NURS 3016 Chapter 16

Pleurisy

Sharp chest pain that worsens with breathing/coughing

Tracheobronchitis

Burning chest pain with cough and fever

Pneumonia

• Sudden onset dyspnea, cough, and fever

• Inflammation and fluid in the air sacs

Orthopnea

Difficulty breathing while laying flat

Paroxysmal Nocturnal Dyspnea

Waking up at night gasping for air

Mucoid Sputum

• Bronchitis

• clear/white sputum

Purulent Sputum

• Bacterial infection

• yellow/green sputum

Rust-Colored Sputum

Indicative of TB or Pneumococcal Pneumonia

Heart Failure

• Pink frothy sputum

• Difficulty of heart to pump blood

Hemoptysis

• Coughing up blood

• Indicative of cancer or TB

Tripod Position

• increases the size of the thoracic cavity, facilitating airflow

• Respiratory distress; COPD

Barrel Chest

• Round chest

• Indicitave of COPD

Clubbing

Chronic hypoxia; nail bed angle > 180 degrees

Cyanosis

Hypoxemia; bluish color

Tachypnea

> 24 breath/min

Bradypnea

< 10 breath/min

Course Crackles

• low-pitched

• bubbling moist sounds

• Velcro

• discontinuous fluid in alveoli

Wheezing

• Continuous

• high pitched

• musical

• narrow airway

Ronchi

• Continuous

• Low pitch

• snoring

• Secretions; clears with cough

Stridor

• Upper airway obstruction; EMERGENCY

• high-pitched crowing sound from the upper airway

• results from tracheal or laryngeal spasm or constriction

Pleural Friction Rub

Pleuritis; inflamed pleura

Consolidation

• Pneumonia

• fluids

• Dullness to percussion

Pneumothorax

• air leaking into pleural space

• Hyperresonance

• collapsed lung

• Often due to injury

Tactile Fremitus

“99” felt as vibration

Bronchophony

Pneumonia; “99” heard loud and clear

Egophony

“E” sounds like “A”

Anemia

Poor oxygenation; pale or grey skin tone

Increased work of breathing

Use of accessory muscles

Tenacious Sputum

Thick; dehydration

Nasal flaring

Respiratory distress; common in children

Polycythemia

• Chronic hypoxia

• smoking

• ruddy/reddish-purple face

Crepitus

Cracking under skin; air in subcutaneous tissue via chest trauma

Chest tenderness

Rib fracture or muscle strain

Hyperresonance

• too much air

• tympany

• hyperinflated lung

Dullness

too much fluid or solid tissue

Emphysema

• Reduced excursion

• Damage to alveolar sacs

• Flat diaphragm

Acute asthma attack

• Severe dyspnea

• retractions

• wheezing

Whispered pectoriloquy

Whispered words heard clearly

Pectus excavatum

Sunken sternum (funnel chest)

Pectus carinatum

Protruding sternum (pigeon chest)

Patient has stridor. What is the PRIORITY action?

Maintain airway (this is an EMERGENCY—upper airway obstruction)

Patient has dyspnea + chest pain. What is your priority?

Treat as emergency → assess oxygenation immediately

Which findings indicate respiratory distress?

• Tripod position

• Use of accessory muscles

• Retractions

• Nasal flaring

Which findings indicate hypoxemia?

• Cyanosis

• Pallor

• Clubbing (chronic)

Patient with wheezing—what is priority intervention?

Improve airflow (bronchodilator, assess airway)

Retractions

• indentations in the supraclavicular fossa and ICSs

Atelactasis

• Collapsed lung; alveoli sacs

• Reduced gas exchange

Ascites

• bloating

• rapid weight gain

• abdominal discomfort

• shortness of breath

Vesicular breath sounds

• soft, low-pitched

• Inspiration greater than expiration

• whisper undertone

• found over most lung fields

Bronchovesicular breath sounds

• Anteriorly between 1st and 2nd ICSs; between scapula

• Intermediate sound

• Inspiration = expiration

Bronchial breath sounds

• Loud, high-pitched

• Inspiration less than expiration

• found over the trachea and larynx

Diabetic ketoacidosis

• Kussmaul respirations with hyperventilation

• Rapid, deep, labored breathing

• ketones

Fine Crackles

• high-pitched

• short popping sounds

• heard during inspiration and not cleared with coughing

• discontinuous fluid in alveoli

Anterior thorax reference line

• Midsternal line

• Midclavicular line

Posterior thorax reference line

• Vertebral line

• Midscapular line

Axillary reference line

• Posterior axillary line

• Midaxillary line

Cheyne-Stokes respirations

• Regular pattern of breathing

• Periods of deep rapid breathing followed by periods of apnea

• May result from severe heart failure

Biot's respirations

• irregular pattern of breathing

• varied depth and rate followed by periods of apnea

• brain damage

• meningitis