UNIT 7: BREAST, THORAX, LUNGS (ABNORALITIES)

NOTES AND BOOK

a recent increase in the size of one breast may indicate inflammation or an abnormal growth

(breast)

• abnormal findings for inspection of size and symmetry of breast

• redness (is associated with breast inflammation)

• peau d’orange

(breast)

• abnormal findings for inspection of color and texture of breast

peau d’orange

(breast)

• pigskin-like or orange peel appearance results from edema, which is seen in metastatic breast disease.

• the edema is caused by blockage lymphatic disease

• resulting from edema

• an orange peel appearance of the breast

• associated with cancer

(breast)

• peau d’orange

paget's disease

(breast)

• redness, mild scaling, and flaking nipple of the may be seen early in Paget's disease of the nipple and then disappear.

• however, this does not mean that the disease is gone, thus further assessment is needed.

• tingling, itching, increased sensitivity, burning, discharge and pain in the nipple are late signs of this.

• nipple can occur in both breasts, but is rare.

• in approximately half of patients with this of the nipple, a lump or mass in the breast can be felt

1. retracted nipple

2. dimpling

3. retracted breast tissue

(breast)

• (3) suggests malignancy

peau d’orange

(breast)

• breast is edematous (pitting edema)

• commo with patients that have breast cancer

paget’s disease

(breast)

• crusty, red, scaly nipples

• assess in the nipples

gynecomastia

(breast)

• enlargement of breast for male patients

• hormonal problem

• possible abuse of steroids

retracted breast

(breast): nipple

• normal to px with malignant tumors

supernumerary nipples

(breast): nipple

• normal variation of the nipples

  • additional nipple

  • found at your embryonic milk line

dimpling or retraction

(breast): retraction and dumpling

• usually caused by a malignant tumor that has fibrous strands attached to the breast tissue and the fascia of the muscles.

• as the muscle contracts, it draws the breast tissue and skin with it, causing dimpling or retraction.

• restricted movement of breast or retraction of the skin or nipple indicates fibrosis and fixation of the underlying tissues.

• this is usually due to an underlying malignant tumor.

malignant tumors

(breast): masses

• most often found in the upper outer quadrant of the breast.

  • they are usually unilateral, with irregular, poorly delineated borders.

  • they are hard and nontender and fixed to underlying tissues.

fibroadenomas

(breast): masses

• are usually 1-5 cm, round or oval, mobile, firm, solid, elastic, nontender, single or multiple benign masses found in one or both breasts.

milk cysts (sacs filled with milk) and infections (mastitis),

(breast): masses

• these may turn into an abscess and occur if breastfeeding or recently given birth.

lipomas

(breast): masses

• are a collection of fatty tissue that may also appear as a lump

intraductal papilloma

(breast): masses

• is a small growth inside a milk duct of the breast, often near the areola. It is harmless and occurs in women ages 35 to 50.

discharge

(breast): nipples

• may be seen in endocrine disorders and with certain medications (i.e., antihypertensives, tricyclic antidepressants, and estrogen).

• from one breast may indicate benign intraductal papilloma, fibrocystic disease, or cancer of the breast.

watery, pink discharge

(breast): nipples

• sometimes there is only a _____________ from the nipple. This should be referred to a primary care provider

barrel chest

(chest & lungs): configuration

• when the diameter in anteroposterior is equal to the transverse diameter

pectus excavatum

(chest & lungs): configuration

• depressed sternum

• funnel because of shape

• congenital

pectus carinatum

(chest & lungs): configuration

• pigeon because of beak

barrel chest

(chest & lungs): configuration

• ribs appearing horizontal at an angle greater than 45 degrees with the spinal column are frequently the result of an increased ratio between the anteroposterior-transverse diameter

barrel chest

(chest & lungs): configuration

• this condition is commonly the result of emphysema due to hyperinflation of the lungs.

tripod position

(chest & lungs): accessory muscles

• client leans forward and uses arms to support weight and lift chest to increase breathing capacity

• this is often seen in COPD.

kyphosis

(chest & lungs)

• normal finding for inspection of configuration:

  • an increased curve of the thoracic spine

  • common in older clients

    • it results from a loss of lung resiliency and a loss of skeletal muscle

    • it may be a normal finding

crepitus

(chest & lungs)

abnormality for crepitus

• can be palpated if air escapes from the lung or other airways into the subcutaneous tissue, as occurs after an open thoracic injury, around a chest tube, or tracheostomy.

