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    Jarvis Chapter 18 Study Guide

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    Emily Cheng
    This document provides a study guide for Jarvis Chapter 18 on the lungs and thorax. It includes definitions of key medical terminology used to describe the lungs, respiratory conditions, and assessment techniques. Some of the key terms defined include alveoli, asthma, atelectasis, bronchiole, bronchitis, dyspnea, and emphysema. It also lists important subjective questions to ask patients about their cough, shortness of breath, chest pain, respiratory infection history, and environmental exposures. Finally, it explains how a nurse would assess aspects of the physical exam like chest expansion, tactile fremitus, and percussion sounds.

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    © All Rights Reserved
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    Jarvis Chapter 18 Study Guide

    Uploaded by

    Emily Cheng
    2K views5 pages
    This document provides a study guide for Jarvis Chapter 18 on the lungs and thorax. It includes definitions of key medical terminology used to describe the lungs, respiratory conditions, and assessment techniques. Some of the key terms defined include alveoli, asthma, atelectasis, bronchiole, bronchitis, dyspnea, and emphysema. It also lists important subjective questions to ask patients about their cough, shortness of breath, chest pain, respiratory infection history, and environmental exposures. Finally, it explains how a nurse would assess aspects of the physical exam like chest expansion, tactile fremitus, and percussion sounds.

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    Health Assessment Study Guide

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    This document provides a study guide for Jarvis Chapter 18 on the lungs and thorax. It includes definitions of key medical terminology used to describe the lungs, respiratory conditions, and assessment techniques. Some of the key terms defined include alveoli, asthma, atelectasis, bronchiole, bronchitis, dyspnea, and emphysema. It also lists important subjective questions to ask patients about their cough, shortness of breath, chest pain, respiratory infection history, and environmental exposures. Finally, it explains how a nurse would assess aspects of the physical exam like chest expansion, tactile fremitus, and percussion sounds.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    2K views5 pages

    Jarvis Chapter 18 Study Guide

    Uploaded by

    Emily Cheng
    This document provides a study guide for Jarvis Chapter 18 on the lungs and thorax. It includes definitions of key medical terminology used to describe the lungs, respiratory conditions, and assessment techniques. Some of the key terms defined include alveoli, asthma, atelectasis, bronchiole, bronchitis, dyspnea, and emphysema. It also lists important subjective questions to ask patients about their cough, shortness of breath, chest pain, respiratory infection history, and environmental exposures. Finally, it explains how a nurse would assess aspects of the physical exam like chest expansion, tactile fremitus, and percussion sounds.

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    © All Rights Reserved
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    Jarvis Chapter 18 Study Guide

    Lungs and Thorax

    Medical terminology:
    Alveoli small outpouchings along the walls
    of the alveolar sacs and alveolar ducts;
    through them, gas exchange takes place
    between alveolar gas and pulmonary
    capillary blood.
    Apnea cessation of breathing, especially
    during sleep.
    Asthma Reactive Airway Disease is an
    allergic hypersensitivity to certain inhaled
    allergens, irritants, microbes, stress or
    exercises. Produces complex response
    characterized by bronchospasm and
    inflammation, edema in walls of
    bronchioles and secretion of highly viscous
    mucus into airways. These factors greatly
    increase airway resistance, esp. during
    expiration. Symptoms: wheezing, dyspnea
    and chest tightness.
    Atelectasis, Collapsed shrunken section of
    alveoli or an entire lung as a result of
    airway obstruction, compression of the
    lung, lack of surfactant
    Angle of Louis an anatomical landmark
    located on the sternum; it can be felt as a
    notch or ridge at the top of the sternum.
    Bradypnea slow breathing. A decreased
    but regular rate (<10 per minute), as in
    drug induced depression of the respiratory
    center in the medulla, increased intracranial
    pressure, and diabetic coma.
    Bronchiole: one of the successively
    smaller channels into which the segmental
    bronchi divide within the
    bronchopulmonary segments.
    Bronchitis is an acute infection of the
    trachea and larger bronchi characterized by
    cough (lasting up to 3 weeks, for acute).
    Acute is viral, chronic caused by smoking.
    Bronchophony: Increased intensity and
    clarity of voice sounds heard over a

