NURS612 Key Points to Review for Exam 2
Week 5
Key Point to Review – STUDENT NOTES
Chest / Lungs
What are examples of When did this issue start?
appropriate history of Has it gotten worse, if so how?
present illness questions Have you had this problem in the past?
you may ask a patient with a Do you have a cough?
chief complaint of a Do you have shortness of breath?
respiratory issue? What time of day do these symptoms occur?
What makes your symptoms worse?
What makes your symptoms better?
Describe how you would Have the patient sit upright and unclothed to the waist.
inspect the chest. How do Note the shape and symmetry of the chest (back and front)
you describe the size shape o Back to the front, the costal angle, the angle of the ribs, and the
(A/P diameter) and intercostal spaces
symmetry of the chest? Clavicles should be prominent superiorly, the sternum usually flat.
What are the thoracic AP diameter: Lateral is usually 1:2
landmarks? Landmarks include: suprasternal notch, clavicles, angle of louis,
costal angle, C7, and T1
Thorax, sternum should be midline and not deviated
Describe how you assess the Count the RR after palpating the pulse.
rate and quality of Resp: Pulse = 1:4
respirations? What is Normal is approx 12-16 bpm
normal and abnormal? Note the pattern
o Should be easy, regular, and without distress, even, neither too
shallow nor too deep.
Describe your assessment Observe the lips & nails for cyanosis, lips for pursing, fingers for
of peripheral areas such as clubbing, and the nostrils for flaring.
the lips and nails as this There should be no cyanosis, lip pursing, clubbing of the fingers,
relates to a respiratory and flaring of the nostrils
assessment. What is normal
and abnormal?
Describe how you palpate Palpate thoracic muscles and skeleton, feeling for pulsations, areas
the chest and trachea. What of tenderness, bulges, depressions, masses, and unusual movement
are normal and abnormal Expect bilateral symmetry and some elasticity to rib cage
findings? What is tactile The sternum, xiphoid, and thoracic spine should be rigid
fremitus? What is thoracic Abnormal:
expansion? o Crepitus, vibration
Thoracic expansion: stand behind pt, during resp place your
thumbs along the spinal processes at the 10th rib w/ your palms
lightly in contact w/ the posterolateral surfaces. Watch your
thumbs move apart. Abnormal: loss of symmetry, no expansion, or
hands moving closer to each other
Tactile Fremitus: using palms or ulnar aspect place hands at the
,NURS612 Key Points to Review for Exam 2
Key Point to Review – STUDENT NOTES
Chest / Lungs
bifurcation of the bronchus anteriorly and posteriorly and have the
patient say “99” or “mickey mouse”. Use light touch and palpate
each side simultaneously. Abnormal: decreased or absent
fremitus, increased fremitus, tremulous fremitus.
Describe how you percuss First, have the patient sit up, lean forward with arms crossed in
the chest. What are normal front: percuss by striking your middle finger of your nondominant
and abnormal findings? hand with the middle finger of your dominant hand.
What do the findings 2nd, have the patient lift arms while percussing lateral and anterior
indicate? sides.
Move from superior to inferior and medial to lateral.
Normal: resonance should be heard over all aspects of lungs
Abnormal:
o hyperresonance is assoc. with hyperinflation which may indicate
emphysema, pneumothorax, or asthma
o dullness or flatness suggests pneumonia, atelectasis, pleural
effusion, or asthma
How do you measure Ask the patient to take a deep breath and hold it
diaphragmatic excursion? Percuss along the scapular line until you locate the lower border,
What is a normal and mark the place where it changes from resonance to dullness
abnormal finding? What do Ask pt to breathe, exhale and hold exhale
the findings indicate? Percuss again and mark when there is a change from resonance to
dullness.
Measure the distance in cm which should be 3-5cm.
