs suggests a large pneumothorax or possibly a large air-filled bulla in the lung
Estimate the extent of diaphragmatic excursion by determining the distance between the level lf dullness on full expirationa dn thelevel of dullness on full inspiration, normally about 3-5.5 cm.
Created by: cljohnson2000