Terms chronic brohchitis Hemoptysis cold, bronchitis, viral infections bacterial infection TB, pneumococcal Pna pulmonary edema

mycophasma pna early heart failure croup cold, bronchitis, pneumonia Orthopnea paroxysmal norcturnal dyspnea diaphoresis ventilation Internal respiration Normal adult chest

Definitions characterized by a history of productive cough for 3 month of the year for 2 years in a row Bloody sputum white or clear mucoid yellow or green rust colored pink frothy hacking cough dry cough barking cough congested cough the difficulty breathing when supine. state mumber of pilow needed to achieve comforts ex two pillow orthopnea awakening from sleep with SOB and needing to be upright to achieve comfort SOB episodes associated with night sweats is distribution of gas inot and out of the pulmoary airways (good air in bad air out) the exhange of gases at teh alvelolar level and the capillary level te thorax has an ellipitacl shape with an nateroposterior to transvers diameter 1:2 or 5:7 note equal anteroposterior to trasverse diameter and that ribs are horizontal instead of the normal downward slope. this is associated with normal aging and also with chronic emphysema and asthma as a rsult of hyperinflataion of lungs a markely sunken sternum and adjacent cartilages (also called funnel breast). depression begins at the second intercostal space to xiphoid with body of sterum. more noticeable on inspiration. Congential, not symptomatic.

barrel chest

pecus excavatum

Pecus Carinatum

a forward protrustion of the sternum, with ribs sloping back at either side and vertical depression along cosochondral junctions(pigeon breast) less common thatn pecus excavautm , but is a minor deformity and requires no treatment a later S-shaped curvaturs of the thoracic and lumabar spine. Note unequal shoulder and scapular height and unequal hip levels (adolescents) an exaggerated posterior eurvature of teh thoracic spine (humpback) that causes significant back pain and limited mobility (aging) occasional sighs puncutated the normal breathing pattern and are purposeful to expand alveoli. indicate emotional dysfunction or may lead to hyperventilation and dizziness rapid shallow breathing over 24 resp per min slow breathing. a drecreased by regular rated (less than 10) durg induced depression or respiratory center of medulla a cycle in which respiration gradulally wax and wane in a regular pattern , incrasing in rate and depth and then decreasing. period las 30-45 sec, with period of apnea lasting 20 sec. increased in both rate and depth . normally occurs with extreme exertion, fear or anxity. Blow off carbon dioxide and causing a decreased level in teh blood (alkalosis) an irregular showllow pattern caused by an overdose of narcotic or anethetics. similar to cheyn-stokes, expcet the at the pattern is irregular. A series of normal resp 3-4 is floowed by period of apnea. cycle lenght is variable lasting anywhere for 10 sec to 1 min. normal inspiration and prolonged expiration to overcome incrased airway resistance. In a person with CO lung disease and situation calling for incrased heart rat may lead to dyspneic episode be cause don't have enough time to fully expiraton air trapping discontinuous HIGH pithced shor crackling popping sounds heard durign inspiration that CAN NOT clear with cough Loud, LOW pitched bubbling and gurgling sound that start i early inspirtation and my contiue through expiration sounds like fin crackles byt do not last and arenot pathologic; disappear after

Scoliosis Kyphosis sigh frequent sigh tachypnea bradypnea

cheyn-stokes respiration

hyperventilation

hypoventilation

Biot's Respiration

Chornic Obstructive Breathing dyspneic crakles (fine) crakles (coarse) Atelectatic crackles

the first few breaths; hear in axillae and bases (usually depent) of lungs A very superficial sound that is course and Low pitched; it has a grating quailty as if two pieces of leather are being rubbed together; sound just like crackles but close to ear; sound are louder if you push tehe stethoscope harder onto the chest . Heard on INSPIRATION and EXPIRATION High ptich musical squeaking sound that sound polyphonic. Predominate in expiratrion byt may occur on both inspiration and expiration Low pithced; monohonic single note, snoring , moaning sounds. Heard through out the cycle but predominate on expiration; may clear some with cough High pitched, inspirator crowing sound louder in the neck than over the chest Percusion sound heard over the lungs befor you make them cry for men with hairy chest what should you do the drease extraneous noise the sound of most breath sounds what part of the stethoscope is use for breath sounds assess heart or breath first when ausculttaon breath , listen to ______________ ventilatory cycle compare breath sound _______to________ A palpabe virbration on the chest have the patient say 99 and feel the vibration , sound generated for the larynx is trasmitted through the lungs where examiner can feel the vibration eaisly throught solid structures than air, the vibration produced sounds are percceptible when transmitted throught solid structures a course crackling caused by fine bead of air palpable under skin surface; casued by air leak into the SQ tissue. Campares to the sound of crumpling cellophane Report ASAP present in condisiton that cause consolidation of thissure or incrased density