Do this on both sides
If less than 3-5cm then it could mean emphysema, massive ascites,
tumor, or fractured rib
What are the 3 types of Vesicular:
normal breath sounds? o Low-pitched, low-intensity heard over all lobes of the lungs
Where are they located on o Soft and short expirations
the chest and describe the Bronchovesicular:
sounds. o Moderately-pitched, moderate-intensity heard over the major
bronchi
o Expiration equals inspiration
Bronchial:
o High-pitched, high-intensity heard over the trachea only
o Loud and long expirations, sometimes a bit longer than
inspiration
Name and describe Fine crackles:
abnormal breath sounds o High pitched, discrete, discontinuous crackling sounds heard
and what these breath during the end of inspiration; not cleared by cough
sounds may indicate as a o Atelectasis, bronchiectasis, congestive heart failure, pulmonary
differential diagnosis. fibrosis
, NURS612 Key Points to Review for Exam 2
Key Point to Review – STUDENT NOTES
Chest / Lungs
Medium crackles:
o Lower, more moist sound heard during the midstage of
inspiration; not cleared by cough
o Atelectasis, bronchiectasis, congestive heart failure, pulmonary
fibrosis
Coarse crackles:
o Loud, bubbly noise heard during inspiration; not cleared by
coughing
o Atelectasis, bronchiectasis, congestive heart failure, pulmonary
fibrosis
Rhonchi (sonorous wheeze):
o Loud, low, course sounds like a snore most often heard
continuously during inspiration and expiration; coughing may
clear sound
o usually means mucus accumulation in trachea of large bronchi
o COPD, acute and chronic bronchitis, asthma, bronchiectasis,
pneumonia
Wheeze (sibilant wheeze):
o Musical noise most often heard continuously during inspiration
and expiration: usually louder during expiration
o COPD, acute and chronic bronchitis, asthma, bronchiectasis,
pneumonia
Pleural friction rub:
o Dry, rubbing, or grating sound, usually caused by inflammation
of pleural surfaces; heard during inspiration or expiration;
loudest over lower lateral anterior surface
o Inflamed pleura; pneumonia, pleuritis, malignancy
Name and describe the Bronchophony: greater clarity and increased loudness of spoken
three types of vocal sounds
resonance. What do the o Consolidation or effusion
vocal resonance indicate? Whispered Pectoriloquy: If extreme (ie in the presence of
consolidation of the lungs), even a whisper can be heard clearly
and intelligibly through the stethoscope
o consolidation
Egophony: when the intensity of the spoken voice is increased and
there is a nasal quality (ie. “e” becomes and stuffy, broad “a”)
o These auditory changes may be present in any condition that
consolidates lung tissue
Week 6
Week 5
Key Point to Review – STUDENT NOTES
Chest / Lungs
What are examples of When did this issue start?
appropriate history of Has it gotten worse, if so how?
present illness questions Have you had this problem in the past?
you may ask a patient with a Do you have a cough?
chief complaint of a Do you have shortness of breath?
respiratory issue? What time of day do these symptoms occur?
What makes your symptoms worse?
What makes your symptoms better?
Describe how you would Have the patient sit upright and unclothed to the waist.
inspect the chest. How do Note the shape and symmetry of the chest (back and front)
you describe the size shape o Back to the front, the costal angle, the angle of the ribs, and the
(A/P diameter) and intercostal spaces
symmetry of the chest? Clavicles should be prominent superiorly, the sternum usually flat.
What are the thoracic AP diameter: Lateral is usually 1:2
landmarks? Landmarks include: suprasternal notch, clavicles, angle of louis,
costal angle, C7, and T1
Thorax, sternum should be midline and not deviated
Describe how you assess the Count the RR after palpating the pulse.
rate and quality of Resp: Pulse = 1:4
respirations? What is Normal is approx 12-16 bpm
normal and abnormal? Note the pattern
o Should be easy, regular, and without distress, even, neither too
shallow nor too deep.
Describe your assessment Observe the lips & nails for cyanosis, lips for pursing, fingers for
of peripheral areas such as clubbing, and the nostrils for flaring.
the lips and nails as this There should be no cyanosis, lip pursing, clubbing of the fingers,
relates to a respiratory and flaring of the nostrils
assessment. What is normal
and abnormal?