    Consolidation - lung as it fills with


    exudate in pneumonia.
    Crackles discontinuous, popping sounds
    heard over inspiration.
    Crepitus: coarse, crackling sensation
    palpable over the skin surface. It occurs in
    subcutaneous emphysema when air escapes
    from the lung and enters the subcutaneous ,
    as after openthoracis injury or surgery.
    Dyspnea: breathlessness or shorthess of
    breath; labored or difficult breathing. It is a
    sign of a variety of disorders and is
    primarily an indication of inadequate
    ventilation or of insufficient amounts of
    oxygen in the circulating blood
    Egophony: auscultation of chest while
    person phonates a long ee-ee sounds
    Emphysema caused by destruction of
    pulmonary connective tissue; characterized
    by permanent enlargement of air sacs distal
    to terminal bronchioles and rupture of
    interalveolar walls. Airway resistance on
    expiration increased, producing a
    hyperinflated lung.
    Fremitus: a vibration perceptible on
    palpation or auscultation;
    Pleural friction rub: produced when
    inflammation of the parietal or visceral
    pleura causes a decrease in the normal
    lubricating fluid. The opposing surfaces
    make a coarse grating sound when rubbed
    together during breathing.
    Hypercapnia: excessive carbon dioxide in
    the blood
    Hyperventiliation: abnormally fast and
    deep breathing, the result of either an
    emotional state or a physiological condition
    Hypoxemia: deficient oxygenation of the
    blood

    bronchus surrounded by consolidated lung


    tissue. Normal voice is muffled and
    indistinct; abnormal words distinct and
    sound close to heart.
    Bronchovesicular over major bronchi
    where fewer alveoli are located.

    Intercostal space: the space between two


    adjacent ribs.
    Orthopnea: difficulty breathing when
    supine
    Paroxymal Nocturnal Tachypnea is
    awakening from sleep with SOB and
    needing to be upright to achieve comfort
    Vesicular breath sounds: the gentle
    rustling sounds of normal breathing heard
    by auscultation over most of the lung
    fields; the inspiratory phase is usually
    longer than the expiratory.
    Wheezes: a continuous musical sounds
    heard over expiration.

    List subjective questions are important to ask when obtaining a health history:
    1. COUGH
    Is there cough, when did it start, gradual or sudden, how long, how often,
    what time of day or night?
    Phlegm or sputum, how much, what color
    Cough up blood? If so, streaks or frank blood? Is there foul odor?
    Describe cough: hacking, dry, barking, hoarse, congested, bubbling?
    Does cough seem to come with anything (activity, position, fever,
    congestion, talking, anxiety)? Does activity make it better or worse?
    Which treatment has been tried (prescription or OTC, vaporizer, rest,
    position change). Does the cough bring any pain in chest or ear? Is it
    tiring?
    2. SHORTNESS OF BREATH (SOB)
    Have you had any shortness of breath, do you have it now, or in the last day?
    When did it start, what brings it on, how severe is it, how long does it last?
    Is it affected by position (lying down)?
    Does it occur at any specific time of day or night?
    SOB episodes associated with night sweats? diaphoresis
    Or cough, chest pain, bluish color arp9ound lips or nails?
    Episodes related to food, pollen, dust, animals, season, emotion or exercise?
    What do you do in a hard-breathing attack? (special position pursed lips
    breathing, oxygen, inhalers or medications?)
    How does SOB affect your work or home activities?
    3. CHEST PAIN W/BREATHING

    Is there chest pain, point exact location to distinguish from cardiac origin chest
    pain and heartburn chest pain.
    When did it start, constant or comes and goes?
    Describe pain: burning, stabbing?
    What brought it on: resp.infection, coughing, trauma? Is it associated w/fever,
    deep breathing, unequal chest inflation
    What have you done to treat it? (medication, heat application)
    4. HISTORY OF RESP. INFECTIONS
    Any past history of breathing trouble or lung diseasessuch as bronchitis,
    emphysema, asthma, pneumonia?
    Any unusually frequent or severe colds?
    Family history of allergies, TB or asthma?
    5. SMOKING HISTORY
    Do you smoke cigarettes/cigars? At what age did you start? How many packs per
    day do you smoke now? How Long?
    Have you ever tried to quit? What helped? Why do you think it did not work?
    What activities do you associate with smoking? Do you live with someone who
    smokes?
    6. ENVIRONMENTAL SMOKE
    Are there any environmental conditions that may affect your breathing? Where do
    you work? At a factory, chemical plant, coal mine, farming, outdoors in a heavy
    traffic?
    Do you do anything to protect your lungs (mask or ventilator system at work)? Do
    you do anything to monitor your exposure? Do you have periodic examinations,
    pulmonary function tests, x-ray image?
    Do you know which specific symptoms to note that may signal breathing
    problems?
    7. PATIENT CENTERED CARE
    Last TB skin test, chest x-ray study, pneumonia vaccine or influenza immunization?
    CHILDREN: what have you done to child-proof your home and yard? Is there
    any possibility of the child inhaling or swallowing toxic substances? Has anyone
    reviewed with you that small things are choking hazards? Has anyone taught you
    emergency care measures in case of accidental choking or a hard-breathing spell?
    Any smokers in home or car w/child?
    AGING ADULT: SOB or fatigue with daily activities? Tell me about your usual
    amount of physical activity. (History of COPD, lung cancer or TB): How are you
    getting along each day? Any weight change in the past 3 months? How much?
    How about energy level? Do you tire more easily? How does your illness affect
    you at home or work?
    Do you have any chest pain w/breathing? Any chest pain after a bout of
    coughing? After a fall?
    Know how and why a nurse would apply the following objective assessments:

