Advanced Physical Assessment
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| When an infant inhale a foreign body, there’s | an equal chance of it going to either side of the lungs
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| Obstructive lung dz, the problem is in | expiration, a passive process
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| Air gets in, but then it gets trapped in | bronchitis, emphysema, asthma- jet black on the XR- diaphragm is compressed
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| Restrictive lung dz | pulmonary fibrosis, pulmonary edema, alveolar pneumonia, kyphoscoliosis, neuromuscular weakness
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| Consolidation | air is replaced with fluid and so it becomes denser- solidified- sound is transmitted better- more fluid or less air- decreased air to fluid ratio- alveolar pneumonia and left ventricular failure
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| With consolidation, you hear what | bronchial and bronchovesicular sounds in the peripheral area, and you hear bronchophony, and egophony and whispered pectoriloquy- tactile fremitus is ↑- ask for a chest XR
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| Atelectasis | collapse of the alveoli- segment of the lung- lung becomes more dense- consolidation- physical obstruction
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| Pneumothorax | air tension enters the pleural space- loses it’s negative space
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| Tension pneumothorax | medical emergency-
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| Pleural effusion | accumulation of fluid in the pleural space- may be protein rich or poor depending on mechanism of production- may compress the underlying lung-
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| Emphysema you find | tachypnea, use of accessory ms, barrel shaped chest, pursed lip, ↑tri pod position, ↓expansion, ↓tactile fremitus, hyperresonance, low lying diaphragm, breath sounds decreased, early crackles, diminished transmission of voice sounds
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| CHF you find | tachypnea, accessory ms use, cyanosis, ↑JVP, edema, fremitis normal or ↑ lung bases bilaterally, bilateral wheezing, voice sounds normal or ↑ bilaterally, late inspiratory crackles ….
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| Reason to hospitalize pt for pneumonia | respiratory distress/ tachypnea… unable to speak… RR 32
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| Pneumonia you find | tachypnea, respiratory distress, possible cyanosis, fever, ↑ tactile fremitus, percussion will be dull in the area, broncho veicular and bronchial in the peripheral areas, wheezing, increased voice sounds- over the area of the consolidation
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| Lobar atelectasis | dyspnea, tachypnea, decreased expansion on that side, absent or ↓tactile fremitus, trachea deviates to one side,↓resp excursion, absent lung sounds, no voice sounds do XR CT
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| Pleural effusion you find | tachypnea, ↓expansion on affected side, …. PERCUSS THIS ONE- dull to flat- lung sounds absent,tactile fremitus decreased, trachea to side
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| Pneumothorax you find | tachypnea, ↓expansion on affected side, do chest XR CT, absent tactile fremitus on affected side, ↓excusion on affected side, trachea deviated away from lg pneumothorax, air surrounding lung is hyperresonant, lung sounds transmitted diminished
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| Always look at what with a respiratory pt? | respiratory rate
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| PND or orthopnea = what | CHF
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| Dull to percussion is what | left sided pleural effusion this would be dullness to one side otherwise percussion/resonance doesn’t mean anything
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| Acute bronchitis | infection in an otherwise healthy chest- 90% viral- just do something for the cough
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| Pulmonary embolism | elevated hr, pt has hx, sudden SOB (immobility, long flight, birth control, hx of DVT)- D-dimer excludes without dx
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| COPD | diminished breath sounds- also tripod position
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