Describe how you palpate Palpate thoracic muscles and skeleton, feeling for pulsations, areas
the chest and trachea. What of tenderness, bulges, depressions, masses, and unusual movement
are normal and abnormal Expect bilateral symmetry and some elasticity to rib cage
findings? What is tactile The sternum, xiphoid, and thoracic spine should be rigid
fremitus? What is thoracic Abnormal:
expansion? o Crepitus, vibration
Thoracic expansion: stand behind pt, during resp place your
thumbs along the spinal processes at the 10th rib w/ your palms
lightly in contact w/ the posterolateral surfaces. Watch your
thumbs move apart. Abnormal: loss of symmetry, no expansion, or
hands moving closer to each other
Tactile Fremitus: using palms or ulnar aspect place hands at the
,NURS612 Key Points to Review for Exam 2
Key Point to Review – STUDENT NOTES
Chest / Lungs
bifurcation of the bronchus anteriorly and posteriorly and have the
patient say “99” or “mickey mouse”. Use light touch and palpate
each side simultaneously. Abnormal: decreased or absent
fremitus, increased fremitus, tremulous fremitus.
Describe how you percuss First, have the patient sit up, lean forward with arms crossed in
the chest. What are normal front: percuss by striking your middle finger of your nondominant
and abnormal findings? hand with the middle finger of your dominant hand.
What do the findings 2nd, have the patient lift arms while percussing lateral and anterior
indicate? sides.
Move from superior to inferior and medial to lateral.
Normal: resonance should be heard over all aspects of lungs
Abnormal:
o hyperresonance is assoc. with hyperinflation which may indicate
emphysema, pneumothorax, or asthma
o dullness or flatness suggests pneumonia, atelectasis, pleural
effusion, or asthma
How do you measure Ask the patient to take a deep breath and hold it
diaphragmatic excursion? Percuss along the scapular line until you locate the lower border,
What is a normal and mark the place where it changes from resonance to dullness
abnormal finding? What do Ask pt to breathe, exhale and hold exhale
the findings indicate? Percuss again and mark when there is a change from resonance to
dullness.
Measure the distance in cm which should be 3-5cm.
Do this on both sides
If less than 3-5cm then it could mean emphysema, massive ascites,
tumor, or fractured rib
What are the 3 types of Vesicular:
normal breath sounds? o Low-pitched, low-intensity heard over all lobes of the lungs
Where are they located on o Soft and short expirations
the chest and describe the Bronchovesicular:
sounds. o Moderately-pitched, moderate-intensity heard over the major
bronchi
o Expiration equals inspiration
Bronchial:
o High-pitched, high-intensity heard over the trachea only
o Loud and long expirations, sometimes a bit longer than
inspiration
Name and describe Fine crackles:
abnormal breath sounds o High pitched, discrete, discontinuous crackling sounds heard
and what these breath during the end of inspiration; not cleared by cough
sounds may indicate as a o Atelectasis, bronchiectasis, congestive heart failure, pulmonary
differential diagnosis. fibrosis
, NURS612 Key Points to Review for Exam 2
Key Point to Review – STUDENT NOTES
Chest / Lungs
Medium crackles:
o Lower, more moist sound heard during the midstage of
inspiration; not cleared by cough
o Atelectasis, bronchiectasis, congestive heart failure, pulmonary
fibrosis
Coarse crackles:
o Loud, bubbly noise heard during inspiration; not cleared by
coughing
o Atelectasis, bronchiectasis, congestive heart failure, pulmonary
fibrosis
Rhonchi (sonorous wheeze):
o Loud, low, course sounds like a snore most often heard
continuously during inspiration and expiration; coughing may
clear sound
o usually means mucus accumulation in trachea of large bronchi
o COPD, acute and chronic bronchitis, asthma, bronchiectasis,
pneumonia
Wheeze (sibilant wheeze):
o Musical noise most often heard continuously during inspiration
and expiration: usually louder during expiration
o COPD, acute and chronic bronchitis, asthma, bronchiectasis,
pneumonia
Pleural friction rub:
o Dry, rubbing, or grating sound, usually caused by inflammation
of pleural surfaces; heard during inspiration or expiration;
loudest over lower lateral anterior surface
o Inflamed pleura; pneumonia, pleuritis, malignancy
Name and describe the Bronchophony: greater clarity and increased loudness of spoken
three types of vocal sounds
resonance. What do the o Consolidation or effusion
vocal resonance indicate? Whispered Pectoriloquy: If extreme (ie in the presence of
consolidation of the lungs), even a whisper can be heard clearly
and intelligibly through the stethoscope
o consolidation
Egophony: when the intensity of the spoken voice is increased and
there is a nasal quality (ie. “e” becomes and stuffy, broad “a”)
o These auditory changes may be present in any condition that
consolidates lung tissue
Week 6