• also may be palpated in areas of extreme congestion or consolidation.

• in such situations, mark margins and monitor to note any decrease or increase in the crepitant area.

unequal fremitus

(chest & lungs)

abnormality fremitus

• is usually the result of consolidation (which increases fremitus) or bronchial obstruction, air trapping in emphysema, pleural effusion, or pneumothorax (which all decreases this).

diminished fremitus

(chest & lungs)

abnormality for fremitus

• even with a loud spoken voice may indicate obstruction of the an tracheobronchial tree.

1. apnea

2. apeustic

3. tachypnea

4. bradypnea

5. hyperventilation

6. hypoventilation

7. cheyne-stokes respiration,

8. biot's respiration.

(chest & lungs)

• abnormal breathing patterns includes:

apnea

(chest & lungs)

• abnormal breathing patterns

  • no breathing/none

apneustic

(chest & lungs)

• abnormal breathing patterns

  • abnormal breathing pattern

biot’s respiration

(chest & lungs)

• abnormal breathing patterns

  • regular breathing followed by apnea

cheyne-stokes

(chest & lungs)

• abnormal breathing patterns

  • irregular–none

kussmaul’s breathing

(chest & lungs)

• abnormal breathing patterns

  • rapid, deep, labored breathing

tenderness over thoracic muscles can result from exercising (e.g., pushups) especially in a previously sedentary client

(chest & lungs)

• abnormal finding for tenderness, sensation, and surface masses

unequal chest expansion

(chest & lungs)

abnormality for chest expansion

• can occur with severe atelectasis (collapse or incomplete expansion), pneumonia, chest trauma, or pneumothorax (air in the pleural space).

decreased chest excursion

(chest & lungs)

abnormality for chest expansion

• at the base of the lungs is characteristic of COPD.

• this is due to decreased diaphragmatic function.

hyperresonance

(chest & lungs)

abnormality for tone

• is elicited in cases of trapped air such as in emphysema or pneumothorax.

dullness

(chest & lungs)

abnormality for diaphragmatic excursion

• is present when fluid or solid tissue replaces air in the lung or occupies the pleural space, such as in lobar pneumonia, pleural effusion, or tumor.

diaphragmatic descent

(chest & lungs)

abnormality for diaphragmatic excursion

• may be limited by atelectasis of the lower lobes or by emphysema, in which diaphragmatic movement and air trapping are minimal.

uneven excursion

(chest & lungs)

abnormality for diaphragmatic excursion

• may be seen with inflammation from unilateral pneumonia, damage. to the phrenic nerve, or splenomegaly.

diminished or absent breath sounds

(chest & lungs)

abnormality for breath sounds

• often indicate that little or no air is moving in or out of the lung area being auscultated.

• this may indicate obstruction within the lungs as a result of secretions, mucus plug, or a foreign object.

• it may also indicate abnormalities of the pleural space such as pleural thickening, pleural effusion, or pneumothorax.

hyperinflated nature of the lungs; loss of elasticity of lung tissue

(chest & lungs)

abnormality for breath sounds

• in cases of emphysema, the _____________, together with a _____________, may result in diminished inspiratory breath sounds.

increased (louder) breath sounds

(chest & lungs)

abnormality for breath sounds

• often occur when consolidation or compression results in a denser lung area that enhances the transmission of sound.

• crackles (rales)

• wheezes (rhonchi)

(chest & lungs)

abnormality for adventitious sounds

• adventitious lung sounds, such as ______and ______ are evident.

fine crackles

(chest & lungs)

abnormality for breath sounds

• characteristics:

  • high-pitched, short, popping sounds heard during inspiration

  • not cleared with coughing

  • sounds are discontinuous and can be simulated by rolling a strand of hair between your fingers near your ear.

• source:

  • inhaled air suddenly opens the small, deflated air passages that are coated and sticky with exudate.

• associated conditions:

  • crackles occurring late in inspiration are associated with restrictive diseases such as pneumonia and congestive heart failure.

