Thorax/Lungs – Week 5 Health Assessment
Abnormality Transmitted Breath Sounds
Egophony- have patient say “eee”
No E to A change noted.
Whispered pectoriloquy- have patient whisper “123”
Whispered pectoriloquy (WP) is inaudible.
Bronchophony- “have patient say 99”
Bronchophony is muffled & indistinct
Abnormal Things to Note:
ARDS alveoli cannot perform gas exchange because they are filled with mucous.
2nd intercostal space needle for tension pneumothorax/decompression
4th intercostal space chest tube (around the nipple line)
T4 vertebrae endotracheal tube tip should be there
C7 protruding vertebral process
T7 and T8 Thoracentesis landmark (d/t pleural effusion or large collection of fluid)
Pectus carinatum pigeon chest
Pectus excavatum funnel chest
Percussion: Horizontal NEVER vertical hand placement
Asthma Wheezing
Irritation and inflammation in the bronchioles
Irritation contributes to mucous formation.
Coughing with cold air or exercise
Steroids to reduce inflammation, with bronchodilators to open the bronchioles.
Pneumonia Cough, fever, SOB
Chest x ray shows consolidation and infiltrates
Dullness on percussion
Bacterial or viral
Aspiration pneumonia risk – elderly, stroke population, ETOH abuse
Pulmonary Edema decreased breath sounds, no sound of inspiration or expiration.
Upper and lower extremity pitting edema
Caused by CHF
Pneumothorax collapsed lung.
Spontaneous pneumothorax – patients are tall, thin, SOB, chest discomfort, Chest x ray shows collapsed lung.
Tension pneumothorax.
o Tracheal deviation, need T2 needle decompression
Possible use of chest tube at T2 for further emergent care
Pulmonary Embolism SOB, pleuritic pain (pain with deep breath), splinting with inspiration
Hypoxia
Tachycardia
Tachypnea
Wells Score and PARC score
CT Angio shows the spot in the lung where the blood is blocked
Pulmonary infarct wedge shaped piece of lung that has died d/t embolism induced hypoxia
Saddle PE large in the main vessel, can cause stroke, mesenteric ischemia, DVTs
o Large enough and there are right ventricular hypertrophy, ↑BNP
Thrombectomy catheter into pulmonary artery and inject TPA
Open thrombectomy open surgery to remove clot manually
IVC filter
o Go through the groin and place filter
If a clot in the groin breaks off it cannot go up to the heart
SOB
HISTORY
• Assess the duration and severity
• Rapid onset: pneumothorax, pulmonary embolism, or increased left ventricular end- diastolic pressure
(LVEDP)
• Hx of respiratory disease
• Occupational history
• Smoking history
Accompanying symptoms
• cough and fever
• Infections, myocarditis, pericarditis, septic emboli
• wheezing
• Acute bronchitis, new onset asthma, foreign body
• chest pain
• Acute or chronic, pleuritic or exertional
• acute pleuritic
• Acute pericarditis, pneumothorax, pleurisy due to an acute viral URI
• periodic chest pain that precedes the onset of dyspnea
• MI, or PE
Dyspnea with no associated symptoms –consider non cardiopulmonary causes of impaired oxygen delivery:
• Anemia Hgb is low and blood is having trouble getting to tissues causing SOB
• Cyanide ingestion
• Carbon monoxide SOB, altered MS, headache, carboxyhemoglobin elevated
• Tx: OXYGEN
• Metabolic acidosis hyperventilation to compensate for acidosis
• Panic disorder
Dry CT visualize chest structures
Lung Cancer
• Cigarette smoking is far and away the leading risk factor for lung cancer, accounting for 85%
TB
• Latent TB – encapsulated in the lung
o Only active when they are no longer encapsulated and they are free in circulation
Obstructive Sleep Apnea (OSA)
Disorder characterized by repeated episodes of the upper airway collapse, particularly during rapid eye movement (REM)
sleep, leading to hypoxemia and disrupted sleep
Can cause excessive daytime sleepiness, which increases risk for occupational accidents and motor vehicle
accidents
o The prevalence in adults ages 30 to 70 is about 15% from men and 5% For women, risk factors
include obesity, male, older age, craniofacial and upper airway abnormalities and being
postmenopausal
Definitive diagnosis is made by polysomnographic in the sleep lab that measures brain waves, airflow,
respiratory effort, oxygenation and heart rhythm.
-Hourly # of episodes of apnea
-Breathing cessation > 10 seconds & hypopnea
TX: CPAP, BIPAP, Weight reduction
Academy of Sleep Medicine: Screen High-Risk patients with sleep evaluation
-STOP-Bang Questionnaire
