Respiratory

Bronchial Sounds

These sound hollow, are louder on exhale, and last longer on exhale. They are heard loudest over the trachea, which is the largest airway.

Bronchovesicular Sounds

Located where the trachea bifurcates into the right and left main bronchi at the sternal angle, these sounds are intermediate in pitch and intensity. Inhales and exhales sound the same length and volume.

Vesicular Sounds

These sounds occur in the lung fields; often you can hear inspiration, but you really can't hear exhalation.

Adventitious Breath Sounds

Abnormal lung sounds that are not typically heard. Examples include: Rhonchi, Crackles (or Rales), Pleural Friction Rub, Wheezing, and Stridor.

Rhonchi

Continuous, crackling, or snoring sounds often due to secretions in bronchi or bronchioles. The volume may decrease when someone coughs or is suctioned.

Crackles (Rales)

Discontinuous sounds, like a campfire, often heard when there is fluid in the alveoli.

Pleural Friction Rub

A grating sound, often painful, caused by inflamed pleura rubbing against each other.

Wheezing

Musical or squeaking sounds caused by inflamed and constricted small airways; common in asthma.

Stridor

A loud, high-pitched sound heard in the upper airway (larynx, trachea) that is usually due to obstruction or severe inflammation.

Breath Sounds

Sounds are produced when air moves in and out of your lungs. You only perform these tests if you suspect something is happening in the lungs.

Voice Sounds

Sounds are produced when you talk. When there is something in the lung fields like fluid, it changes the way sound travels.

Three Tests for Voice Sounds

Bronchophony, whispered pectoriloquy, and egophony. These tests are only done if issues are suspected in the lungs.

Costal Cartilage Changes with Age

Calcification of the costal cartilage can make it more rigid, making it difficult for the rib cage to expand and take deep breaths.

Deterioration of Muscles with Age

This results in a weaker cough.

Kyphosis

An exaggerated thoracic curvature of the spine can increase the AP diameter.

Rigidity of Respiratory Structures with Age

This can make it necessary for the individual to breathe a little shallower and faster to compensate.

Atelectasis

Hypoinflation of small airways often due to nonuse, such as after surgery. Findings include: diminished breath sounds, decreased tactile fremitus, and dullness on percussion.

Pneumonia

Fluid in the lung due to an infectious agent. Findings include: fever, cough with purulent sputum (pus), rails or crackles, and increased breath/voice sounds.

Asthma

Characterized by inflammation, bronchoconstriction, and mucus production. Findings include: cough, dyspnea, chest tightness, retractions, accessory muscle use, and wheezing.

COPD

Umbrella term encompassing chronic bronchitis and emphysema.

Chronic Bronchitis

Inflammation of the bronchi, often associated with orthopnea and tachypnea with prolonged expiratory time.

Emphysema

Deterioration of the alveoli leading to wheezing and crackles. An increased AP diameter (barrel chest) may be noted with chronic bronchitis.

Pleural Effusion

Fluid in the pleural space. Findings include: dyspnea, decreased chest wall movement, dullness on percussion, and decreased breath sounds.

Pneumothorax

Air in the pleural cavity, leading to lung collapse. Findings include: decreased chest wall movement, hyperresonance on percussion, absent breath sounds, and tracheal displacement.

Tuberculosis (TB)

A bacterial infection, commonly found in the lungs in either an active or latent phase. Active TB findings include: fatigue, anorexia, weight loss, night sweats, low-grade fevers, and chronic cough with hemoptysis.

Lung Cancer

Often fatal, it is characterized by tumors growing in the lung tissue. Findings include: cough with blood, nail clubbing, and dullness on percussion.

Acute Respiratory Distress Syndrome (ARDS)

A condition usually caused by the body's overreaction to external pain, such as from trauma or shock, causing capillaries in the lungs to leak fluid into the lungs. Findings include: restlessness, sudden/severe dyspnea, persistent hypoxemia, and frothy sputum.

Respiratory Syncytial Virus (RSV)

A virus that can cause significant respiratory distress, especially in babies. Because of the virus, they may also tend to have inflammation.

Croup

Characterized by a "wet seal bark" sound, it is often caused by stridor or swelling in the upper respiratory area.

Visceral Pleura

The pleura that touches the actual lung itself.

Alveoli

The functional unit of the lung where gas exchange occurs.

Sternal Angle (Angle of Louis)

An anatomical landmark where the lungs bifurcate and the trachea breaks off.

Costal Angle

Should be about a right, or 90-degree, angle.

Intercostal Spaces

Spaces used in respiratory and cardiac assessments, named for the rib right below them.

Axillary Line

Your armpit.

Midclavicular Line

Middle of your clavicle.

Midsternal

Middle of your sternum

Packs Per Day (PPD)

Average of what a patient typically smokes a day.

Pack Years (PY)

Packs per day multiplied by the years that someone has been smoking.

Sputum

Exudate in the lungs or what is physically coughed out.

Dyspnea

Shortness of breath.

Orthopnea

Difficulty breathing when lying flat.

Eupnea

Normal breathing pattern.

Tachypnea

A breathing pattern with a rate greater than 20 and shallow breaths.

Hyperventilation

A breathing pattern with a rate greater than 20 and deep respiration.

Bradypnea

A breathing pattern with a rate less than 12 and regular rhythm.

Hypoventilation

Irregular, shallow, and slow breaths.

Cheyne-Stokes

Breathing pattern- speeding up, slowing down, breaths get deeper/shallower, then a pause (apnea), also known as the death rattle.

Apnea

No breathing.

Sigh

An increase in inhalation.

Biot Respirations

Irregular breathing where they just start breathing all over the place and then it just cuts off

Air Trapping

Trapping air inside the lungs, exhaling for longer.

Retractions

Skin between ribs gets sucked in.

Accessory Muscle Use

Using muscles in the neck, shoulders, nose, and mouth, to draw in air.

Anterior Posterior (AP) Diameter

This measurement is 2:1 ratio, using your hands to see a width of the chest and depth of the rib-cage.

Costal Angle of the Ribs Measurement

Making a tent shape at the bottom of the ribcage to see if 90-degree angle.

Symmetric Chest Expansion

Equal chest expansion on both sides during breathing.

Costochondritis

Inflammation of the costal cartilage itself.

Crepitus (Subcutaneous Emphysema)

Air underneath the skin; feels like rice crispy treats.

Tactile Fremitus

Used when a patient says 99, assessing where the vibration in the chest is going as you move to different parts of the chest, decreasing as you descend.

Resonance

Hollow sound indicating normal lung fields when performing percussion.

Dullness

Muffled and stopping sound during percussion that indicates solid masses.

Hyperresonance

Louder and more hollow sound during percussion that indicates too much air, typically with COPD.

Flatness

Soft and short bone during percussion.