Match the respiratory term with its description

G. Adolescence is a

J. Because their eyes produce fewer

5. Match the respiratory term with its description

Answer Term Description

F Dyspnea A. Inspiratory and expiratory sounds about equal in length C Wheezes B. Fade away about one third of the way through expiration

E Cough C. Suggest partial airway obstruction from secretions, tissue infl ammation, or a foreign body

A Bronchovesicular sounds D. Have a short silence between inspiratory and expiratory sounds

B Vesicular sounds E. May be caused by infl ammation of the respiratory mucosa or tension in the air passages from a tumor or enlarged peribronchial lymph nodes

D Bronchial sounds F. Shortness of breath

6. Match the disease process to its corresponding location of chest pain.

Answer Disease Process Corresponding Location of Chest F Tracheobronchitis A. Retrosternal or across the anterior chest

I Pericarditis B. Precordial, below the left breast, or across the anterior chest H Dissecting aortic aneurysm C. Retrosternal, may radiate to the back

C Refl ex esophagitis D. Often below the left breast

G Diffuse esophageal spasm E. Sometimes radiating to the shoulders, arms, neck, lower jaw, or upper abdomen

D Costochondritis F. Upper sternal or on either side of the sternum J Pleuritic pain G. Retrosternal, may radiate to the back, arms, and jaw

B Anxiety H. Anterior chest, radiating to the neck, back, or abdomen

A Angina pectoris I. Precordial, may radiate to the tip of the shoulder and to the neck E Myocardial infarction J. Chest wall overlying the process

Activity C SHORT ANSWER

7. Student answers should include the following information:

a. Abnormalities of the chest are described in two dimensions:

i. Along the vertical axis

ii. Around the circumference of the chest b. Vertical locations

i. You must be able to count the ribs and inter- spaces.

ii. Sternal angle, also termed the angle of Louis, is the best guide.

iii. Move your fi nger down approximately 5 cm to the horizontal bony ridge joining the manubrium to the body of the sternum.

iv. Move your fi nger laterally and fi nd the adjacent 2nd rib and costal cartilage.

v. Using two fi ngers, “walk down” the intercostal spaces, one space at a time, on an oblique line.

c. Circumference of the chest

i. The midsternal and vertebral lines are pre- cise.

ii. Midclavicular line drops vertically from the midpoint of the clavicle.

iii. Anterior and posterior axillary lines iv. Midaxillary line

v. Vertebral line vi. Scapular line

8. Student answers should include the following:

a. Crackles

i. Late inspiratory crackles result from a series of tiny explosions when small airways, defl ated during expiration, pop open during inspiration.

b. Coarse crackles

i. Crackles result from air bubbles fl owing through secretions or lightly closed airways during respiration.

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c. Early inspiratory crackles

i. Appear and end soon after the start of inspiration

ii. Often coarse and relatively few in number iii. Causes include chronic bronchitis and

asthma.

d. Midinspiratory and expiratory crackles i. Heard in bronchiectasis but are not specifi c

for this diagnosis e. Wheezes

i. Occur when air fl ows rapidly through bronchi that are narrowed nearly to the point of closure

ii. Causes of wheezes throughout the chest include asthma, chronic bronchitis, COPD, and congestive heart failure (cardiac asthma).

f. Rhonchi

i. Secretions in the larger airways g. Stridor

i. High-pitched harsh sound that is entirely or predominantly inspiratory

ii. Indicates a partial obstruction of the larynx or trachea, and demands immediate attention iii. Sometimes described as a seal’s bark h. Pleural rub

i. Creaking sounds

ii. Infl amed and roughened pleural surfaces grate against each other.

iii. Usually confi ned to a relatively small area of the chest wall

The black boxes in this table suggest a framework for clinical assessment. Start with the three boxes under Percussion Note: resonant, dull, and hyperresonant. Then move from each of these to other boxes that emphasize some of the key differences among various conditions. The changes described vary with the extent and severity of the disorder. Abnor- malities deep in the chest usually produce fewer signs than superfi cial ones, and may cause no signs at all. Use the table for the direction of typical changes, not for absolute distinctions.

Condition

Percussion

Note Trachea Breath Sounds

Adventitious Sounds

Tactile Fremitus and Transmitted Voice Sounds Normal

The tracheobronchial tree and alveoli are clear; pleurae are thin and close together;

mobility of the chest wall is unimpaired.

Resonant Midline Vesicular, except perhaps bronchovesicular and bronchial sounds over the large bronchi and trachea, respectively

None, except perhaps a few transient inspiratory crackles at the bases of the lungs

Normal

Chronic Bronchitis The bronchi are chronically infl amed and a productive cough is present. Air- way obstruction may develop.

Resonant Midline Vesicular (normal) None; or scattered coarse crackles in early inspiration and perhaps expiration; or wheezes or rhonchi

Normal

Left-Sided Heart Failure (Early) Increased pressure in

the pulmonary veins causes congestion and interstitial edema (around the alveoli);

bronchial mucosa may become edematous.

Resonant Midline Vesicular Late inspiratory crackles in the dependent portions of the lungs; possibly wheezes

Normal TABLE 13-7 PHYSICAL FINDINGS IN SELECTED CHEST DISORDERS

9. Student answers should include the following:

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ANSWERS 163

Condition

Percussion

Note Trachea Breath Sounds

Adventitious Sounds

Tactile Fremitus and Transmitted Voice Sounds Consolidation

Alveoli fi ll with fl uid or blood cells, as in pneumonia, pulmonary edema, or pulmonary hemorrhage.

Dull over the airless area

Midline Bronchial over the involved area

Late inspiratory crackles over the involved area

Increased over the involved area, with bron- chophony, egophony, and whis- pered pecto- riloquy Atelectasis (Lobar Obstruction)

When a plug in a mainstem bronchus (as from mucus or a foreign object) obstructs air fl ow, affected lung tissue collapses into an airless state.

Dull over the airless area

May be shifted toward involved side

Usually absent when bronchial plug persists.

Exceptions include right upper lobe atelectasis, where adjacent tracheal sounds may be transmitted.

None Usually

absent when the bronchial plug persists.

In exceptions (e.g., right upper lobe atelectasis) may be increased Pleural Effusion

Fluid accumulates in the pleural space and separates air-fi lled lung from the chest wall, blocking the transmission of sound.

Dull to fl at over the fl uid

Shifted toward opposite side in a large effusion

Decreased to absent, but bronchial breath sounds may be heard near top of large effusion

None, except a pos- sible pleural rub

Decreased to absent, but may be increased toward the top of a large effusion Pneumothorax

When air leaks into the pleural space, usually unilaterally, the lung recoils from the chest wall. Pleural air blocks transmission of sound.

Shifted toward opposite side if much air

Decreased to absent over the pleural air

None, except a pos- sible pleural rub

Decreased to absent over the pleural air

Chronic Obstructive Pulmonary Disease (COPD) Slowly progressive dis-

order in which the distal air spaces enlarge and lungs become hyperinfl ated.

Chronic bronchitis is often associated.

Hyperres- onant or tympanitic over the pleural air

Midline Decreased to absent

None, or the crackles, wheezes, and rhonchi of associated chronic bronchitis

Decreased TABLE 13-7 PHYSICAL FINDINGS IN SELECTED CHEST DISORDERS (Continued)

(continued)

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10. Student answers should include discussions of the

Dalam dokumen Student Laboratory Manual for Bates’ Nursing Guide to Physical Examination and History Taking (Halaman 169-172)