  • crackles occurring early in inspiration are associated with obstructive disorders such as bronchitis, asthma, Or emphysema.

coarse crackles

(chest & lungs)

abnormality for breath sounds

• characteristics:

  • low-pitched, bubbling, moist sounds that may persist from early inspiration to early expiration

  • also described as softly separating Velcro

• source:

  • inhaled air comes into contact with secretions in the large bronchi and trachea.

• associated conditions:

  • may indicate pneumonia, pulmonary edema, and pulmonary fibrosis.

  • "Velcro rales" of pulmonary fibrosis are heard louder and closer to stethoscope, usually do not change location, and are more common in clients with long-term COPD.

pleural friction rub

(chest & lungs)

abnormality for breath sounds

• characteristics:

  • coarse, dry, grating sound

  • sound is much like crackles, only more superficial and occurring during both inspiration and expiration.

• source:

  • sound is the result of rubbing of two inflamed pleural surfaces.

• associated conditions:

  • pleuritis

sibilant wheeze

(chest & lungs)

abnormality for breath sounds

• characteristics:

  • high-pitched, musical sounds

  • heard primarily during expiration but may also be heard on inspiration.

• source:

  • air passes through constricted passages (caused by swelling, secretions, or tumor).

• associated conditions:

  • often heard in cases of acute asthma or chronic emphysema.

sonorous wheeze

(chest & lungs)

abnormality for breath sounds

• characteristics:

  • low-pitched snoring moaning sounds heard primarily during expiration but may be heard throughout the respiratory cycle.

• source:

  • same as sibilant wheeze.

  • the pitch of the wheeze cannot be correlated to the size of the passageway that generates it.

• associated conditions:

  • are often heard in cases of bronchitis or single obstructions and snoring before an episode of sleep apnea.

stridor

(chest & lungs)

• abnormality for breath sounds

  • is a harsh, honking wheeze with severe broncholaryngospasm, such as occurs with croup

normal (eupnea)

(chest & lungs)

• respiration patterns:

  • description: 12-20 breaths/min and regular

  • clinical indication: normal breathing pattern

tachypnea

(chest & lungs)

• respiration patterns:

  • description: more than 24 breaths/min and shallow

  • clinical indication: may be a normal response to; can fever, anxiety, or exercise occur insufficiency, with respiratory alkalosis, pneumonia, or pleurisy

bradypnea

(chest & lungs)

• respiration patterns:

  • description: less than 10 breaths/min and regular

  • clinical indication: may be normal in well-conditioned athletes; can occur with medication-induced depression of the respiratory center, diabetic coma, neurologic damage
    

hyperventilation

(chest & lungs)

• respiration patterns:

  • description: increased rate and increased depth

  • clinical indication: usually occurs with extreme exercise, fear, or anxiety; causes of hyperventilation include disorders of the central nervous system, an overdose of the drug salicylate, or severe anxiety

kussmaul breathing

(chest & lungs)

• respiration patterns:

  • description: rapid, deep, labored

  • clinical indication: a type of hyperventilation associated with diabetic ketoacidosis

hypoventilation

(chest & lungs)

• respiration patterns:

  • description: decreased rate, decreased depth, irregular pattern

  • clinical indication: usually associated with overdose of narcotics or anesthetics

cheyne-stokes respiration

(chest & lungs)

• respiration patterns:

  • description: regular pattern characterized by alternating periods of deep, rapid breathing followed by periods of apnea

  • clinical indication: may result from severe congestive heart failure, drug overdose, increased intracranial pressure, or renal failure; may be noted in elderly persons during sleep, not related to any disease process

biot’s pattern

(chest & lungs)

• respiration patterns:

  • description: irregular pattern characterized by varying depth and rate of respirations followed by periods of apnea

  • clinical indication: may be seen with meningitis or severe brain damage

ataxic

(chest & lungs)

• respiration patterns:

  • description: significant disorganization with irregular and varying depths of respiration

  • clinical indication: more extreme expression of biot's respirations indicating respiratory compromise

air tapping

(chest & lungs)

• respiration patterns:

  • description: increasing difficulty in getting breath out

  • clinical indication: in chronic obstructive pulmonary disease, air is trapped in the lungs during forced expiration