    Anterior/posterior to transverse ratio- What would a barrel chest signify? How


    does the AP/Transverse ratio change with a barrel chest?
    Barrel chest occurs in COPD because the lungs are chronically overinflated with
    air, so the rib cage stays partially expanded all the time. This makes breathing less
    efficient and aggravates shortness of breath. The anteriorposterior diameter (AP)
    should be less than the transverse diameter (.70 to .75 in adults). In barrel chest
    AP=transverse.

    Skin color, condition and patient position:


    Skin color should be consistent with persons genetic background, with
    allowance for sun-exposed areas on chest and back. No cyanosis or pallor should
    be present. Any lesions should be noted, inquire about any change in a nevus on
    the back (where the persona may have difficulty monitoring). Cyanosis occurs
    with hypoxia.
    Chest expansion:
    Symmetric chest expansion confirmed by placing your warmed hands sideways
    on posterolateral chest wall with thumbs pointing together at the level of T9 or
    T10. Slide your hands medially to pinch up a small fold of skin between your
    thumbs, ask the person to take deep breath. Hands serve as a mechanical amplifier
    as person inhales deeply, your thumbs should move apart symmetrically. Note any
    lag in expansion. Unequal chest expansion occurs with marked atelectasis, lobar
    pneumonia, pleural effusion, thoracic trauma such as fractured ribs or
    pneumothorax. Pain accompanies deep breathing when pleurae are inflamed.

    Tactile fremitus:
    Access tactile or vocal fremitus, this is a palpable vibration. Use either ball of
    fingers or ulnar edge of one hand and touch the persons chest while he or she
    repeats the words ninety nine or blue moon. Start over lung apices and
    palpate from one side to another. Symmetry is most important vibrations should
    feel the same in the corresponding area on each side. Avoid palpating over
    scapulae because bone will damp out sound transmission. Fremitus is most
    prominent between the scapulae and around the sternum (where major bronchi are
    closest to the chest wall), and normally decreases as you progress down because
    more and more tissue impedes sound transmission. Decreased fremitus occurs
    with obstructed bronchus, pleural effusion or thickening, pneumothorax, or
    emphysema. Increased fremitus occurs with compression or consolidation of lung
    tissue (like in lobar pneumonia). Rhoncal fremitus is palpable with thick bronchial
    secretions. Pleural friction fremitus is palpable with inflammation of the pleura.

    Percussion: when and why would resonance and dullness be present?


    Resonance is the low-pitched, clear, hollow sound that predominates in healthy lung
    tissue in the adult. However, it is a relative term and there is no constant standard, i.e. it
    may be duller in an athlete with heavily muscular chest wall or in a heavily obese adult
    with subcutaneous fat. Asymmetry in percussion is important as it indicates underlying
    disease. Hyperresonance is a lower-pitched, booming sound found when too much air is

    present (emphysema or pneumothorax). A dull note, soft, muffled thud, signals


    pneumonia, pleural effusion, atelectasis or tumor.
    Understand where to auscultate for normal bronchial, broncho-vesicular and vesicular
    breath sounds.
    Bronchial (tracheal) trachea and larynx
    Bronchiovesicular over major bronchi where fewer alveoli are located:
    Posterior - between scapulae (esp. on right)
    Anterior around upper sternum in 1st and 2nd intercostal spaces
    Vesicular over peripheral lung fields where air flows through smaller bronchioles and
    alveoli

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