:leural friction rub

Wheez (high-pitched) Sibilant Wheez (low ptiched) (sonorous rhonchi) Stridor Resonance when should you check kids lungs wet hair on chest high pithces diaphragm heart complete ventilatory cycle 1. side 2. side Tactile Fremitus how is tactile Fremitus assessed sound travels

creptius action if creptius is heard areas of INCREASED

fremitus areas of DECRASED fremitus fine crackles coarse crackles atelectatic crackles normal voice sounds abnormal voice sounds when is voice sound used decreased vocal resonance increased vocal resonance drug with resp SE Epinephrine and beta blockers, NSAIDS and ASA Narcotic eupnea Hyperresonance dull Bronchial breath sounds Bronchovesicular breath sounds Vesicular breath sounds

of tissue ; tumor, pulmonary fibrosis, pnx presen when condition exist causing absence of air movement , obstructs transmission of vibrations; emphysema, copd, atelectasis, pneumothorax originate in alveoli, are often end-inspiration . Not cleared with cough. sounds like rolling hair between finger loud, bubbly noise , originate inteh larger airways , being mid inspiraton, may be slightly altered by cough ut will reappear shortly few crackles in teh bases disappears after first few breaths. not patologic heard only in the periphery dependent areas of the lungs vocal resonance is heard as muffled, non distinct pathology that incrase lung density enhances transmission of voice if any abnormalities have been detected during inspection, palpation or auscultation asthma, atelectasis, emphysema, pneumothorax pnx, plumonary fibrosis epinephrine, beta blockers, narcotic, NSAOD and ASA these drugs cause bronchospasm these drugs cause respitory depression normal breath breathing a lower pitched booming sound found when too much air is present as in emphysema or pneumothorax a not (soft , muffled thud) signals abnormal diensity in the lungs as with pnx, pleural effusion, atelectasis or tumor heard around trachea, loud, inspiration is shor and expiration is longer eard of the 2 main bronchi at 1st and 2nd ICSaath the sternal borader and posterior between scapulae, sound moderate, inspiration =expiration (coarse breath sounds) heard over the periphery the lungs, soft, breezy, inspiration is longer thatn

expiration Bronchophony Egophony listen to posterior chest as patient says "99", normal to hear muffuled non distinct abnormal to hear distinct and understandable listen to patient while saying (ee-ee-ee), sound like nondistinct "ee" if you hear "a-a-a" document E changed to A listen to person whispering :1-2-3", barely audible, abn with only small amount sof consolidation whipsered voice is clear and distincly, but still faint(soft) would sound like wishing directly into stethoscope sound not normally heard in the lungs or noral sounds auscultated in an abnormal place. Superimpose on normal breath sounds. breath sound may be absent or diminished feel this halow U-shaped depression just abofe the sternum in between th clavicles the breast bone the manubrium, the body and xiphoid preocess is the articulation of the manubrium and the body of he sternum and is continuous to the the second rib. The site of treacheal bifurcation into the right and left main bronchi. center of chest bsects the cner of each clavicle at a point halfway between the palpated sernoclavicular and acromioclavicular joint line do the joint of the shoulder line runs down from the apex ofhte axilla and lies between and parallel to the other two anterior and posterior continuse down for them posterior axillary fold where the latissius dorsi muscle inserts highest poin of lung tissue 3 or 4 cm above the inner third of the clavicles lower border rests on the diaphragm at about the sixth ribin the midclavicluar line.

whisper pectoriloquy

Adventitous sounds Asthma, emphysema, atelectasis suprasternal notch sternum sernal oagleor angle of louis midsternal line midclavicular line anterior axillary line midaxillary line posterior axillary line apex of lung base of lung